Very early risk of stroke after a first transient ischemic attack

Background and Purpose - The commonly quoted early risks of stroke after a first transient ischemic attack (TIA) - 1% to 2% at 7 days and 2% to 4% at 1 month - are likely to be underestimates because of the delay before inclusion into previous studies and the exclusion of patients who had a stroke during this time. Therefore, it is uncertain how urgently TIA patients should be assessed. We used data from the Oxford Community Stroke Project ( OCSP) to estimate the very early stroke risk after a TIA and investigated the potential effects of the delays before specialist assessment. Methods - All OCSP patients who had a first-ever definite TIA during the study period (n = 209) were included. Three analyses were used to estimate the early stroke risk after a first TIA starting from 3 different dates: assessment by a neurologist, referral to the TIA service, and onset of first TIA. Results - The stroke risk from assessment by a neurologist was 1.9% [95% confidence interval (CI), 0.1 to 3.8] at 7 days and 4.4% ( 95% CI, 1.6 to 7.2) at 30 days. The 7- and 30-day stroke risks from referral were 2.4% ( 95% CI, 0.3 to 4.5) and 4.9% ( 95% CI, 1.9 to 7.8), respectively, and from onset of first-ever TIA were 8.6% ( 95% CI, 4.8 to 12.4) and 12.0% ( 95% CI, 7.6 to 16.4), respectively. Conclusions - The early risk of stroke from date of first-ever TIA is likely to be higher than commonly quoted. Public education about the symptoms of TIA is needed so that medical attention is sought more urgently and stroke prevention strategies are implemented sooner.