Urgent Need for Secondary Stroke Prevention After Transient Ischemic Attack

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Abstract:

Objective: To review symptom awareness, diagnostic techniques, and therapeutic interventions for the recognition and treatment of transient ischemic attack (TIA) and to discuss secondary stroke prevention after TIA.

Data Sources: Published information related to recognition and treatment of TIA and the prevention of a secondary cerebrovascular event after TIA.

Data Synthesis: Literature review reveals high risk for an early, secondary cerebrovascular event after TIA. Historically, TIA was not treated urgently; today, it is understood that TIA is a sign of a serious condition and may be an indication of impending disability and death. Prompt initiation of treatment may significantly reduce morbidity and mortality. However, many factors, such as low public awareness of symptoms, lack of urgency, or unavailability of brain imaging devices, are responsible for treatment delay. Delay between symptom onset and symptom diagnosis may preclude the use of tissue-plasminogen activator, which must be administered within a three-hour window from time of onset. Other therapeutic interventions for secondary stroke prevention after a TIA include the early use of antiplatelet agents (aspirin, clopidogrel, dipyridamole), and may involve procedures such as carotid endarterectomy and stenting. Risk reduction may also be achieved by treating hypertension and hypercholesterolemia.

Conclusion: TIA and stroke must be recognized and treated urgently. Through public education, readily available information, access to diagnostic imaging devices, and aggressive preventive strategies and treatments, the frequency and severity of secondary cerebrovascular events, as well as the economic burden of secondary stroke, could be substantially reduced.

Abbreviations: BP = Blood pressure, CE = Carotid endarterectomy, EMS = Emergency medical services, ER = Extended release, ESPRIT = European/Australasian Stroke Prevention in Reversible Ischemia Trial, ESPS-2 = European Stroke Prevention Study 2, HPS = Heart Protection Study, MATCH = Management of Atherothrombosis in High-risk Patients with Recent Transient Ischemic Attack or Ischemic Stroke, MI = Myocardial infarction, PAD = Peripheral artery disease, PRoFESS = Prevention Regimen for Effectively Avoiding Second Strokes, SALT = Swedish Aspirin Low-dose Trial, SPARCL = Stroke Prevention by Aggressive Reduction in Cholesterol Levels, TIA = Transient ischemic attack, tPA = Tissue plasminogen activator.

Consult Pharm 2008;23:131-40.
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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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