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 The findings, reported in the New England Journal of Medicine, are
more evidence of the benefits of sending someone to a hospital even
if muscle weakness or slurred speech has only lasted for a few
seconds, lead author Dr. Pierre Amarenco of Bichat Hospital in Paris
told Reuters Health by phone.
That's because mini-strokes, also known as transient ischemic
attacks or TIAs, are often the harbinger of a potentially-deadly
stroke that can come within a matter of hours or days.
"You should worry about symptoms even if they last for just a few
seconds or a few minutes," Amarenco said.
"The study showed that the widespread, systematic implementation of
specialized TIA units across multiple sites, countries, and
continents can make a difference in the care of these patients,"
write Drs. Ralph Sacco and Tatjana Rundek of the University of Miami
in an accompanying editorial.
The ongoing study, which used previous stroke estimates for
comparison, was based on data from 4,789 patients from
TIAregistry.org, an international registry designed to follow cases
for as long as five years.
It didn't include a comparison group, which would offer the best
evidence, but it "helps build the evidence base for the importance
of getting in for early treatment," said Dr. Donna Arnett, dean of
public health at the University of Kentucky and past president of
the American Heart Association.
Any kind of mini-stroke "should lead you to be evaluated," said
Arnett, who was not involved in the study.
Research reported prior to 2004 had suggested that the stroke risk
is 10 percent two days after mini-stroke symptoms appear and between
8 percent and 20 percent for the 30- to 90-day period after symptom
onset.
But in the new study, Amarenco and his colleagues found stroke risks
of 1.5 percent at two days, 2.1 percent at seven days and 3.7
percent at 90 days when mini-strokes were treated aggressively.
One year after symptoms, the stroke rate was 5.1 percent.
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"Although this was not a randomized trial and there was no
comparison group to assess whether specialized units performed
better than nonspecialized (stroke) units, these (newly-reported)
risks are substantially lower than expected. Outcomes in this study
were at least 50 percent lower than those reported in previous
studies," Sacco and Rundek write.
"The rate was remarkably lower," Arnett told Reuters Health. The
study was also noteworthy because, over the long haul, patients did
a particularly good job of taking the medications they were given.
The researchers also found that the one-year stroke risk doubled
when multiple blood vessel clogs were seen with brain imaging, a
large artery was narrowed by heart disease and the patient scored a
6 or 7 on a seven-point scale that assesses stroke risk factors.
More than two thirds of the patients in the study had a score of 4
or higher but the researchers caution that "limiting urgent
assessment to patients with a score of 4 or more would miss
approximately 20 percent of those with early recurrent strokes."
SOURCE: http://bit.ly/1MGDlo3 New England Journal of Medicine,
online April 20, 2016.
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