Please see also Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study [PubMed Abstract] [Full-Text HTML]. BMJ. 2021; 372: n49.
In this post I to and excerpt from the European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Eur Stroke J. 2021 Jun;6(2):V.
All that follows is from the above resource.
The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is
to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational
Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic
principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be dueto focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in
patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4
or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral
large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet
treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4
or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours
after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if
managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional
confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of
carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg
ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as
due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual
patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.
Transient ischaemic attack (TIA), TIA clinic, dual anti-platelet treatment (DAPT), clopidogrel, ticagrelor, aspirin, secondary prevention, large vessel stenosis, clinical prediction tools, ABCD2
Date received: 4 October 2020; accepted: 16 January 2021