Written by Alexander Sheehan and Ketan Patel
Patients with transient ischemic attack (TIA) or minor stroke remain at high risk of subsequent stroke for up to 10 years, emphasizing the need for sustained secondary prevention beyond the initial acute period.
TIA – the warning shot that keeps on reloading
While most literature has focused on 90-day risk of stroke after TIA or minor stroke, this article found a nearly 20% risk of another stroke within 10 years, underscoring the importance of long-term vigilance and prevention beyond the ED. Additionally, patients with a chronic stroke history often present to the emergency department, and understanding their long-term risks may influence decisions to admit or discharge.
This systematic review and meta-analysis examined 171,068 patients with TIA or minor stroke across 38 cohort studies to determine long-term stroke risk. With no specific intervention, it compared stroke incidence over time and found a pooled stroke rate of 5.94 per 100 person-years in year one, decreasing to approximately 1.8 annually thereafter. Cumulative stroke incidence reached 12.5% at 5 years and 19.8% at 10 years, demonstrating a persistent long-term risk.
Key limitations include high heterogeneity across studies, reliance on aggregate data, potential underestimation of early stroke events, limited long-term bleeding risk data, and reduced generalizability due to variable definitions, settings, and surveillance methods.
How does this change my practice?
While chronic management of stroke and TIA is not typically addressed in the emergency setting, this study provides compelling evidence that influences ED care. Specifically, the long-term risk of a prior TIA should not be underestimated in subsequent evaluations of stroke patients presenting to the ED, especially outside of the subacute window.
Source
Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis. JAMA. 2025 May 6;333(17):1508-1519. doi: 10.1001/jama.2025.2033. PMID: 40136306
