Background Early risk of major stroke is high after both transient ischaemic attack (TIA) and minor stroke, but the time course of risk may differ. If so, reliable data would help to target secondary prevention.
Methods We prospectively ascertained all incident and recurrent TIA and stroke in a population based study (Oxford Vascular Study) from April 2002 to March 2007. Patients received best secondary preventive treatment according to current guidelines. The timing of all recurrent events within the first year was analysed.
Results Among 1234 patients (491 TIA, 516 minor ischaemic stroke NIHSS 0–5, 227 major ischaemic stroke NIHSSS >5), there were 82 recurrent strokes at 7 days (6.6%), 142 at 90 days (11.5%) and 197 at 1 year (16.0%). For all recurrences during the first year, the median time to event was 4 days for TIA vs 28 days for minor stroke (p<0.0001). The risk of recurrent stroke after TIA was about double that after minor stroke at 7-days (50 vs 29), whereas the proportions reversed at 8–90 days (22 vs 32) and risk was substantially higher after minor stroke during 90-days to 1-year (39 vs 14, p-trend=0.00002).
Conclusions Stroke recurrence after minor stroke is delayed compared with TIA, and risk is greatest during the subacute phase despite current best medical treatment. There is a major unmet need for more effective prevention of recurrence in the subacute phase after minor ischaemic stroke.
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