Management of Atherothrombosis with Clopidogrel in High-Risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke (MATCH): Study Design and Baseline Data

A transient ischaemic attack (TIA) is a common medical encounter, which is often managed suboptimally in the acute phase. A TIA should be treated as a medical emergency as studies have shown that high-risk patients can go on to have a stroke within seven days of a TIA. An audit was completed looking at referrals to the TIA clinic. Results prompted the production of a TIA care pathway, which prompted health-care teams on the appropriate management of these patients.

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Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

BMJ ◽

10.1136/bmj.k5130 ◽

2018 ◽

pp. k5130 ◽

Cited By ~ 21

Author(s):

Kameshwar Prasad ◽

Reed Siemieniuk ◽

Qiukui Hao ◽

Gordon Guyatt ◽

Martin O’Donnell ◽

...

Keyword(s):

High Risk ◽

Ischaemic Stroke ◽

Antiplatelet Therapy ◽

Transient Ischaemic Attack ◽

Dual Antiplatelet Therapy ◽

Recurrent Stroke ◽

Minor Stroke ◽

Strong Recommendation ◽

Ischaemic Attack

What is the role of dual antiplatelet therapy after high risk transient ischaemic attack or minor stroke? Specifically, does dual antiplatelet therapy with a combination of aspirin and clopidogrel lead to a greater reduction in recurrent stroke and death over the use of aspirin alone when given in the first 24 hours after a high risk transient ischaemic attack or minor ischaemic stroke? An expert panel produced a strong recommendation for initiating dual antiplatelet therapy within 24 hours of the onset of symptoms, and for continuing it for 10-21 days. Current practice is typically to use a single drug

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Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

BMJ ◽

10.1136/bmj.l103 ◽

2019 ◽

pp. l103 ◽

Cited By ~ 1

Keyword(s):

Clinical Practice ◽

High Risk ◽

Ischaemic Stroke ◽

Antiplatelet Therapy ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Transient Ischaemic Attack ◽

Dual Antiplatelet Therapy ◽

Ischaemic Attack

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Outcomes of Medicare beneficiaries hospitalised with transient ischaemic attack and stratification using the ABCD2 score

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000372 ◽

2020 ◽

pp. svn-2020-000372

Author(s):

Shreyansh Shah ◽

Li Liang ◽

Durgesh Bhandary ◽

Saga Johansson ◽

Eric E Smith ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Intracranial Haemorrhage ◽

Haemorrhagic Stroke ◽

Medicare Beneficiaries ◽

Ischaemic Attack

BackgroundLong-term outcomes for Medicare beneficiaries hospitalised with transient ischaemic attack (TIA) and role of ABCD2 score in identifying high-risk individuals are not studied.MethodsWe identified 40 825 Medicare beneficiaries hospitalised from 2011 to 2014 for a TIA to a Get With The Guidelines (GWTG)-Stroke hospital and classified them using ABCD2 score. Proportional hazards models were used to assess 1-year event rates of mortality and rehospitalisation (all-cause, ischaemic stroke, haemorrhagic stroke, myocardial infarction, and gastrointestinal and intracranial haemorrhage) for high-risk versus low-risk groups adjusted for patient and hospital characteristics.ResultsOf the 40 825 patients, 35 118 (86%) were high risk (ABCD2 ≥4) and 5707 (14%) were low risk (ABCD2=0–3). Overall rate of mortality during 1-year follow-up after hospital discharge for the index TIA was 11.7%, 44.3% were rehospitalised for any reason and 3.6% were readmitted due to stroke. Patients with ABCD2 score ≥4 had higher mortality at 1 year than not (adjusted HR 1.18, 95% CI 1.07 to 1.30). Adjusted risks for ischaemic stroke, all-cause readmission and mortality/all-cause readmission at 1 year were also significantly higher for patients with ABCD2 score ≥4 vs 0–3. In contrast, haemorrhagic stroke, myocardial infarction, gastrointestinal bleeding and intracranial haemorrhage risk were not significantly different by ABCD2 score.ConclusionsThis study validates the use of ABCD2 score for long-term risk assessment after TIA in patients aged 65 years and older. Attentive efforts for community-based follow-up care after TIA are needed for ongoing prevention in Medicare beneficiaries who were hospitalised for TIA.

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