Evidence map›Paper›PMID 24523876›Full record

SynthesisPloS one2014

Systematic review of observational studies assessing bleeding risk in patients with atrial fibrillation not using anticoagulants.

Luciane Cruz Lopes, Frederick A Spencer, Ignacio Neumann, Matthew Ventresca, Shanil Ebrahim, Qi Zhou, Neera Bhatnagar, Sam Schulman, John Eikelboom, Gordon Guyatt

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
0.8field-weighted citation impact, top 24% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 19 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
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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

10 authors at 2 institutions in 4 countries.

Luciane Cruz LopesPharmaceutical Sciences Postgraduate Course, University of Sorocaba, Sao Paulo, Brazil.
Frederick A SpencerDepartment of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
Ignacio NeumannInternal Medicine Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Matthew VentrescaDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Shanil EbrahimDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada ; Stanford Prevention Research Center, Stanford University, Stanford, California, United States of America.
Qi ZhouDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Neera BhatnagarHealth Sciences Library McMaster University, Hamilton, Ontario, Canada.
Sam SchulmanDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
John EikelboomDepartment of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, Ontario, Canada.
Gordon GuyattDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
McMaster University · CAUniversidade de Sorocaba · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with atrial fibrillation considering use of anticoagulants must balance stroke reduction against bleeding risk. Knowledge of bleeding risk without the use of anticoagulants may help inform this decision. PURPOSE: To determine the rate of major bleeding reported in observational studies of atrial fibrillation patients not receiving Vitamin K antagonists (VKA). DATA SOURCES: We searched MEDLINE, EMBASE and CINAHL to October 2011 and examined reference lists of eligible studies and related reviews. STUDY SELECTION: All longitudinal cohort studies that included over 100 adult patients with atrial fibrillation not receiving VKA. DATA EXTRACTION: Teams of two reviewers independently and in duplicate adjudicated eligibility, assessed risk of bias and abstracted study characteristics and outcomes. DATA SYNTHESIS: Twenty-one eligible studies included 96,448 patients. Major bleeding rates varied widely, from 0 to 4.69 events per 100 patient-years. The pooled estimate in 13 studies with 78839 patients was 1.59 with a 99% confidence interval of 1.10 to 2.3 and median 1.42 (interquartile range 0.62-2.70). Pooled estimates for fatal bleeding and non-fatal bleeding from 4 studies that reported these outcomes were, respectively, 0.40 (0.34 to 0.46) and 1.18 (0.30 to 4.56) per 100 patient-years. In 9 randomized controlled trials (RCTs) the median rate of major bleeding in patients not receiving either anticoagulant or antiplatelet therapy was 0.6 (interquartile 0.2 to 0.90), and in 12 RCTs the median rate of major bleeding in patients receiving a single antiplatelet agent was 0.75 (interquartile 0.4 to 1.4).

conclusionResults suggest that patients with atrial fibrillation not receiving VKA enrolled in observational studies represent a population on average at higher risk of bleeding.

Indexed as

AgedAged, 80 and overAnticoagulantsAtrial FibrillationFemaleHemorrhageHumansLongitudinal StudiesMaleMiddle AgedObservational Studies as TopicRandomized Controlled Trials as TopicRiskVitamin KAnticoagulantsVitamin K

Identifiers

PMID24523876
PMCPMC3921139
OpenAlexW2083482655

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.