Meta-analysis attests to progress in reducing post-TIA stroke risk

  • Shahjouei S & al.
  • JAMA Neurol
  • 12.10.2020

  • von Susan London
  • Clinical Essentials
Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten. Der Zugang zum gesamten Inhalt dieser Seite ist nur Angehörigen medizinischer Fachkreise vorbehalten.

Takeaway

  • Patients experiencing transient ischemic attack (TIA) still have an elevated risk for ischemic stroke during early follow-up, but there has been progress in averting this outcome.

Why this matters

  • Recognition of the importance of urgent TIA management has increased.

Key results

  • Estimated overall subsequent ischemic stroke incidence rate:
    • 2.4% within 2 days.
    • 3.8% within 7 days.
    • 4.1% within 30 days.
    • 4.7% within 90 days.
  • Rates fell significantly over time:
    • Within 2 days:
      • 3.4% before 1999.
      • 2.1% during 1999-2007 (P=.0001).
      • 2.1% after 2007 (P<.0001>
    • Within 7 days:
      • 5.5% before 1999.
      • 2.9% during 1999-2007 (P<.0001>
      • 3.2% after 2007 (P<.0001>
    • Within 30 days:
      • 6.3% before 1999.
      • 2.9% during 1999-2007 (P<.0001>
      • 3.4% after 2007 (P<.0001>
    • Within 90 days:
      • 7.4% before 1999.
      • 3.9% during 1999-2007 (P<.0001>
      • 3.9% after 2007 (P<.0001>

Study design

  • Systematic review (68 studies, 223,866 patients) and meta-analysis (68 studies, 206,455 patients) of TIA outcomes.
  • Study recruitment spanned from 1971 to 2019.
  • Main outcome: incident ischemic stroke after TIA.
  • Funding: Geisinger Health Plan Quality; NIH.

Limitations

  • Studies differed on definition of TIA, first vs recurrent TIA.
  • Most studies were conducted in industrialized countries.