Evidence map›Paper›PMID 31984228›Full record

ArticleEuropean stroke journal2019

Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: A European Stroke Organisation guideline.

Catharina Jm Klijn, Maurizio Paciaroni, Eivind Berge, Eleni Korompoki, Janika Kõrv, Avtar Lal, Jukka Putaala, David J Werring

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European stroke journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06542770 (Subtle Ultrasound Atrial Anomalies Predicts the Early Diagnosis of Silent Atrial Fibrillation Detected by Implantable Cardiac Monitor in Patients With Cryptogenic Stroke. A Randomized Trial), which is not on this map. Cited by 100 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
100citing papers in PubMed, 17 pooled it
14.7field-weighted citation impact, top 1% 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.

NCT06542770 narecruitingnot on this mapstarted 2021, after this paper: background citation

Subtle Ultrasound Atrial Anomalies Predicts the Early Diagnosis of Silent Atrial Fibrillation Detected by Implantable Cardiac Monitor in Patients With Cryptogenic Stroke. A Randomized Trial

TypeinterventionalSponsorParc de Salut MarRan2021 to 2024Enrolled100ConditionsParoxysmal Atrial Fibrillation, Cardiac Rhythm Disorder, Left Atrial Dilatation, Cryptogenic StrokeArmsEarly implant of cardiac monitor
3 · Its place in the literature

Who cites it

100 citing papers in PubMed, 17 syntheses or guidelines pooled it, 196 citations in OpenAlex.

  1. Pooled it
  2. Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial fibrillation and large artery atherosclerosis: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Pooled it
  3. Timing of anticoagulation therapy in patients with acute ischemic stroke and atrial fibrillation: a GRADE-based expert opinion recommendation.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Pooled it
  4. Guideline
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  6. Guideline
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  10. A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization.International journal of stroke : official journal of the International Stroke Society · 2023
    Pooled it
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  12. Antithrombotic treatment after stroke due to intracerebral haemorrhage.The Cochrane database of systematic reviews · 2023
    Pooled it
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  14. Guideline
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  18. Trial
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40 more citing papers are in PubMed but not listed here.

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

8 authors at 8 institutions in 8 countries.

Catharina Jm KlijnDepartment of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
Maurizio PaciaroniStroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Eivind BergeDepartment of Cardiology, Oslo University Hospital, Oslo, Norway.
Eleni KorompokiFirst Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece.
Janika KõrvEuropean Stroke Organisation, Basel, Switzerland.
Avtar LalDepartment of Internal Medicine, Oslo University Hospital, Oslo, Norway.
Jukka PutaalaEuropean Stroke Organisation, Basel, Switzerland.
David J WerringStroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.
Azienda Ospedaliera di Perugia · ITEuropean CanCer Organisation · BEEuropean Stroke Organisation · CHImperial College London · GBNational Hospital for Neurology and Neurosurgery · GBOslo University Hospital · NORadboud University Medical Center · NLTartu University Hospital · EE

Funding

British Heart Foundation CS/17/6/33361
6 · The paper itself

Abstract

Patients with ischemic stroke or transient ischemic attack and non-valvular atrial fibrillation have a high risk of recurrent stroke and other vascular events. The aim of this guideline is to provide recommendations on antithrombotic medication for secondary prevention of stroke and other vascular outcomes in these patients. The working group identified questions and outcomes, graded evidence, and developed recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach and the European Stroke Organisation (ESO) standard operating procedure for guidelines. The guideline was reviewed and approved by the ESO guideline board and the ESO executive committee. In patients with atrial fibrillation and previous stroke or transient ischemic attack, oral anticoagulants reduce the risk of recurrence over antiplatelets or no antithrombotic treatment. Non-vitamin K antagonist oral anticoagulants are preferred over vitamin K antagonists because they have a lower risk of major bleeding and death. Recommendations are weak regarding timing of treatment, (re-)starting oral anticoagulants in patients with previous intracerebral haemorrhage, and treatment in specific patient subgroups of those of older age, with cognitive impairment, renal failure or small vessel disease, because of a lack of strong evidence. In conclusion, for patients with atrial fibrillation and ischemic stroke or transient ischemic attack, non-vitamin K antagonist oral anticoagulants are the preferred treatment for secondary prevention of recurrent stroke or thromboembolism. Further research is required to determine the best timing for initiating oral anticoagulants after an acute ischemic stroke, whether or not oral anticoagulants should be (re)started in patients with a history of intracerebral haemorrhage, and the best secondary preventive treatment in specific subgroups.

Indexed as

atrial fibrillationGuidelinessecondary preventionstroke

Identifiers

PMID31984228
PMCPMC6960695
OpenAlexW2938287289

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.