Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services

doi:10.1136/bmj.37991.635266.44

BMJ 2004;328:326 (7 February), doi:10.1136/bmj.37991.635266.44 (published 26 January 2004)

Primary care

Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services

A J Coull, clinical research fellow¹, J K Lovett, clinical research fellow¹, P M Rothwell, reader in clinical neurology¹, Oxford Vascular Study

¹ Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: P M Rothwell peter.rothwell{at}clneuro.ox.ac.uk

Objective To estimate the very early stroke risk after a transientischaemic attack (TIA) or minor stroke and thereby inform theplanning of effective stroke prevention services.

Design Population based prospective cohort study of patientswith TIA or stroke.

Setting Nine general practices in Oxfordshire, England, fromApril 2002 to April 2003.

Participants All patients who had a TIA (n = 87) or minor stroke(n = 87) during the study period and who presented to medicalattention.

Main outcome measures Risk of recurrent stroke at seven days,one month, and three months after TIAs and minor strokes.

Results The estimated risk of recurrent stroke was 8.0% (95%confidence interval 2.3% to 13.7%) at seven days, 11.5% (4.8%to 18.2%) at one month, and 17.3% (9.3% to 25.3%) at three monthsafter a TIA. The risks at these three time periods after a minorstroke were 11.5% (4.8% to 11.2%), 15.0% (7.5% to 22.5%), and18.5% (10.3% to 26.7%).

Conclusions The early risks of stroke after a TIA or minor strokeare much higher than commonly quoted. More research is neededto determine whether these risks can be reduced by more rapidinstigation of preventive treatment.

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