Background: Current Transient Ischaemic Attack (TIA) management in the Emergency Department (ED) is largely informed by studies conducted prior to the era of Direct Oral Anticoagulants (DOACs). The outcome of patients suspected of TIA presenting to ED while on a DOAC is poorly understood.
Aims: To examine the working diagnosis at first TIA clinic attendance in patients on a DOAC presenting with suspected TIA to the ED.
Methods: Retrospective study of all patients who presented to the emergency departments at our health service with the principal diagnosis coded as a transient ischaemic attack between December 2020 and November 2021.
Results: Of 599 presentations, 352 were followed up in the public TIA clinic and included in analysis, (median age 73y [IQR 63-80], 50% male). Median time from ED to clinic review was 26 days (IQR 15-45), with 167 (47%) having MRI post discharge from ED (median days to imaging 30 [IQR 9-56]). Of 352 patients, 35 were on a DOAC at the time of presentation. For these patients, 12, 6, 5 and 12 patients had a working diagnosis of TIA, stroke, migraine and “others” at clinic review respectively. This compares to 104, 32, 74 and 104 in the same diagnostic categories respectively in those not on a DOAC (n= 314) (χ2 = 2.62; df = 3; p = 0.45). There were 3/352 patients on warfarin and excluded from comparison.
Conclusion: Initial clinic diagnosis was TIA/Stroke in 51% of DOAC patients coded with TIA as a primary diagnosis in ED, compared to 43% in those not on a DOAC. Further effort is needed to investigate the heightened stroke risk and decrease the stroke burden in DOAC patients.