Comparison of Anticoagulation and Surgical Treatments of TIA. A Review and Consolidation of Recent Natural History and Treatment Studies

Combined results of selected studies of the natural history and therapeutic results in patients with TIA indicate that anticoagulation therapy is clearly worthwhile in the prevention of completed strokes during the first 40 months after onset. Surgery is somewhat less valuable, but preferable to nihilism, which is associated with new completed strokes in 19% of patients and death in 20% of patients followed for an average of 40 months from onset of TIAs. The incidence of death from all causes is remarkably similar in both treated and untreated patients during this follow-up period, suggesting that fears of increased mortality in patients treated with anticoagulants are either unfounded or compensated by decreased mortality from occlusive strokes.