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Urgent treatment after a transient ischaemic attack helps prevent stroke

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.335.7625.851-c (Published 25 October 2007) Cite this as: BMJ 2007;335:851

Up to one in 10 people who have a transient ischaemic attack will go on to have a disabling stroke, often within the first week. Rapid assessment and treatment of risk factors such as high blood pressure can help reduce the risk, say researchers from the UK.

In 2002, they set up a dedicated outpatient clinic for patients with transient ischaemic attack or minor stroke referred by nine primary care practices in Oxfordshire. In 2004, the clinic abandoned its appointment system, saw patients within a day on average, and started treatment with aspirin as they came through the door. Other preventive treatments such as statins, antihypertensive drugs, and anticoagulants were started immediately if appropriate.

A rigorous before and after study suggests the change was associated with an 80% reduction in the incidence of stroke. During the first two years, 10.3% (32/310) of patients sent to the clinic had a stroke within 90 days. Between 2004 and 2007 the proportion fell to 2.1% (6/281), giving an adjusted hazard ratio of 0.2 (95% CI 0.08 to 0.49). The authors estimate that nearly 10 000 fewer strokes would occur every year in the UK if all patients with transient ischaemic attack were seen and treated this fast.

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