Authors
Rothwell PM, Giles MF, Chandratheva A, et al.
Title
Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison.
References
Lancet 2007;370:1432-1442.
Background
The risk of stroke is significant in the first week after a TIA or minor stroke. Preventative treatment strategies used early may decrease the risk of recurrent TIA or stroke.
Purpose
To determine the effect of more rapid treatment after TIA and minor stroke in patients who are not admitted directly to hospital.
Design
Population-based \"before-and-after study\" of all incident and recurrent TIA and stroke in Oxfordshire, UK 91,000 individuals registered with 63 primary-care physicians. In the first phase, patients with TIA symptoms were required to be assessed at the EXPRESS study specialty clinic, by appointment. Standardized treatment recommendations were faxed to the patient’s physician. In the second phase, similar patients were treated immediately at the EXPRESS study specialty clinic, without need for an appointment.
Exclusion Criteria
None.
Follow-Up
5 years
Treatment Regimen
In both phases: Clopidogrel 300 mg loading dose, then 75 mg daily x 30 days. High risk patients received simvastatin 40 mg/day. Antihypertensive medications were prescribed when indicated.
Results
Primary endpoint: risk of stroke within 90 days of first seeking medical attention. The primary endpoint was 10.3% (phase 1) and 2.1% (phase 2); p=0.0001. There was no increase in intracerebral haemorrhage or other bleeding.
Summary
Early assessment and treatment of patients with TIA or minor stroke resulted in a 80% risk reduction in the risk of stroke within 90 days.
Implications
None.
Related Figures
[7]