National stroke association guidelines for the management of transient ischemic attacks

S. Claiborne Johnston, Mai N. Nguyen-Huynh, Miriam E. Schwarz, Kate Fuller, Christina E. Williams, S. Andrew Josephson, Graeme J. Hankey, Robert G. Hart, Steven R. Levine, Jose Biller, Robert D. Brown, Ralph L. Sacco, L. Jaap Rappelle, Peter J. Koudstaal, Julien Bogousslavsky, Louis R. Caplan, Jan Van Gijn, Ale Algra, Peter M. Rothwell, Harold P. AdamsGregory W. Albers

Research output: Contribution to journalReview article

154 Scopus citations

Abstract

Objective: Transient ischemic attacks are common and important harbingers of subsequent stroke. Management varies widely, and most published guidelines have not been updated in several years. We sought to create comprehensive, unbiased, evidence-based guidelines for the management of patients with transient ischemic attacks. Methods: Fifteen expert panelists were selected based on objective criteria, using publication metrics that predicted nomination by practitioners in the field. Prior published guidelines were identified through systematic review, and recommendations derived from them were rated independently for quality by the experts. Highest quality recommendations were selected and subsequently edited by the panelists using a modified Delphi approach with multiple iterations of questionnaires to reach consensus on new changes. Experts were provided systematic reviews of recent clinical studies and were asked to justify wording changes based on new evidence and to rate the final recommendations based on level of evidence and quality. No expert was allowed to contribute to recommendations on a topic for which there could be any perception of a conflict of interest. Results: Of 257 guidelines documents identified by systematic review, 13 documents containing 137 recommendations met all entry criteria. Six iterations of questionnaires were required to reach consensus on wording of 53 final recommendations. Final recommendations covered initial management, evaluation, medical treatment, surgical treatment, and risk factor management. Interpretation: The final recommendations on the care of patients with transient ischemic attacks emphasize the importance of urgent evaluation and treatment. The novel approach used to develop these guidelines is feasible, allows for rapid updating, and may reduce bias.

Original languageEnglish (US)
Pages (from-to)301-313
Number of pages13
JournalAnnals of neurology
Volume60
Issue number3
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Johnston, S. C., Nguyen-Huynh, M. N., Schwarz, M. E., Fuller, K., Williams, C. E., Josephson, S. A., Hankey, G. J., Hart, R. G., Levine, S. R., Biller, J., Brown, R. D., Sacco, R. L., Rappelle, L. J., Koudstaal, P. J., Bogousslavsky, J., Caplan, L. R., Van Gijn, J., Algra, A., Rothwell, P. M., ... Albers, G. W. (2006). National stroke association guidelines for the management of transient ischemic attacks. Annals of neurology, 60(3), 301-313. https://doi.org/10.1002/ana.20942