SynthesisEuropean heart journal2015
Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: an individual participant data meta-analysis.
Synthesis in European heart journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 5 of them syntheses that pooled 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.
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.
Who cites it
27 citing papers in PubMed, 5 syntheses or guidelines pooled it, 112 citations in OpenAlex.
- Aspirin or anticoagulation after cryptogenic stroke with patent foramen ovale: systematic review and meta-analysis of randomized controlled trials.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2020Pooled it
- Patent foramen ovale closure versus medical therapy after cryptogenic stroke: An updated meta-analysis of all randomized clinical trials.Cardiology journal · 2019Pooled it
- Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis.Internal and emergency medicine · 2018Pooled it
- Percutaneous closure versus medical therapy for stroke with patent foramen Ovale: a systematic review and meta-analysis.BMC cardiovascular disorders · 2018Pooled it
- Device Closure of Patent Foramen Ovale After Stroke: Pooled Analysis of Completed Randomized Trials.Journal of the American College of Cardiology · 2016Pooled it
- Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial.The Lancet. Neurology · 2018Trial
- Comparison of the Antithrombotic Strategy Implemented to Prevent Early Recurrence before Closure of Patent Foramen Ovale.Cerebrovascular diseases (Basel, Switzerland) · 2026Article
- Understanding the Failure of Medical Therapy in PFO-Associated Stroke and the Benefits of Closure: A Narrative Review.Neurology international · 2026Review
- Migraine and patent foramen ovale: correlation, coexistence, dependence. A narrative review.Headache · 2026Review
- Uncovering the Risks and Benefits of Patent Foramen Ovale (PFO) Closure in Cryptogenic Stroke: A Case Study.Cureus · 2024Article
- Pulmonary embolism and renal artery thrombosis in a patient with patent foramen ovale.Acta bio-medica : Atenei Parmensis · 2022Article
- Short-term results of percutaneous closure of a patent foramen ovale guided by transoesophageal echocardiography in patients with cryptogenic stroke: a retrospective study.Journal of cardiothoracic surgery · 2022Article
- The Hype Surrounding Patent Foramen Ovale Closure and Cryptogenic Stroke: A Walk Through History.Heart international · 2022Review
- Stroke Prevention in Patients with Patent Foramen Ovale.Current cardiology reports · 2021Review
- Prognostic significance of patent foramen ovale in anticoagulated patients with atrial fibrillation.Open heart · 2020Article
- Antithrombotic Management of Ischemic Stroke.Current treatment options in cardiovascular medicine · 2019Review
- Statement on Antiplatelet Agents and Anticoagulants in Cardiology - 2019.Arquivos brasileiros de cardiologia · 2019Article
- Patent foramen ovale and long-term risk of ischaemic stroke after surgery.European heart journal · 2019Observational
- Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale.Cardiovascular diagnosis and therapy · 2018Review
- Patent foramen ovale and stroke.Journal of neurology · 2018Review
Corrections and comments
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Authors and funding
14 authors at 11 institutions in 7 countries.
Funding
Abstract
aimsThe preferred antithrombotic strategy for secondary prevention in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO) is unknown. We pooled multiple observational studies and used propensity score-based methods to estimate the comparative effectiveness of oral anticoagulation (OAC) compared with antiplatelet therapy (APT). METHODS AND
resultsIndividual participant data from 12 databases of medically treated patients with CS and PFO were analysed with Cox regression models, to estimate database-specific hazard ratios (HRs) comparing OAC with APT, for both the primary composite outcome [recurrent stroke, transient ischaemic attack (TIA), or death] and stroke alone. Propensity scores were applied via inverse probability of treatment weighting to control for confounding. We synthesized database-specific HRs using random-effects meta-analysis models. This analysis included 2385 (OAC = 804 and APT = 1581) patients with 227 composite endpoints (stroke/TIA/death). The difference between OAC and APT was not statistically significant for the primary composite outcome [adjusted HR = 0.76, 95% confidence interval (CI) 0.52-1.12] or for the secondary outcome of stroke alone (adjusted HR = 0.75, 95% CI 0.44-1.27). Results were consistent in analyses applying alternative weighting schemes, with the exception that OAC had a statistically significant beneficial effect on the composite outcome in analyses standardized to the patient population who actually received APT (adjusted HR = 0.64, 95% CI 0.42-0.99). Subgroup analyses did not detect statistically significant heterogeneity of treatment effects across clinically important patient groups.
conclusionWe did not find a statistically significant difference comparing OAC with APT; our results justify randomized trials comparing different antithrombotic approaches in these patients.
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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.