Research supports establishment of specialized TIA clinics
Original article
Lavallée PC et al. (2007) A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 6: 953–960 PubMed
A quarter of strokes are preceded by a transient ischemic attack (TIA). The attacks last only minutes and recovery is quick and complete, so TIAs can easily be ignored by sufferers or missed by physicians. Even if patients do attend hospital after a TIA, immediate assessment with brain and vascular imaging and rapid initiation of preventive treatment is not the norm. To improve care for patients with TIA, Lavallée et al. set up the 'SOS-TIA' clinic to provide 24 h access to assessment and treatment facilities for doctors working in the administrative region of Paris.
During the period 2003–2005, the clinic admitted 1,085 patients with suspected TIA. Just over half of patients were seen within 24 h of the symptomatic episode. Neurological, arterial and cardiac imaging was performed within 4 h of admission. TIA was confirmed in 643 patients and strongly suspected in 144, and 58 patients had minor ischemic strokes. Patients began a stroke prevention program, with additional treatment as necessary, including oral anticoagulants for atrial fibrillation (n = 30), initiation or modification of blood-pressure-lowering or blood-lipid-lowering therapy (n = 225 and n = 315, respectively), and urgent carotid revascularization (n = 43). Almost three-quarters of all patients seen were sent home on the same day as admission. This prompt evaluation and treatment reduced the risk of subsequent stroke within 90 days of a TIA to a rate of only 1.24%, as compared with 5.96% as predicted by the ABCD2 scores.
The authors conclude that immediate assessment and treatment in specialist clinics with 24 h access could prevent a substantial number of subsequent strokes in patients presenting with TIA.
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Subject areas under which this article appears: Stroke