Timing of TIAs preceding stroke: time window for prevention is very short.
BACKGROUND
Patients with TIA are at increased risk of ischemic stroke and require preventive treatment. However, clinical guidelines differ on how urgently patients should be assessed.


OBJECTIVE
To determine the potential consequences of delays in investigation and treatment, the authors studied the timing of TIAs preceding ischemic stroke.


METHODS
The authors studied patients who presented with a recent ischemic stroke and had a preceding TIA in two population-based studies (Oxford Vascular Study [OXVASC]; Oxfordshire Community Stroke Project [OCSP]) and two randomized trials (UK TIA Aspirin Trial [UK-TIA]; European Carotid Surgery Trial [ECST]).


RESULTS
Of 2,416 patients who had presented with an ischemic stroke, 549 (23%) gave a history of a preceding TIA (18% in OXVASC, 15% in OCSP, 23% in UK-TIA, 26% in ECST). Where a preceding TIA had occurred, the timing was highly consistent across the studies, with 17% occurring on the day of the stroke, 9% on the previous day, and 43% at some point during the 7 days prior to the stroke. No clinical characteristics or vascular risk factors identified patients in whom there was a close temporal association between TIA and stroke.


CONCLUSIONS
In patients presenting with ischemic stroke, TIAs occur most often during the hours and days immediately preceding the stroke.
Rothwell
Peter M
PM
Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK. peter.rothwell@clneuro.ox.ac.uk
Warlow
Charles P
CP
D015984:Causality; D015331:Cohort Studies; D018450:Disease Progression; D042241:Early Diagnosis; D004635:Emergency Medicine / Q000592:standards; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology