[A transient ischaemic attack (TIA) is an emergency].

Numerous clinical trials have shown the efficacy of stroke prevention in patients with transient ischaemic attacks (TIAs) using surgical (carotid endarterectomy) or medical treatment (antiplatelet agents, antihypertensive drugs and statins). In all of these studies, however, the interval between the ischaemic event and treatment was weeks or months. The recently published EXPRESS study from Oxford showed that stroke prevention is even more effective when patients are seen within 1 day of referral, rather than after a few days. The study showed that an immediate referral policy resulted in a 90-day stroke rate of 2.1% over the last 2.5 years, compared with a rate of 10.3% found in the preceding 2.5-year period, during which the median delay was 3 days. Baseline characteristics and delays in seeking medical attention were similar in both periods. A TIA service in Paris reported a similarly low stroke rate, although they did not include an internal control group. These results imply that patients with TIAs should be examined and treated within hours, rather than days.