Stroke and TIA (STIA) - QOF indicator

Stroke and TIA in QOF 2026/27

The stroke and transient ischaemic attack (TIA) area of QOF focuses on ongoing treatment to prevent further vascular events. For 2026/27, STIA007 carries 4 points and measures whether eligible patients have a record of antiplatelet or anticoagulant use in the preceding 12 months, with achievement thresholds of 57–97%.

Ongoing management

Why stroke and TIA are included

• In the developed world, stroke ranks third among causes of death, and one quarter of deaths from stroke occur in people under the age of 65. Evidence from NICE supports better outcomes through appropriate diagnosis and management.

STIA007: basis and rationale

STIA007 is based on NICE IND133.

• After a stroke, long-term antiplatelet treatment lowers the risk of serious vascular events by about a quarter. For people who have had an ischaemic cerebrovascular event, antiplatelet prescribing is advised to help prevent another stroke and other vascular events.

• The British National Formulary (BNF) advises continuing treatment long term after a TIA or ischaemic stroke to reduce subsequent cardiovascular events. Its treatment recommendations are outlined below.

Treatment recommendations from the BNF

For a TIA or ischaemic stroke without associated atrial fibrillation (AF), clopidogrel is the recommended long-term option, although its use in TIA is unlicensed. Where contraindications or intolerance rule out clopidogrel, modified-release dipyridamole can be used with aspirin.

If neither aspirin nor clopidogrel can be used because of contraindications or intolerance, the recommended option is modified-release dipyridamole alone. If these problems instead exclude both modified-release dipyridamole and clopidogrel, aspirin alone is recommended.

Following a stroke associated with AF, patients should be assessed for long-term warfarin sodium or another anticoagulant. The BNF directs readers to its initial management advice under ischaemic stroke.

Further information

• NICE TA210 (2010) provides guidance on using clopidogrel and modified-release dipyridamole to prevent occlusive vascular events.

STIA007: reporting and verification

The criteria for meeting this indicator are set out in its definition in the table above.