Stroke risk after TIA
| Risk group | Score | 2 days | 7 days | 90 days |
|---|---|---|---|---|
| Low | 0–3 | 1.0% | 1.2% | 3.1% |
| Moderate | 4–5 | 4.1% | 5.9% | 9.8% |
| High | 6–7 | 8.1% | 11.7% | 17.8% |
Pooled cohorts, n = 4,809 (Johnston 2007). The 2-day risk is what the score was built to predict.
Score & evidence
Score
A Age 60 years or older 1
B Blood pressure 140/90 mmHg or higher 1
C Clinical: unilateral weakness 2
speech disturbance, no weakness 1
D Duration: 60 minutes or longer 2
10 to 59 minutes 1
D Diabetes 1
Total 0 to 7
Read with care
- The score applies to patients already diagnosed with TIA. It does not diagnose TIA.
- A low score does not exclude high risk. In a 2015 meta-analysis, ABCD² of 4 or more was 86.7% sensitive but only 35.4% specific for stroke within 7 days, and 20% of patients scoring under 4 had carotid stenosis over 50% or atrial fibrillation (Wardlaw 2015).
- Trial context: CHANCE (2013) and POINT (2018), the trials of short-course clopidogrel plus aspirin, defined high-risk TIA as ABCD² of 4 or more. That describes who was enrolled; it is not a treatment recommendation.
References
Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores
to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369(9558):283–92.
doi:10.1016/S0140-6736(07)60150-0
Wardlaw JM, Brazzelli M, Chappell FM, et al. ABCD2 score and secondary stroke prevention:
meta-analysis and effect per 1,000 patients triaged. Neurology 2015;85(4):373–80.
doi:10.1212/WNL.0000000000001780
Wang Y, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack
(CHANCE). N Engl J Med 2013;369(1):11–9.
doi:10.1056/NEJMoa1215340
Johnston SC, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA
(POINT). N Engl J Med 2018;379(3):215–25.
doi:10.1056/NEJMoa1800410