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Patients with transient ischemic attack with ABCD2 <4 can have similar 90-day stroke risk as patients with transient

Pierre Amarenco1, Julien Labreuche, Philippa C Lavallée

  • 1INSERM U-698 and the Department of Neurology and Stroke Center, Paris-Diderot University, Bichat University Hospital, Paris, France. pierre.amarenco@bch.aphp.fr

Stroke
|December 14, 2011
PubMed

Insights

Patients with transient ischemic attack (TIA) should be evaluated promptly, regardless of their ABCD(2) score. Some low-score TIA patients have treatable conditions and a higher risk of stroke.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Emergency Medicine

Background:

  • Guidelines suggest evaluating transient ischemic attack (TIA) patients with ABCD(2) scores below 4 within a week.
  • The safety of delayed evaluation for these patients remains uncertain.

Purpose of the Study:

  • To determine if transient ischemic attack (TIA) patients with an ABCD(2) score less than 4 can be safely evaluated within a week.
  • To compare stroke rates in TIA patients based on ABCD(2) scores and emergency treatment criteria.

Main Methods:

  • A prospective cohort study of 1679 patients with definite or possible transient ischemic attack (TIA).
  • Patients were evaluated in a rapidly accessible TIA clinic, with 87% seen within 24 hours.
  • Emergency treatment criteria included significant artery stenosis or cardiac embolism.

Main Results:

  • The 90-day stroke rate was 3.4% for ABCD(2) scores ≥4, 3.9% for scores <4 with emergency criteria, and 0.4% for scores <4 without emergency criteria.
  • A statistically significant difference in stroke rates was observed between groups (P <0.0001).

Conclusions:

  • Transient ischemic attack (TIA) patients require prompt evaluation irrespective of their ABCD(2) score.
  • Lower ABCD(2) scores do not exclude the presence of treatable causes with elevated short-term stroke risk.
Abstract

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