Management and outcome of patients with transient ischemic attack admitted to a stroke unit.
BACKGROUND
The way in which patients with transient ischemic attack (TIA) are investigated and treated varies substantially worldwide. There are no data on the management and outcome of TIA patients admitted to a stroke unit. We assessed to what extent rapid management of TIA patients admitted to a stroke unit led to specific treatments which can prevent stroke and evaluated the early risk and predictors of stroke in these patients.


METHODS
From January 2003 to November 2005, 203 consecutive patients with a recent (<48 h) TIA were admitted to our stroke unit. All patients had a diffusion-weighted imaging (DWI) on admission, a standardized etiological workup, and were followed up to 3 months.


RESULTS
The median (interquartile range) time from TIA onset to admission to the stroke unit was 12 h (5-25). DWI revealed acute lesions in 64 patients (32%). Of the 203 patients, 147 (72%) were treated by antiplatelet therapy and 56 (28%) with high doses of heparin, soon after their admission. In addition, 7 patients (3%) had a carotid revascularization. The risk of stroke was 2.5% (95% CI, 0.3-4.7) at 1 week, and 3.5% (1.0-6.1) at 3 months. In multivariate analysis, a score > or =5 at the previously validated ABCD score (HR = 5.0; 1.0-25.8; p = 0.06) and the presence of DWI abnormalities (HR = 10.3; 1.2-86.7; p = 0.03) were independent predictors of stroke at 3 months.


CONCLUSIONS
Early management of TIA in a stroke unit leads to specific treatments in a significant proportion of cases. The presence of acute lesions on DWI and the ABCD score predict the 3-month risk of stroke after TIA.
Calvet
David
D
Faculté de Médecine René Descartes, Université Paris 5, EA 4055, Paris, France.
Lamy
Catherine
C
Touzé
Emmanuel
E
Oppenheim
Catherine
C
Meder
Jean-François
JF
Mas
Jean-Louis
JL
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002339:Carotid Arteries / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006305:Health Status Indicators; D006493:Heparin / Q000627:therapeutic use; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin