Evidence map›Paper›PMID 33093818›Full record

ArticleEuropean heart journal supplements : journal of the European Society of Cardiology2020

Non-vitamin K oral anticoagulants for secondary stroke prevention in patients with atrial fibrillation.

Hans-Christoph Diener, Graeme J Hankey, J Donald Easton, Gregory Y H Lip, Robert G Hart, Valeria Caso

Erratum issuedOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal supplements : journal of the European Society of Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 19 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 1 pooled it
3.9field-weighted citation impact, top 5% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.

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  11. 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 · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 6 institutions in 7 countries.

Hans-Christoph DienerInstitute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Hufelandstrasse 55, Essen 45147, Germany.
Graeme J HankeyMedical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, 6009 Perth, Australia.
J Donald EastonDepartment of Neurology, University of California, San Francisco, Sandler Neurosciences Center, 675 Nelson Rising Lane, San Francisco, CA 94158-0663, USA.
Gregory Y H LipLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building 6 West Derby Street Liverpool L7 8TX, UK.
Robert G HartHamilton Health Sciences, Population Health Research Institute, 237 Barton Street East Hamilton, Ontario L8L 2X2, Canada.
Valeria CasoStroke Unit, University of Perugia, Santa Maria della Misericordia Hospital, Ospedale S. Maria della Misericordia S. Andrea delle Fratte, 06156 Perugia, Italy.
Institut für Medizinische Informatik, Biometrie und Epidemiologie · DEPopulation Health Research Institute · CAUniversity of California, San Francisco · USUniversity of Liverpool · GBUniversity of Perugia · ITUniversity of Western Australia · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The aims of this article are to review the evidence regarding the use of non-vitamin K oral anticoagulants (NOACs) for secondary stroke prevention as compared to vitamin K antagonists in patients with atrial fibrillation (AF) and in patients with embolic strokes of uncertain source (ESUS), and when to initiate or resume anticoagulation after an ischaemic stroke or intracranial haemorrhage. Four large trials compared NOACs with warfarin in patients with AF. In our meta-analyses, the rate of all stroke or systemic embolism (SE) was 4.94% with NOACs vs. 5.73% with warfarin. Among the patients with AF and previous transient ischaemic attack or ischaemic stroke, the rate of haemorrhagic stroke was halved with a NOAC vs. warfarin, and the rate of major bleeding was 5.7% with a NOAC vs. 6.4% with warfarin. There was no significant difference in mortality. In a trial comparing apixaban with aspirin in patients with AF, the rate of stroke or SE was 2.4% at 1 year with apixaban vs. 9.2% at 1 year with aspirin and the rates of major bleeding were 4.1% with apixaban vs. 2.9% with aspirin. Data from registries confirmed the results from the randomized trials. Initiation or resumption of anticoagulation after ischaemic stroke or cerebral haemorrhage depends on the size and severity of stroke and the risk of recurrent bleeding. Two large trials tested the hypothesis that NOACs are more effective than 100 mg aspirin in patients with ESUS. Neither trial showed a significant benefit of the NOAC over aspirin. In the meta-analysis, the rate all stroke or SE was 4.94% with NOACs vs. 5.73% with warfarin and the rate of haemorrhagic stroke was halved with a NOAC. The four NOACs had broadly similar efficacy for the major outcomes in secondary stroke prevention.

Indexed as

Atrial fibrillationEmbolic stroke of undetermined source (ESUS)Non-vitamin K oral anticoagulants (NOACs)Secondary stroke preventionStrokeTIAWarfarin

Identifiers

PMID33093818
PMCPMC7556747
OpenAlexW3086706701

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.