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Early TIA care could stop 10,000 strokes

GPs should initiate treatment immediately in patients they suspect have suffered a transient ischaemic attack, warn leading Oxford researchers.

The difference between delayed and prompt treatment is an 80% drop in the risk of early recurrent stroke, results from a trial of an outpatient assessment clinic show.

In phase 1 of the five-year study patients were referred to the clinic by fax and offered an appointment, which took up to an average of three days.

Medication was then prescribed by the GP on the say so of the clinic – a delay of a further 20 days.

In phase 2 of the study, access to the clinic was on an open, same-day basis and treatment of aspirin, blood pressure lowering drugs and a statin was initiated by the clinic that day.

The 90-day risk of recurrent stroke fell from 10.3% to 2.1% once patients were receiving quick treatment.

Most current TIA clinics in the UK are run weekly but the results show treatment needs to be initiated immediately, the researchers concluded.

Professor Peter Rothwell, study leader and director of the Stroke Prevention Re-search Unit at the University of Oxford said GPs should be starting treatment straight away even if though some of the patients would not have had a TIA on assessment.

'It would make sense for GPs to start medication immediately and the role of the TIA clinic could be for diagnostic tests.

'GPs probably see two or three a year so it's not big numbers - it would mean some patients would be unnecessarily treated for a few days but without any significant risk,' he added.

He added that quick treatment for TIA could prevent 10,000 strokes in the UK every year.

He added clinics did not necessarily need to be daily but an open-access policy should be adopted.

Dr Jonathan Mant, senior clinical lecturer in the Department of Primary Care and General Practice at the University of Birmingham said the results had big implications for general practice and suggested GPs should be giving treatment before assessment could be arranged.

'It's still not clear what's the optimum set-up, you could argue that if GPs could initiate treatment and do a good job you don't need the specialist clinics at all.'

Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society and GP in Richmond said there was no reason GPs could not initiate treatment with the drugs suggested before full assessment.

'In the case of aspirin, most GPs would probably start treatment anyway.'

The EXPRESS study of 1200 patients is published early online in The Lancet.

Medication used in studyMedication used in study Medication used in study

300mg loading dose of aspirin followed by 75mg daily dose
ACE inhibitor plus diuretic
Simvastatin 40mg
Additional antiplatelet drug for those at particularly high risk

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