ArticleTherapeutic advances in neurological disorders2016
Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis.
Article in Therapeutic advances in neurological disorders, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
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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.
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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.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Interventions and Strategies to Improve Oral Anticoagulant Use in Patients with Atrial Fibrillation: A Systematic Review of Systematic Reviews.Clinical drug investigation · 2018Pooled it
- A Systematic Review of Network Meta-Analyses and Real-World Evidence Comparing Apixaban and Rivaroxaban in Nonvalvular Atrial Fibrillation.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Laboratory Assessment of the Anticoagulant Activity of Apixaban in Patients With Nonvalvular Atrial Fibrillation.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis · 2018Trial
- Review
- Sex Differences in the Participation in Secondary Prevention Stroke Studies.Journal of the American Heart Association · 2025Article
- Cerebrovascular disease in women.Therapeutic advances in neurological disorders · 2021Review
- Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation.Annals of neurology · 2020Article
- Risk of recurrent stroke for Asian stroke patients treated with non-vitamin K antagonist oral anticoagulant and warfarin.Therapeutic advances in chronic disease · 2020Article
- Efficacy and Safety of Non-Vitamin K Anticoagulants for Atrial Fibrillation in Relation to Different Renal Function Levels: A Network Meta-Analysis.Cardiovascular therapeutics · 2020Review
- Embolic strokes of undetermined source: theoretical construct or useful clinical tool?Therapeutic advances in neurological disorders · 2019Review
- Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke.Journal of stroke · 2018Article
- Under-representation of women in stroke randomized controlled trials: inadvertent selection bias leading to suboptimal conclusions.Therapeutic advances in neurological disorders · 2017Article
- Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis.Therapeutic advances in neurological disorders · 2016Article
Corrections and comments
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Authors and funding
18 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundNovel oral anticoagulants (NOACs) have shown to be both safe and effective for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). We conducted a network meta-analysis (NMA) using published data from secondary prevention subgroups of different phase III randomized clinical trials (RCTs) comparing individual NOACs with warfarin.
methodsEligible studies were identified by searching MEDLINE and SCOPUS and the Cochrane Central Register of Controlled Trials databases. First, we conducted a pairwise meta-analysis for each pairwise comparison, and then we performed NMA to combine direct and indirect evidence for any given pair of treatments. The comparative effects of all NOACs against warfarin were ranked with the surface under the cumulative ranking (SUCRA) curve for each outcome.
resultsWe identified four RCTs (including 15,240 patients) comparing individual NOACs (apixaban, dabigatran, rivaroxaban) with warfarin. Using indirect evidence, dabigatran was related to a significantly lower risk of hemorrhagic stroke compared with rivaroxaban [risk ratio (RR) 0.28; 95% confidence interval (CI) 0.11-0.75], while rivaroxaban was associated with a significantly lower risk of major gastrointestinal bleeding compared with dabigatran (RR 0.14; 95% CI 0.03-0.74). We also performed clustered ranking plot for the primary efficacy and safety endpoints to identify the treatment with the probably best benefit-to-risk ratio profile.
conclusionsThe three NOACs showed differences in terms of safety and efficacy for secondary stroke prevention in NVAF. Our findings can serve only as hypothesis generation and require independent confirmation in head-to-head RCTs, owing to the sparse available evidence and increased uncertainty in both indirect effect estimates and ranking of treatments.
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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.