ArticleJournal of the American College of Cardiology2016
Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke.
Article in Journal of the American College of Cardiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 2 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
52 citing papers in PubMed, 2 syntheses or guidelines pooled it, 132 citations in OpenAlex.
- Risk of Intracranial Hemorrhage Associated With Direct Oral Anticoagulation vs Antiplatelet Therapy: A Systematic Review and Meta-Analysis.JAMA network open · 2024Pooled it
- More efficacious, equally safe: a meta-analysis comparing the safety of direct oral anticoagulants versus aspirin.Journal of thrombosis and thrombolysis · 2018Pooled it
- Stroke Risk Reduction in Atrial Fibrillation Through Pharmacist Prescribing: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Efficacy of mobile health-technology integrated care based on the 'Atrial fibrillation Better Care' (ABC) pathway in relation to sex: a report from the mAFA-II randomized clinical trial.Internal and emergency medicine · 2023Trial
- Efficacy and safety of dronedarone across age and sex subgroups: a post hoc analysis of the ATHENA study among patients with non-permanent atrial fibrillation/flutter.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2022Trial
- Trial
- Electronic physician notifications to improve guideline-based anticoagulation in atrial fibrillation: a randomized controlled trial.Journal of general internal medicine · 2018Trial
- Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial.Implementation science : IS · 2016Trial
- Oral Anticoagulant Use Among Residents in VA Long-Term Care With Atrial Fibrillation After the 2014 ACC/AHA Guideline.Journal of the American Medical Directors Association · 2026Observational
- Improvement in age- and sex-dependent mortality in patients with atrial fibrillation between 2011 and 2016 - a nationwide retrospective study from Hungary.Archives of medical science : AMS · 2026Article
- 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.Circulation · 2025Review
- Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Direct Oral Anticoagulant Use in Older Adults with Atrial Fibrillation: Challenges and Solutions.European cardiology · 2025Review
- Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2024Article
- Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention.European journal of clinical pharmacology · 2023Article
- Sociodemographic determinants of oral anticoagulant prescription in patients with atrial fibrillations: findings from the PINNACLE registry using machine learning.Heart rhythm O2 · 2023Article
- Non‑persistence to Oral Anticoagulation Therapy in Elderly Patients with Non‑valvular Atrial Fibrillation.Patient preference and adherence · 2023Article
- Barriers to stroke prevention in Atrial Fibrillation: Insights from the global anticoagulation Roundtable.International journal of cardiology. Heart & vasculature · 2022Review
- Racial and sex differences in optimizing anticoagulation therapy for patients with atrial fibrillation.American heart journal plus : cardiology research and practice · 2022Article
- Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management?Vascular health and risk management · 2022Article
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Authors and funding
9 authors at 8 institutions in 1 country.
Funding
Abstract
backgroundOral anticoagulation (OAC), rather than aspirin, is recommended in patients with atrial fibrillation (AF) at moderate to high risk of stroke.
objectivesThis study sought to examine patient and practice-level factors associated with prescription of aspirin alone compared with OAC in AF patients at intermediate to high stroke risk in real-world cardiology practices.
methodsThe authors identified 2 cohorts of outpatients with AF and intermediate to high thromboembolic risk (CHADS2 score ≥2 and CHA2DS2-VASc ≥2) enrolled in the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient and practice characteristics, the authors examined the prevalence and predictors of aspirin alone versus OAC prescription in AF patients at risk for stroke.
resultsOf 210,380 identified patients with CHADS2 score ≥2 on antithrombotic therapy, 80,371 (38.2%) were treated with aspirin alone, and 130,009 (61.8%) were treated with warfarin or non-vitamin K antagonist OACs. In the cohort of 294,642 patients with CHA2DS2-VASc ≥2, 118,398 (40.2%) were treated with aspirin alone, and 176,244 (59.8%) were treated with warfarin or non-vitamin K antagonist OACs. After multivariable adjustment, hypertension, dyslipidemia, coronary artery disease, prior myocardial infarction, unstable and stable angina, recent coronary artery bypass graft, and peripheral arterial disease were associated with prescription of aspirin only, whereas male sex, higher body mass index, prior stroke/transient ischemic attack, prior systemic embolism, and congestive heart failure were associated with more frequent prescription of OAC.
conclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
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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.