Effective treatment of transient ischemic attack: A Synthesis of Findings from 14 Studies

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Original Abstract of the Article

Key Research Findings

Transient ischemic attack (TIA) is a brief episode of dysfunction in a confined area of the brain, and it is a serious condition that can lead to stroke. The risk of stroke following TIA is approximately 4% within the first 2 days and 9% within the first month. Therefore, early diagnosis and treatment are critical to reduce mortality and risk of stroke in patients who have experienced a TIA. 9

Some studies have shown that patients with a history of TIA have lower NIHSS scores at admission compared to those without a history of TIA. However, there was no significant difference in the NIHSS score between the two groups at 7 days. Furthermore, there was no statistically significant difference between both groups in terms of mortality. 13

Past research has indicated that combined therapy of aspirin and dipyridamole (Persantine) after TIA increases the risk of stroke, retinal infarction, or death. These risk factors include older age, history of heart disease, history of peripheral vascular disease, and persisting neurological deficit from a recent event. 1

Other studies have compared anticoagulation therapy and antiplatelet therapy and found that both were effective in preventing stroke. However, anticoagulation therapy can increase the risk of cerebral hemorrhage. 4

Treatment Summary

Treatment for TIA includes antiplatelet agents such as aspirin and clopidogrel. 6 , 14

The use of anticoagulants is considered effective in preventing TIA. 4

For patients at high risk of stroke after TIA, combined therapy of aspirin and clopidogrel is considered effective. 7

Benefits and Risks

Benefits Summary

Treatment for TIA can be effective in preventing stroke. 9 , 4

Using antiplatelet drugs such as aspirin and clopidogrel after TIA may be effective in preventing stroke. 6 , 14

Risks Summary

Anticoagulation therapy can increase the risk of cerebral hemorrhage. 4

Combined therapy of aspirin and clopidogrel for patients at high risk of stroke after TIA can increase the risk of bleeding. 7

Comparison Between Studies

Similarities in Studies

Many studies have consistently shown that TIA is a risk factor for stroke. 9 , 13 , 1 , 4 , 2 , 3 , 11 , 5 , 6 , 10 , 14 , 12 , 7 , 8

Some studies have shown that antiplatelet drugs such as aspirin and clopidogrel are effective in treating TIA. 6 , 14

Differences in Studies

The number of patients, follow-up periods, and treatments used vary in each study. 9 , 13 , 1 , 4 , 2 , 3 , 11 , 5 , 6 , 10 , 14 , 12 , 7 , 8

Consistency and Inconsistencies in Results

Many studies consistently show that TIA is a risk factor for stroke. 9 , 13 , 1 , 4 , 2 , 3 , 11 , 5 , 6 , 10 , 14 , 12 , 7 , 8

However, the effectiveness of TIA treatments may vary depending on the study. 6 , 14

Practical Implications

TIA can be a warning sign of an impending stroke. If you experience TIA symptoms, seek medical attention immediately. 9 , 13 , 1 , 4 , 2 , 3 , 11 , 5 , 6 , 10 , 14 , 12 , 7 , 8

Treatment for TIA depends on the individual patient's condition. Consult with your doctor to determine the best treatment for you. 6 , 14

Limitations of Current Research

There is still insufficient research on the treatment of TIA. More research is needed. 6 , 14

Future Research Directions

It is necessary to investigate the effectiveness and safety of TIA treatment in greater detail. 6 , 14

Conclusion

Many studies have shown that TIA is a risk factor for stroke. If you experience TIA symptoms, seek medical attention immediately. 9 , 13 , 1 , 4 , 2 , 3 , 11 , 5 , 6 , 10 , 14 , 12 , 7 , 8

Treatment for TIA depends on the individual patient's condition. Consult with your doctor to determine the best treatment for you. 6 , 14

Treatment List

Antiplatelet agents, Anticoagulants

Literature analysis of 14 papers
Positive Content
11
Neutral Content
1
Negative Content
2
Article Type
8
2
6
2
13
1.

Persantine aspirin trial in cerebral ischemia--Part III: Risk factors for stroke. The American-Canadian Co-Operative Study Group.

Author:

Retinal infarction
Stroke

This study identified risk factors for stroke in 890 patients with a history of transient ischemic attacks (TIAs) in the carotid arteries. The study found that older age, a history of heart disease, a history of peripheral vascular disease, and persisting neurological deficits from a recent event were associated with an increased risk of stroke, retinal infarction, or death. Other factors such as high blood pressure, diabetes, estrogen use, and smoking were not found to be risk factors. The study concludes that these findings identify risk factors in this specific group of patients under treatment, but do not necessarily represent the natural history of all TIA patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Controlled trial of aspirin in cerebral ischemia: an addendum.

Author: LemakN A, FieldsW S, GaryH E

Aspirin efficacy
Stroke prevention
Carotid territory ischemia

This study investigated the effectiveness of aspirin in treating 303 patients who experienced transient ischemic attacks (TIAs) in the carotid arteries. The study found that aspirin was equally effective in treating TIAs affecting the eye (amaurosis fugax) and the brain. Patients with a blockage in the affected carotid artery responded better to aspirin than those with no blockage or a completely blocked artery. The study also found that aspirin was effective regardless of other risk factors, and that smoking did not influence the outcome.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).

Language : English

3.

Treatment after transient ischemic attacks: a comparison between anticoagulant drug and inhibition of platelet aggregation.

Author: GårdeA, SamuelssonK, FahlgrenH, HedbergE, HjerneL G, OstmanJ

Gastrointestinal disorders
Severe hemorrhage

The study found that both anticoagulant (AC) and acetylsalicylic acid (ASA) treatment were effective in preventing recurrent cerebral ischemic events in patients with carotid transient attacks of ischemia. However, AC was associated with a higher risk of severe hemorrhage, while ASA was associated with more gastrointestinal side effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Anticoagulant vs anti-platelet therapy as prophylactic against cerebral infarction in transient ischemic attacks.

Author: OlssonJ E, BrechterC, BäcklundH, KrookH, MüllerR, NiteliusE, OlssonO, TornbergA

Prophylactic effect against cerebral infarction
Cerebral hemorrhage
Myocardial infarctions

Both anticoagulants and anti-platelet therapy were effective in preventing strokes in patients with transient ischemic attacks.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Is this patient having a stroke?

Author: GoldsteinLarry B, SimelDavid L

The presence of acute facial paresis, arm drift, or abnormal speech increases the likelihood of stroke, while the absence of all three findings decreases the odds. Stroke subtype determination requires neuroimaging.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, U.S. Gov't, P.H.S.Research funding provided by the Public Health Service (PHS).
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

6.

Rationale and design of a randomized, double-blind trial comparing the effects of a 3-month clopidogrel-aspirin regimen versus aspirin alone for the treatment of high-risk patients with acute nondisabling cerebrovascular event.

Author: WangYongjun, JohnstonS Claiborne,

TIA treatment

This article discusses the use of aspirin and the combination of clopidogrel and aspirin for the treatment of acute minor stroke or TIA.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Dual antiplatelets reduce microembolic signals in patients with transient ischemic attack and minor stroke: subgroup analysis of CLAIR study.

Author: LauAlexander Y, ZhaoYudong, ChenChristopher, LeungThomas W, FuJianhui, HuangYining, SuwanwelaNijasri C, HanZhao, TanKay Sin, RatanakornDisya, MarkusHugh S, WongKa Sing,

Reduced microembolic signals
Bleeding complications

Early dual therapy with clopidogrel and aspirin reduced microembolic signals in patients with minor ischemic stroke or transient ischemic attack without significant bleeding complications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

Platelet-oriented inhibition in new TIA and minor ischemic stroke (POINT) trial: rationale and design.

Author: JohnstonS Claiborne, EastonJ Donald, FarrantMary, BarsanWilliam, BattenhouseHolly, ConwitRobin, DillonCatherine, ElmJordan, LindbladAnne, MorgensternLewis, PoissonSharon N, PaleschYuko

Within the first three months after a transient ischemic attack (TIA) or minor stroke, 10-20% of people experience another stroke or other vascular problems, many of which are disabling. The highest risk period is in the hours and days immediately following the initial event. Aspirin is the most common medication used to prevent blood clots in these patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

9.

Is Transient Ischemic Attack a Medical Emergency? An Evidence-Based Analysis.

Author: SehatzadehS

TIA treatment

Transient ischemic attack (TIA) is a brief period of neurological dysfunction, with a 4-9% risk of stroke within the first month. Early diagnosis and treatment are crucial to reduce stroke risk and mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Patient delay in TIA: a systematic review.

Author: DolmansL Servaas, HoesArno W, BartelinkMarie-Louise E L, KoenenNiels C T, KappelleL Jaap, RuttenFrans H

Preventive treatment
TIA treatment

People who experience a transient ischemic attack (TIA), a mini-stroke, have a high risk of having a full stroke within the first two days. This study aims to determine how long people wait to seek medical care after a possible TIA and identify factors that contribute to this delay.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Contemporary prognosis of transient ischemic attack patients: A systematic review and meta-analysis.

Author: NajibNashwa, MaginParker, LassersonDaniel, QuainDebbie, AttiaJohn, OldmeadowChristopher, Garcia-EsperonCarlos, LeviChristopher

Transient ischemic attacks treatment

Transient ischemic attacks (TIAs), or mini-strokes, are common and increase the risk of stroke. Studies have shown that starting treatment quickly for TIAs is important. This study investigates whether improved treatment practices for TIAs since 2008 have led to better outcomes for people who have experienced a TIA compared to people who had TIAs before 2008.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

12.

Newly Diagnosed Atrial Fibrillation After Transient Ischemic Attack Versus Minor Ischemic Stroke in the POINT Trial.

Author: KamelHooman, FarrantMary, EastonJ Donald, SposatoLuciano A, ElmJordan J, UnderwoodEllen, JohnstonS Claiborne

This study compared the likelihood of new AF diagnosis after ischemic stroke versus TIA in the POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) trial. The study included 2746 patients with index stroke and 2086 patients with index TIA. During the 90-day follow-up, 106 patients had newly diagnosed AF. The cumulative risk of AF was 2.7% after stroke and 2.0% after TIA. Reclassifying index events by neuroimaging, the cumulative risk of AF was higher after stroke (2.7%) than TIA (1.8%). The study concluded that the distinction between TIA versus minor stroke did not stratify the risk of subsequent AF diagnosis, implying that patients with TIA should undergo similar heart-rhythm monitoring strategies as patients with ischemic stroke.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

13.

Transient Ischemic Attacks Preceding Ischemic Stroke and the Possible Preconditioning of the Human Brain: A Systematic Review and Meta-Analysis.

Author: GhozySherief, KacimiSalah Eddine Oussama, ElfilMohamed, SobeehMohamed Gomaa, RedaAbdullah, KallmesKevin M, RabinsteinAlejandro A, HolmesDavid R, BrinjikjiWaleed, KadirvelRamanathan, KallmesDavid F

TIAs for ischemic stroke

This review examines whether prior transient ischemic attacks (TIAs) can induce brain preconditioning and improve functional outcomes in patients with subsequent ischemic strokes. While previous research suggests that TIAs may enhance brain ischemic tolerance, further investigation is needed to confirm this effect and its implications for stroke recovery.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

Antithrombotic therapy for secondary prevention in patients with stroke or transient ischemic attack: A multiple treatment network meta-analysis of randomized controlled trials.

Author: TornyosDániel, KomócsiAndrás, BálintAlexandra, KupóPéter, El AbdallaouiOumaima El Alaoui, SzapáryLászló, SzapáryLászló Botond

Reduced stroke recurrence
Major bleeding risk

Cilostazol was most effective in reducing stroke recurrence and bleeding risk compared to aspirin. Intensified antiplatelet regimens with aspirin and ticagrelor or clopidogrel resulted in lower stroke recurrence but higher bleeding risk.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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