Observational studyAnnals of neurology2019
Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation.
Observational study in Annals of neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03826927 (New Oral Anticoagulants in Stroke Patients-Long Term Prevention of Recurrent Stroke in Patients With Atrial Fibrillation- a National Prospective Registry), which is not on this map. Cited by 55 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.
New Oral Anticoagulants in Stroke Patients-Long Term Prevention of Recurrent Stroke in Patients With Atrial Fibrillation- a National Prospective Registry (NOACISP Long Term)
Who cites it
55 citing papers in PubMed, 2 syntheses or guidelines pooled it, 100 citations in OpenAlex.
- Early versus late oral anticoagulants after acute ischemic stroke in atrial fibrillation patients: a meta-analysis of randomized controlled trials.Proceedings (Baylor University. Medical Center) · 2026Pooled it
- Non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with previous stroke or intracranial hemorrhage: A systematic review and meta-analysis of observational studies.Clinical cardiology · 2021Pooled it
- Trial
- The optimum anticoagulation time after endovascular thrombectomy for atrial fibrillation-related large vessel occlusion stroke: a real-world study.Journal of neurology · 2023Trial
- Trial
- Early treatment of Atrial fibrillation for Stroke prevention Trial in acute STROKE (EAST-STROKE): protocol for an international investigator-initiated, prospective, randomised, open, blinded endpoint assessment (PROBE) interventional multi-centre trial.European stroke journal · 2026Article
- Early Anticoagulation in Acute Ischemic Stroke With Atrial Fibrillation.Journal of stroke · 2026Review
- Malignancy-Associated Pulmonary Embolism: Mortality, Recurrence, and Bleeding Risks.Journal of clinical medicine · 2025Article
- Anticoagulation therapy after reperfusion treatment for acute ischemic stroke with non-valvular atrial fibrillation: a multicenter retrospective study.Scientific reports · 2025Article
- Antiplatelet Agents and Oral Anticoagulant Use in Patients with Atrial Fibrillation and Carotid Artery Disease After First-Time Ischaemic Stroke.Cardiovascular drugs and therapy · 2024Article
- AF-React study: Prevalence of thrombotic events in patients with atrial fibrillation receiving NOACs - real-world data analysis from northern Portugal primary healthcare.Frontiers in medicine · 2024Article
- Impact of renal function variability on long-term prognosis in ischemic stroke patients with atrial fibrillation.Frontiers in neurology · 2024Article
- Update of Anticoagulation Use in Cardioembolic Stroke With a Special Reference to Endovascular Treatment.Journal of stroke · 2024Review
- Andexanet alfa for oral fxa inhibitor-associated major acute intracerebral hemorrhage: insights into clinically relevant thromboembolic events from the ANNEXA-I study.Jornal vascular brasileiro · 2024Article
- Early or late initiation of dabigatran versus vitamin-K-antagonists in acute ischemic stroke or TIA: The PRODAST study.International journal of stroke : official journal of the International Stroke Society · 2023Observational
- Atrial Fibrillation Detected before or after Stroke: Role of Anticoagulation.Annals of neurology · 2023Article
- Role of cerebral microbleeds in acute ischemic stroke and atrial fibrillation.Journal of thrombosis and thrombolysis · 2023Review
- Evaluation of the timing of using direct oral anticoagulants after ischemic stroke for patients with atrial fibrillation.Heliyon · 2023Article
- Once versus twice daily direct oral anticoagulants in patients with recent stroke and atrial fibrillation.European stroke journal · 2022Article
- Early Anticoagulation in Patients with Acute Ischemic Stroke Due to Atrial Fibrillation: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
40 authors at 11 institutions in 8 countries.
Funding
Abstract
objectiveWe compared outcomes after treatment with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and a recent cerebral ischemia.
methodsWe conducted an individual patient data analysis of seven prospective cohort studies. We included patients with AF and a recent cerebral ischemia (<3 months before starting oral anticoagulation) and a minimum follow-up of 3 months. We analyzed the association between type of anticoagulation (DOAC versus VKA) with the composite primary endpoint (recurrent ischemic stroke [AIS], intracerebral hemorrhage [ICH], or mortality) using mixed-effects Cox proportional hazards regression models; we calculated adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs).
resultsWe included 4,912 patients (median age, 78 years [interquartile range {IQR}, 71-84]; 2,331 [47.5%] women; median National Institute of Health Stroke Severity Scale at onset, 5 [IQR, 2-12]); 2,256 (45.9%) patients received VKAs and 2,656 (54.1%) DOACs. Median time from index event to starting oral anticoagulation was 5 days (IQR, 2-14) for VKAs and 5 days (IQR, 2-11) for DOACs (p = 0.53). There were 262 acute ischemic strokes (AISs; 4.4%/year), 71 intracranial hemorrrhages (ICHs; 1.2%/year), and 439 deaths (7.4%/year) during the total follow-up of 5,970 patient-years. Compared to VKAs, DOAC treatment was associated with reduced risks of the composite endpoint (HR, 0.82; 95% CI, 0.67-1.00; p = 0.05) and ICH (HR, 0.42; 95% CI, 0.24-0.71; p < 0.01); we found no differences for the risk of recurrent AIS (HR, 0.91; 95% CI, 0.70-1.19; p = 0.5) and mortality (HR, 0.83; 95% CI, 0.68-1.03; p = 0.09).
interpretationDOAC treatment commenced early after recent cerebral ischemia related to AF was associated with reduced risk of poor clinical outcomes compared to VKA, mainly attributed to lower risks of ICH. ANN NEUROL 2019;85:823-834.
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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.