Safe to treat low-risk stroke patients at outpatient TIA clinic

Patients with ABCD2 scores of 0-4 can be treated safely at the transient ischaemic attack (TIA) clinic as they are low risk for subsequent stroke following appropriate treatment and/or intervention, a study carried out in Ireland has concluded.

In a paper published in the November / December edition of the Irish Medical Journal (IMJ), researchers said a rapid access clinic for patients with recent (1-7 days) TIA and ABCD2 scores ≤4 was being run in Cork University Hospital.

However, the rate of stroke after attending the clinic was unknown.

TIA, O’Brien et al wrote, was associated with considerable morbidity and mortality because it was “a harbinger for the imminent development of stroke with the majority of strokes occurring in the first 90 days post-TIA”.

The stroke risk after TIA depended largely on clinical features, vascular risk factors and the underlying pathophysiology of the TIA.

They added, therefore, stroke risk was ununiform, with the majority of patients experiencing a benign short-term prognosis.

But because symptoms of TIA typically resolve, “a serendipitous opportunity to commence treatment is presented, which may ultimately forestall the possible onset of debilitating brain infarction”, they added.

The overall aim of the study, O’Brien et al added, was to evaluate recurrent seven-day, 90-day and one year-stroke risk among the first 250 low-risk patients attending the TIA clinic.

Data was collected from the iSoft Clinical Manager software, neuroimaging and chart reviews, and postal survey. The results showed that risk for recurrent stroke was zero (n=0/266) at seven days, zero (n=266) at 90 days and 0.4 per cent (n=1/266) at one year.

Among patients with TIA, 8.7 per cent (n=6/69) had a carotid endarterectomy and 5.8 per cent (n=4/69) were commenced on anticoagulation therapy.

Researchers said their study had helped shed light on the growing evidence that management of patients with TIA was safe in an outpatient clinic but was largely dependent upon swift referral, rapid assessment, and timely diagnosis.

“However, the caveat must be inserted that ABCD2/ABCD3-I scores ≤4 does not necessarily exclude all high-risk cases as 8.8 per cent of apparent low risk TIA clinic patients had a high-risk aetiology (symptomatic carotid stenosis or AF) identified and, successfully, treated,” they added.

IMJ; Vol 113, No. 10, P198.