Evidence map›Paper›PMID 22315271›Full record

GuidelineChest2012

Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

John J You, Daniel E Singer, Patricia A Howard, Deirdre A Lane, Mark H Eckman, Margaret C Fang, Elaine M Hylek, Sam Schulman, Alan S Go, Michael Hughes and 4 more

3 registry-linked trialsOpen access · bronzeAbstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Chest, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 284 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
284citing papers in PubMed, 11 pooled it
98.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02376777 completednot on this mapstarted 2014, after this paper: background citation

Comparison of Accidents and Their Circumstances With Oral Anticoagulants. The CACAO Study

TypeobservationalSponsorCNGE IRMG AssociationRan2014 to 2017Enrolled4,162ConditionsCardiovascular Complications, Hemorrhagic Disorders, Embolism and ThrombosisArmsFollow up
NCT03021928 phase3unknown statusnot on this mapstarted 2017, after this paper: background citation

Optimal Delay Time to Initiate Anticoagulation After Ischemic Stroke in Atrial Fibrillation

TypeinterventionalSponsorUniversity of Texas at AustinRan2017 to 2023Enrolled200ConditionsStrokeArmsTime-To-Treatment Randomization
NCT06168838 unknown statusnot on this mapstarted 2023, after this paper: background citation

Anticoagulant-associated Intracranial Hemorrhage: Patient Characteristics and Outcomes From National Institute of Neurology and Neurosurgery Manuel Velasco: Single-Center Observational Study

TypeobservationalSponsorEl Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco SuarezRan2023 to 2024Enrolled1,200ConditionsAnticoagulant-induced Bleeding, Intracranial HemorrhagesArmsAnticoagulant
3 · Its place in the literature

Who cites it

284 citing papers in PubMed, 11 syntheses or guidelines pooled it, 918 citations in OpenAlex.

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  9. Guideline
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  20. A new score with superior stroke risk prediction in atrial fibrillation: entropy-based information gain approaches in a large nationwide cohort.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025
    Review

224 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 11 institutions in 3 countries.

John J YouDepartment of Medicine, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Daniel E SingerDepartment of Medicine, General Medicine Division, Massachusetts General Hospital, Boston, MA; Harvard Medical School, and Clinical Epidemiology Unit, General Medicine Division, Massachusetts General Hospital, Boston, MA.
Patricia A HowardSchool of Pharmacy, University of Kansas Medical Center, Kansas City, KS.
Deirdre A LaneUniversity of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England.
Mark H EckmanDepartment of Clinical Medicine, Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH.
Margaret C FangDepartment of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA.
Elaine M HylekBoston University Medical Center Research Unit, Section of General Internal Medicine, Boston, MA.
Sam SchulmanDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Alan S GoComprehensive Clinical Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Michael HughesDecision Resources Inc, London, England.
Frederick A SpencerDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Warren J ManningSection of Non-invasive Cardiac Imaging, Beth Israel Deaconess Medical Center, Boston, MA.
Jonathan L HalperinThe Cardiovascular Institute, Mount Sinai Medical Center, New York, NY.
Gregory Y H LipUniversity of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England. Electronic address: g.y.h.lip@bham.ac.uk.
McMaster University · CAUniversity of Birmingham · GBBeth Israel Deaconess Medical Center · USBoston University · USDecision Research · USHarvard University · USKaiser Permanente · USMount Sinai Medical Center · USSan Francisco General Hospital · USUniversity of Cincinnati · USUniversity of Kansas Medical Center · US

Funding

Cincinnati Center for Clinical and Translational Sciences and TrainingUL1TR000077 · NCATS · UNIVERSITY OF CINCINNATI · PI HEUBI, JAMES E., TSEVAT, JOEL · 2012 to 2014
$9.9M
Antithrombotic Therapy and Prevention of Thrombosis: ACCP Evidence-Based ClinicalR13HL104758 · NHLBI · AMERICAN COLLEGE OF CHEST PHYSICIANS · PI LEWIS, SANDRA ZELMAN · 2010 to 2010
$11k
NCATS NIH HHS UL1 TR000077NHLBI NIH HHS R13 HL104758
6 · The paper itself

Abstract

backgroundThe risk of stroke varies considerably across different groups of patients with atrial fibrillation (AF). Antithrombotic prophylaxis for stroke is associated with an increased risk of bleeding. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios.

methodsWe used the methods described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement.

resultsFor patients with nonrheumatic AF, including those with paroxysmal AF, who are (1) at low risk of stroke (eg, CHADS(2) [congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischemic attack] score of 0), we suggest no therapy rather than antithrombotic therapy, and for patients choosing antithrombotic therapy, we suggest aspirin rather than oral anticoagulation or combination therapy with aspirin and clopidogrel; (2) at intermediate risk of stroke (eg, CHADS(2) score of 1), we recommend oral anticoagulation rather than no therapy, and we suggest oral anticoagulation rather than aspirin or combination therapy with aspirin and clopidogrel; and (3) at high risk of stroke (eg, CHADS(2) score of ≥ 2), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest dabigatran 150 mg bid rather than adjusted-dose vitamin K antagonist therapy.

conclusionsOral anticoagulation is the optimal choice of antithrombotic therapy for patients with AF at high risk of stroke (CHADS(2) score of ≥ 2). At lower levels of stroke risk, antithrombotic treatment decisions will require a more individualized approach.

Indexed as

Evidence-Based MedicineSocieties, MedicalAdministration, OralAnticoagulantsAspirinAtrial FibrillationAtrial FlutterBenzimidazolesbeta-AlanineClopidogrelDabigatranDose-Response Relationship, DrugDrug Therapy, CombinationElectric CountershockFibrinolytic AgentsHemorrhageAnticoagulantsAspirinBenzimidazolesbeta-AlanineClopidogrelDabigatranFibrinolytic AgentsTiclopidineVitamin K

Identifiers

PMID22315271
PMCPMC3278056
OpenAlexW2126206943

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.