Q&A: Educate physicians regarding TIA etiologies


March 29, 2012

Q: Can you please help me locate information regarding etiologies of transient ischemic attack (TIA)? I would like to use this information to help my CDI team encourage physicians to consider “precerebral stenosis” as a possible cause of TIA where there is any narrowing.

A:  The most important thing to keep in mind is that anti-platelet therapy is recommended for every patient with any degree of carotid stenosis because it can cause stroke or cerebral vascular accident (CVA).  

If a patient has had a TIA and any degree of stenosis is present the risk is higher. If stenosis is less than 50% only medical therapy (including anti-platelet drugs) is recommended, never surgery. If the physician notes greater than 70% stenosis (“critical stenosis”), medical therapy is inadequate and surgery is almost always necessary.

Many physicians become confused by the meaning of “non-critical” stenosis thinking it means “insignificant,” but they always treat the patient with anti-platelet drugs to prevent TIA or stroke. However, “non-critical” means simply that surgery is not yet indicated. 
Do try to approach the physicians/neurologists at your facility to help you develop appropriate queries and to identify the supporting information they most typically turn to identify TIA etiologies. They could end up being among your CDI team’s most valuable assets.  
Editor’s Note: This question was answered by Richard D. Pinson, MD, FACP, CCS, of HCQ Consulting in Houston and author of the 2012 CDI Pocket Guide. Contact him at 615-969-5228 or email rpinson@hcqconsulting.com.

Does your CDI program review records for patient safety indicators?
No, but we are considering expanding in this area
Yes, but we are only in the pilot program stages
Don't know
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