Fast treatment key after minor stroke
Patients who receive treatment for a minor stroke within 24 hours reduce their risk of a second stroke by 80% compared with those who wait three days or more to see a doctor, according to a new study released today.
Many patients who experience the relatively mild and temporary symptoms of a minor stroke -- slurred speech, arm weakness and dizziness -- often forgo seeing a doctor for days or weeks. Some doctors also fail to initiate immediate treatment for such symptoms.
But researchers in Oxford, England, found in a study of 1,278 stroke patients that even the mildest strokes need to be treated quickly with blood thinners and cholesterol-lowering drugs to avoid a recurrence.
“If someone has either the warning signs of a stroke or has a mild stroke, they need to seek urgent medical care,” said Dr. Michael Alexander, who directs the Neurovascular Center at Cedars-Sinai Medical Center and who was not involved in the study.
“If that means coming to the emergency room, then they need to do that,” he said. “If the doctor says, ‘See you in a week or two weeks,’ that should not be sufficient.”
Strokes are blockages or ruptures in blood vessels that damage the brain. According to the American Heart Assn., about 700,000 Americans a year suffer a stroke; about 150,000 die.
A minor stroke can cause slurred speech or mild weakness in an arm without total disability.
A transient ischemic attack -- also known as a mini-stroke -- has temporary symptoms, such as losing vision or the ability to speak for 20 or 30 minutes.
About 20% of patients who have had minor and transient strokes have full strokes within three months, said Dr. Bruce Ovbiagele, who directs the stroke program at Olive View-UCLA Medical Center and who was not involved in the study.
The researchers, who published their study in the journal Lancet Neurology, set up a clinic for minor and transient strokes and asked primary-care physicians in the Oxford area to refer patients who did not require immediate hospital admission.
Patients were evaluated at the clinic or at home and received prescriptions for basic drugs, such as aspirin, statins or blood-pressure medication.
In the first phase of the study, from 2002 to 2004, 310 stroke patients were evaluated at the clinic in a median of three days and received a first prescription in a median of 20.
In the second phase, 2004 to 2007, 281 patients went to an “express” clinic, where they were assessed and started on drugs within a day.
The researchers found that patients who visited the first-phase clinic had a 10.3% risk of a second stroke within 90 days. Patients evaluated and treated at the express clinic within 24 hours had a 2.1% chance of a recurrence within 90 days.
Ovbiagele, a national spokesman for the American Stroke Assn., said the findings made sense because the underlying conditions that triggered a minor stroke -- blood clots or plaque build-up, for example -- don’t go away.
The first week after any stroke is considered particularly dangerous. “There’s some kind of unstable situation that’s more than likely to occur very, very soon,” Ovbiagele said.
Stroke researchers said they did not know the average length of time it took for Americans who suffer minor and transient strokes to get treatment, but they estimated that it often takes several days to a week.
“The first thing people should do is recognize a mini-stroke is an emergency,” said Dr. Patrick D. Lyden, the medical director of the UC San Diego Medical Center Stroke Center. He was not involved in the study.
