Lancet neurology
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Review
Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis.
Stroke is often preceded by transient ischaemic attack (TIA), but studies of stroke risk after TIA are logistically difficult and have yielded conflicting results. However, reliable estimation of this risk is necessary for planning effective service provision, clinical trials, and public education. We therefore did a systematic review of all studies of stroke risk early after TIA. ⋯ The reported early risks of stroke after TIA were highly heterogeneous, but this could be largely accounted for by differences in study method, setting, and treatment, with lowest risks in studies of emergency treatment in specialist stroke services.
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Multicenter Study
Multicentre search for genetic susceptibility loci in sporadic epilepsy syndrome and seizure types: a case-control study.
The Epilepsy Genetics (EPIGEN) Consortium was established to undertake genetic mapping analyses with augmented statistical power to detect variants that influence the development and treatment of common forms of epilepsy. ⋯ The underlying genetic component to sporadic epilepsy is clearly complex. Results suggest that many SNPs contribute to disease predisposition in an apparently population-specific manner. However, subtle differences in phenotyping across cohorts, combined with a poor understanding of how the underlying genetic component to epilepsy aligns with current phenotypic classifications, might also account for apparent population-specific genetic risk factors. Variations across five genes warrant further study in independent cohorts to clarify the tentative association.
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Atrial fibrillation (AF) is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Anticoagulant therapy reduces the risk of stroke, and the greatest benefit is seen in patients at highest absolute risk. Aspirin is a less effective alternative, and any benefit of aspirin might be due to its favourable effects on arterial thrombosis caused by vascular disease. ⋯ The underuse of anticoagulation might also be related to uncertain risk of thromboembolism in individual patients and a perceived overestimation of the benefit and underestimation of risk of bleeding with warfarin in clinical trials. In this Review, we summarise the data for and against warfarin and aspirin therapies and discuss the clinical assessments and risk stratifications that guide the use of antithrombotic therapy for stroke prevention in patients with AF. Possible barriers to the uptake of anticoagulation therapy are also discussed.
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Randomized Controlled Trial
Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial.
Patients with transient ischaemic attack (TIA) or minor stroke are at high immediate risk of stroke. The optimum early treatment options for these patients are not known. ⋯ Immediately after TIA or minor stroke, patients are at high risk of stroke, which might be reduced by using clopidogrel in addition to aspirin. The haemorrhagic risks of the combination of aspirin and clopidogrel do not seem to offset this potential benefit. We were unable to provide evidence of benefit of simvastatin in this setting. This aggressive prevention approach merits further study.