Evidence map›Paper›PMID 32052481›Full record

ArticleAnnals of neurology2020

Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation.

David J Seiffge, Gian Marco De Marchis, Masatoshi Koga, Maurizio Paciaroni, Duncan Wilson, Manuel Cappellari, Kosmas Macha Md, Georgios Tsivgoulis, Gareth Ambler, Shoji Arihiro and 25 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of neurology, 2020. 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 114 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
114citing papers in PubMed, 8 pooled it
–field-weighted citation impact
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.

NCT03826927 completednot on this map

New Oral Anticoagulants in Stroke Patients-Long Term Prevention of Recurrent Stroke in Patients With Atrial Fibrillation- a National Prospective Registry (NOACISP Long Term)

TypeobservationalSponsorUniversity Hospital, Basel, SwitzerlandRan2013 to 2021Enrolled1,023ConditionsStroke, Atrial FibrillationArmstreatment with NOACs or VKAs
3 · Its place in the literature

Who cites it

114 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Clinical characteristics and outcomes of ischemic stroke despite appropriate oral anticoagulation for atrial fibrillation: A systematic review and meta-analysis of real-world studies.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
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54 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

35 authors.

David J SeiffgeStroke Research Center, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.ORCID https://orcid.org/0000-0003-3890-3849
Gian Marco De MarchisNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
Masatoshi KogaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Maurizio PaciaroniStroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Duncan WilsonStroke Research Center, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Manuel CappellariStroke Unit, Department of Neuroscience, University Hospital Integrated Trust of Verona, Verona, Italy.
Kosmas Macha MdDepartment of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany.
Georgios TsivgoulisSecond Department of Neurology, National and Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece.
Gareth AmblerDepartment of Statistical Science, University College London, London, United Kingdom.
Shoji ArihiroDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Leo H BonatiNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
Bruno BonettiStroke Unit, Department of Neuroscience, University Hospital Integrated Trust of Verona, Verona, Italy.
Bernd KallmünzerDepartment of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany.
Keith W MuirInstitute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Paolo BoviStroke Unit, Department of Neuroscience, University Hospital Integrated Trust of Verona, Verona, Italy.
Henrik GensickeNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
Manabu InoueDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Stefan SchwabDepartment of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany.
Shadi YaghiNYU Langone Health, New York, NY.
Martin M BrownStroke Research Center, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Philippe LyrerNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
Masahito TakagiDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Monica AcciarreseStroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Hans Rolf JagerNeuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, United Kingdom.
Alexandros A PolymerisNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
Kazunori ToyodaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Michele VentiStroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Christopher TraenkaNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
Hiroshi YamagamiDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Andrea AlbertiStroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Sohei YoshimuraDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Valeria CasoStroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Stefan T EngelterNeurology and Stroke Center, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.
David J WerringStroke Research Center, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
RAF, RAF-DOAC, CROMIS-2, SAMURAI, NOACISP, Erlangen, and Verona registry collaborators

Funding

Bangerter-Rhyner FoundationBayerBayer StiftungBritish Heart Foundation CS/17/6/33361Stroke AssociationSwiss Heart FoundationSwiss National Science FoundationSwiss Society of Neurology
6 · The paper itself

Abstract

objectiveIt is not known whether patients with atrial fibrillation (AF) with ischemic stroke despite oral anticoagulant therapy are at increased risk for further recurrent strokes or how ongoing secondary prevention should be managed.

methodsWe conducted an individual patient data pooled analysis of 7 prospective cohort studies that recruited patients with AF and recent cerebral ischemia. We compared patients taking oral anticoagulants (vitamin K antagonists [VKA] or direct oral anticoagulants [DOAC]) prior to index event (OAC

resultsWe included 5,413 patients (median age = 78 years [interquartile range (IQR) = 71-84 years]; 5,136 [96.7%] had ischemic stroke as the index event, median National Institutes of Health Stroke Scale on admission = 6 [IQR = 2-12]). The median CHA

interpretationPatients with AF who have an ischemic stroke despite previous oral anticoagulation are at a higher risk for recurrent ischemic stroke despite a CHA

Identifiers

PMID32052481
PMCPMC7383617

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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.