Medicine (Austin & Northern Health) - Research Publications

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Type: Abstract × Author: Dewey, Helen ×

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    One-year risk of stroke after transient ischemic attack or minor stroke in Hunter New England, Australia (INSIST study)
    Tomari, S ; Levi, C ; Lasserson, D ; Quain, D ; Valderas, J ; Dewey, H ; Barber, A ; Spratt, N ; Cadilhac, D ; Feigin, V ; Rothwell, P ; Zareie, H ; Garcia-Esperon, C ; Davey, A ; Najib, N ; Sales, M ; Magin, P (CSIRO PUBLISHING, 2021-08-06)
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    The Characteristics of Patients With Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study)
    Tomari, S ; Magin, P ; Lasserson, D ; Quain, D ; Valderas, JM ; Dewey, HM ; Barber, PA ; Spratt, NJ ; Cadilhac, DA ; Feigin, VL ; Rothwell, PM ; Zareie, H ; Garcia-Esperon, C ; Davey, A ; Najib, N ; Sales, M ; Levi, CR (FRONTIERS MEDIA SA, 2020-05-15)
    Background: Transient ischemic attack (TIA) and minor stroke (TIAMS) are risk factors for stroke recurrence. Some TIAMS may be preventable by appropriate primary prevention. We aimed to recruit "possible-TIAMS" patients in the INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study. Methods: A prospective inception cohort study performed across 16 Hunter-Manning region, Australia, general practices in the catchment of one secondary-care acute neurovascular clinic. Possible-TIAMS patients were recruited from August 2012 to August 2016. We describe the baseline demographics, risk factors and pre-event medications of participating patients. Results: There were 613 participants (mean age; 69 ± 12 years, 335 women), and 604 (99%) were Caucasian. Hypertension was the most common risk factor (69%) followed by hyperlipidemia (52%), diabetes mellitus (17%), atrial fibrillation (AF) (17%), prior TIA (13%) or stroke (10%). Eighty-nine (36%) of the 249 participants taking antiplatelet therapy had no known history of cardiovascular morbidity. Of 102 participants with known AF, 91 (89%) had a CHA2DS2-VASc score ≥ 2 but only 47 (46%) were taking anticoagulation therapy. Among 304 participants taking an antiplatelet or anticoagulant agent, 30 (10%) had stopped taking these in the month prior to the index event. Conclusion: This study provides the first contemporary data on TIAMS or TIAMS-mimics in Australia. Community and health provider education is required to address the under-use of anticoagulation therapy in patients with known AF, possibly inappropriate use of antiplatelet therapy and possibly inappropriate discontinuation of antiplatelet or anticoagulation therapy.