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Tia Abcd2 Tool 1

The ABCD2 score is a risk assessment tool used to predict short-term stroke risk after a transient ischemic attack (TIA). It calculates a score based on five factors to determine the risk of stroke within 2 days and 90 days, with higher scores associated with greater risk. Clinical guidelines recommend prompt initial evaluation within 12 hours of a TIA and completion within 48 hours, along with brain imaging, vascular imaging, laboratory tests, and electrocardiography within 48 hours. Treatment may include antithrombotic therapy, management of risk factors like hypertension and diabetes, lifestyle changes like smoking cessation, and carotid endarterectomy for high-grade carotid stenosis.

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394 views2 pages

Tia Abcd2 Tool 1

The ABCD2 score is a risk assessment tool used to predict short-term stroke risk after a transient ischemic attack (TIA). It calculates a score based on five factors to determine the risk of stroke within 2 days and 90 days, with higher scores associated with greater risk. Clinical guidelines recommend prompt initial evaluation within 12 hours of a TIA and completion within 48 hours, along with brain imaging, vascular imaging, laboratory tests, and electrocardiography within 48 hours. Treatment may include antithrombotic therapy, management of risk factors like hypertension and diabetes, lifestyle changes like smoking cessation, and carotid endarterectomy for high-grade carotid stenosis.

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Siti Rahmah
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Transient Ischemic Attack (TIA):

Prognosis and Key Management Considerations

The ABCD2 score is a risk assessment tool designed to improve the prediction of short-term stroke risk
after a transient ischemic attack (TIA). The score is optimized 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.

Using the ABCD2 Score


Higher ABCD2 scores are associated with greater
risk of stroke during the 2, 7, 30, and 90 days after
a TIA (Figure). The authors of the ABCD2 score
made the following recommendations for hospital
observation:1

25%
2DayRisk
20%

7DayRisk

ABCD
Score
0-3

1.0%

Hospital observation may be


unnecessary without another
indication (e.g., new atrial fibrillation)

4-5

4.1%

Hospital observation justified in most


situations

6-7

8.1%

Hospital observation worthwhile

Comment

StrokeRisk

30DayRisk

2-day
Stroke
Risk

90DayRisk

15%

10%

5%

0%

[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.

ABCD2Score

Clinical consensus guidelines recommend urgent evaluation and treatment of patients with TIA. The following
recommendations were redacted from the National Stroke Association Guidelines.2

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: Full blood count, serum electrolytes and creatinine; fasting blood glucose and lipids
Electrocardiography: Recommended within 48 hours
Brain imaging study: CT or MRI within 48 hours
Vascular imaging: Carotid imaging, CT or MR angiography, or transcranial Doppler within 48 hours

Antithrombotic Therapy
o 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
o 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 mm Hg or <130/80 mm Hg 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

Carotid endarterectomy: Preferably within 2 weeks of cerebral or retinal TIA in those with TIA
attributed to a high-grade internal carotid artery stenosis:
o 70-99% internal carotid artery stenosis: Recommended
o 50-69% stenosis: Recommended for certain patients and only at centers with perioperative
complication rate <6%
o <50% stenosis: Not recommended
Bypass surgery: Not recommended

Abbreviations: MR, magnetic resonance; TIA, transient ischemic attack


[2] Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA, et al. National Stroke Association guidelines for the
management of transient ischemic attacks. Ann Neurol 60: 301-313, 2006.

Sponsored by National Stroke Association with a grant from Boehringer-Ingelheim

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