Expedited Management of Low-Risk Transient Ischemic Attack Patients: The "Fast-Track" TIA Protocol

Area of Science:

• Neurology
• Cardiology
• Emergency Medicine

Background:

• Transient ischemic attack (TIA) is a critical warning sign for acute ischemic stroke (AIS).
• Risk stratification is essential as not all TIA patients face equal risks for subsequent AIS.
• Current management protocols may not optimally expedite care for low-risk TIA patients.

Purpose of the Study:

• To evaluate the feasibility and safety of the "Fast-Track" TIA Protocol (FTTP).
• To expedite outpatient management for low-risk TIA patients identified by an ABCD score ≤ 3.
• To reduce the risk of acute ischemic stroke in TIA patients through prompt outpatient evaluation.

Main Methods:

• Retrospective analysis of TIA patients presenting between April 2020 and February 2021.
• Eligibility for FTTP: ABCD score ≤ 3, no large vessel occlusion or significant stenosis.
• FTTP patients received dual antiplatelet therapy, statin, and outpatient testing (echo, Holter, labs) with 30-day follow-up.

Main Results:

• 182 patients evaluated; 35 (22%) qualified for FTTP and were discharged from the ED.
• Median ABCD² score was 2 for FTTP patients vs. 4 for admitted patients.
• Three FTTP patients re-presented, but none experienced a symptomatic stroke, indicating safety.

Conclusions:

• The FTTP is a feasible and safe approach for managing selected low-risk TIA patients.
• Outpatient management via FTTP demonstrated low rates of re-presentation and ischemic stroke.
• Further research is needed to define the optimal patient cohort for outpatient TIA management.