OBJECTIVES: To estimate clinical outcomes, health care utilization and cost burden of patients who suffered a transient ischemic attack (TIA) during the 180 days after a diagnosis of non-valvular atrial fibrillation (NVAF) and compare it with patients who did not. METHODS: Based on 2005-2007 US insurance claim files, patients aged 65 years and older who have had two or more primary diagnoses of NVAF, occurring within 30 days of one another, were selected. The 180 days follow-up event rates, health care facility use and costs for patients with and without a TIA were compared. Risk adjustment was performed using the propensity score matching (PSM) method with the ProbChoice™ algorithm. RESULTS: A total of 18,575 patients were identified with NVAF, of which 163 (0.88%) suffered a TIA during the 180 days after the NVAF diagnosis. Patients were not significantly different in terms of gender, region, and baseline comorbid conditions. After PSM risk-adjustment for pre-specified covariates, outpatient emergency room (ER) visits (85.89% vs. 48.47% p<0.0001), cardiovascular-related length of stay (6.59 days vs. 5.57 days, p<0.0001) and ischemic stroke events (89.57 vs. 8 /100 person years, p<0.0001) were higher for patients who suffered a TIA compared to those who did not.  Although risk-adjusted outpatient office visit, international normalized ratio (INR) testing, Coumadin outpatient visit, drug and other costs did not differ significantly between the two groups, patients who suffered a TIA had significantly higher inpatient ($21,740 vs. $22,663, p<0.0001) and total ($31,675 vs. $18,045, p<0.0001) expenditures. CONCLUSIONS: After adjusting for patient clinical and demographic characteristics, total health care utilization and cost burden were higher for patients who suffered a TIA after an NVAF diagnosis, relative to patients who did not.