Transient Ischaemic Attack (TIA)
ABCD2 score
| Variable | Score |
|---|---|
Age |
|
>60 |
1 |
Blood Pressure (mmHg) |
|
SBP >140 or DBP>90 |
1 |
Clinical Features (choose one) |
|
Any unilateral weakness (face/arm/leg) with or without speech disturbance |
2 |
Speech disturbance (without motor weakness) |
1 |
Duration of symptoms (min) |
|
10 - 59 |
1 |
>60 |
2 |
Diabetes |
1 |
Total ABCD2 score |
The ABCD2 score is a risk assessment tool designed to improve the prediction of short-term stroke risk after a TIA. The score is optimised to predict the risk of stroke within 2 days after a TIA, but also predicts stroke risk within 90 days. The ABCD2 score is calculated by summing up points for five independent factors.
Higher ABCD2 scores are associated with greater risk of stroke during the 2, 7, 30, and 90 days after a TIA. The authors (Ref 1) of the ABCD2 score made the following recommendations for hospital observation:
ABCD2 score |
2 day stroke risk |
Comment |
|---|---|---|
0 - 3 |
1% |
Hospital observation may be unnecessary without another indication (e.g. new AF) |
4 - 5 |
4.1% |
Hospital admission justified in most situations |
6 - 7 |
8.1% |
Hospital admission recommended |
Evaluation
- Initial Evaluation: Prompt initial evaluation (within 12h); evaluation completed within 48 hours.
- Hospitalization: Should be considered to facilitate early therapy and secondary prevention.
- Lab testing: FBC, U&E, fasting blood glucose and lipids
- ECG in all.
- Brain imaging : CT or MRI within 48 hours.
- Vascular imaging: Carotid imaging, CT or MR angiography, or transcranial Doppler within 48 hours
Medical management
- Antithrombotic Therapy
- Atherothrombotic TIA: Daily long-term antiplatelet therapy: combination extended-release dipyridamole plus aspirin (reasonable as first choice), clopidogrel, or aspirin alone. Anticoagulation is not recommended.
- Cardioembolic TIA: Long-term anticoagulation for atrial fibrillation (continuous or paroxysmal). If patient intolerant to anticoagulation, aspirin 325 mg daily; clopidogrel 75 mg daily if intolerant to aspirin.
- Hypertension: Lower blood pressure to <140/90 mmHg or <130/80 mmHg for diabetics, with an ACE inhibitor alone or in combination with a diuretic, or with an angiotensin-receptor blocker.
- Lipids: Initiate a daily statin. Goal LDL-cholesterol level <2.59 mmol/l (<100mg/dl)
- Smoking: Initiate a cessation program.
- Diabetes: Fasting blood glucose goal <126mg/dl.
- Physical activity: Recommend ≥10 min of exercise such as walking, bicycling, running, or swimming ≥3 times/week.
Surgical management
- Carotid endarterectomy: Preferably within 2 weeks of cerebral or retinal TIA in those with TIA attributed to a high-grade internal carotid artery stenosis:
- 70-99% internal carotid artery stenosis: Recommended.
- 50-69% stenosis: Recommended for patients but only at centres with perioperative complication rate <6%
- <50% stenosis: Not recommended.
- Bypass surgery: Not recommended
[1] Johnston SC, Rothwell PM, Huynh-Huynh MN, Giles MF, Elkins JS, Sidney S, "Validation and refinement of scores to predict very early stroke risk after transient ischemic attack," Lancet, 369:283-292, 2007.
References
[1] Johnston SC, Rothwell PM, Huynh-Huynh MN, Giles MF, Elkins JS, Sidney S, "Validation and refinement of scores to predict very early stroke risk after transient ischemic attack," Lancet, 369:283-292, 2007.
