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WHAT IS YOUR RISK OF A MAJOR STROKE IF YOU HAVE HAD A TRANSIENT ISCHEMIC ATTACK (TIA) OR A MINOR STROKE

  First we need to define the terms.  A transient ischemic attack (TIA) is a short-term stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms, which usually occur suddenly, are similar to those of stroke but do not last as long. Most symptoms of a TIA disappear within an hour, although they may persist for up to 24 hours. Symptoms can include: numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion or difficulty in talking or understanding speech; trouble seeing in one or both eyes; and difficulty with walking, dizziness, or loss of balance and coordination.(1)

A minor stroke has a fairly complicated definition.  The person having one should be able to do most of these things; be alert and responsive, know the current month and their age, open and shut their eyes on command, be able to grip and release with one hand, etc. (2)  Lack of this ability means that the person has had a major, not a minor, stroke. 

Coull et al studied the risk of having a major stroke at one week, one month and three months after having either a TIA or a minor stroke. (3)  They found that the commonly quoted risk of a major stroke after these events of 1-2% at one week and 4% at one month are underestimates.  They studied a population of over 90,000 people in Oxfordshire, England over a one year period.  There were 87 people who were diagnosed with TIA and 87 who had a minor stroke.  

Risk of Recurrent Stroke

  TIA Minor Stroke
At one week 8.0% 11.5%
At one month 11.5% 15.0%
At three months 17.3% 18.5%

These rates are clearly much higher than the "conventional wisdom" states.  

Editor's Note:  This was not the point of  the Coull article but I noticed it while preparing this page.  

Antiplatelet vs. Anticoagulation Therapy in Preventing TIAs and Minor Strokes

  TIA Minor Stroke
% of people on antiplatelet therapy 51% 41%
% of people on anticoagulation therapy 7% 1%

A study such as this is not designed to show cause and effect but these are very dramatic differences in the occurrence rates on antiplatelet (aspirin etc) and anticoagulation (warfarin etc).  Despite what you see in advertising, antiplatelet therapy does not appear to be very effective in preventing these events.

 

References:

1. http://www.ninds.nih.gov/health_and_medical/disorders/tia_doc.htm (Viewed March 16, 2004)

2. http://www.strokecenter.org/trials/scales/nihss.html (Viewed March 16, 2004)

3. Coull AJ et al. BMJ 2004;328:326-8.

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Last updated August 29, 2004