Stroke :: Early treatment of minor stroke reduces major stroke risks

Rapid assessment and treatment of minor strokes and transient-ischaemic attacks (TIAs) massively reduces the chances of occurrence of subsequent major stroke, conclude two separate studies, one early Online and in an upcoming edition of The Lancet, and the other early Online and in the November issue of The Lancet Neurology.

The risk of a major stroke occurring in the first month after a minor stroke or TIA is 10%. The Lancet study shows that early initiation of current treatments following a minor stroke or TIA reduces that risk by 80%.

Such actions if universally applied could prevent almost 10000 strokes per year in the UK alone.

Professor Peter Rothwell, Stroke Prevention Research Unit, Radcliffe Infirmary, University of Oxford, UK, and colleagues did a prospective before and after study, with phase one running April 2002 to September 2004 and phase two running Oct 2004 to March 2007. They looked at the effect of urgent assessment and immediate treatment in specialist clinics, compared with subsequent initiation of such treatment in primary care, in all patients with minor stroke or TIA who were not admitted directly to hospital. The study was nested within a rigorous population based study of stroke and TIA (the Oxford Vascular Study, OXVASC), and as such case investigation and follow-up were complete and identical in both phases.

In phase one, the median delay to assessment in clinic was 3 days, while the median time to first prescription of treatment was 20 days. These values were reduced to 1 day for both assessment and prescription in phase two. The researchers found that the 90-day risk of recurrent stroke in phase one patients was 10·3% (32/310 patients), while in phase two the risk was 2·1% (6/281 patients), meaning that immediate assessment and treatment in phase two reduced the risk of recurrence by 80%. Further, they found that the reduction in risk was independent of age and sex, and early treatment did not increase the risk of bleeding or other complications.

The authors say: “Our data indicate that urgent assessment and early initiation of a combination of existing preventative treatments can reduce risk of early recurrent stroke after TIA or minor stroke by about 80%…extrapolated across the UK population, this equates to the prevention of nearly 10000 strokes per year.”

They conclude: “Further follow-up is required to determine long-term outcome, but these results have immediate implications for the service provision and public education about TIA and minor stroke.”

Leave a Comment