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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Early intervention prevents recurrent stroke

The Lancet has published the results of a prospective study that aimed to quantify the benefits of urgent treatment of transient ischaemic attack (TIA) and minor stroke in preventing recurrent strokes.

The study ran over 2 phases, the first was 'usual care' and the second was a rapid assessment and treatment. The primary outcome was the risk of stroke within 90 days of first seeking medical attention. The study recruited 1278 patients from the Oxford Vascular Study who presented with TIA or stroke. Of these, 591 patients were seen in the study clinic.

Phase 2 of the study reduced assessment time from a median of 3 days to less than 1 day. Median time to first prescription of treatment fell from 20 days to 1 day. Both of these changes were statistically significant (p < 0·0001).

The primary outcome occurred in 10·3% (32/310) of the patients during phase 1 of the study compared to 2·1% (6/281) in phase 2. The adjusted hazard ratio was calculated to be 0·20 (95% CI 0·08-0·49; p=0·0001). This reduction in risk was independent of age or gender and early treatment was did not increase the risk of intracerebral haemorrhage or other bleeding.

The Department of Health already have a National Stroke Strategy that highlights stroke as the third biggest cause of death in the UK and the largest single cause of severe disability. Since 2001, the National Service Framework for Older People has targeted reductions in stroke and the provision of specialist stroke services.

Action: Clinicians should ensure that they are aware of the local specialist stroke service and ensure patients are referred quickly for assessment and treatment when a TIA or minor stroke is suspected.

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