Knowledge and management of transient ischemic attacks among US primary care physicians

A TIA may represent an important opportunity to prevent stroke.1 A recent study found that over 10% of patients diagnosed with TIA in the emergency department return with a stroke within 90 days,2 and that long-term stroke risk is also elevated.3 Management guidelines have been established for patients with TIA, including the use of antiplatelet agents, the use of oral anticoagulation with warfarin in atrial fibrillation, and carotid endarterectomy for severe carotid stenosis.4 Despite these guidelines, some studies have found that only 44 to 46% of patients with atrial fibrillation who were eligible for anticoagulation received it,5 and less than one-third of patients with TIA with severe carotid stenosis got carotid endarterectomy.6 Another study found that a third of patients with first-ever TIA diagnosed in primary care clinics were neither hospitalized nor received any further workup.7 Suboptimal management of TIA may contribute to the high subsequent risk of stroke. Difficulty in reliably diagnosing …