Evidence map›Paper›PMID 34142118›Full record

SynthesisEuropean heart journal. Cardiovascular pharmacotherapy2022

Antiplatelet therapy in patients with atrial fibrillation: a systematic review and meta-analysis of randomized trials.

Alexander P Benz, Isabelle Johansson, Willem J M Dewilde, Renato D Lopes, Roxana Mehran, Samantha Sartori, Nikolaus Sarafoff, Satoshi Yasuda, William F McIntyre, Jeff S Healey and 3 more

Erratum issuedOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal. Cardiovascular pharmacotherapy, 2022. 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 14 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 2 pooled it
2.5field-weighted citation impact, top 9% 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

14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.

  1. Pooled it
  2. Antithrombotic treatment after stroke due to intracerebral haemorrhage.The Cochrane database of systematic reviews · 2023
    Pooled it
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 7 institutions in 5 countries.

Alexander P BenzPopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.ORCID 0000-0003-2555-1266
Isabelle JohanssonPopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.
Willem J M DewildeDepartment of Cardiology, Imeldaziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium.
Renato D LopesDuke Clinical Research Institute, Duke University School of Medicine, 200 Morris St., Durham, NC 27701, USA.
Roxana MehranThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.ORCID 0000-0002-5546-262X
Samantha SartoriThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.ORCID 0000-0003-0618-9409
Nikolaus SarafoffDeutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Technische Universität, Lazarettstraße 36, 80636 Munich, Germany.
Satoshi YasudaDepartment of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
William F McIntyrePopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.
Jeff S HealeyPopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.
Ashkan ShoamaneshPopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.
John W EikelboomPopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.
Stuart J ConnollyPopulation Health Research Institute, McMaster University, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.
Population Health Research Institute · CAMount Sinai Hospital · USDeutsches Herzzentrum der Charité · DEDuke University · USImelda Hospital · BEJohannes Gutenberg University Mainz · DETohoku University · JP

Funding

CIHR
6 · The paper itself

Abstract

aimsThe aim of this study was to systematically assess the effects of antiplatelets on clinical outcomes in patients with atrial fibrillation (AF), treated and not-treated with oral anticoagulation. METHODS AND

resultsWe searched MEDLINE, Embase, and CENTRAL from inception until September 2020. From 5446 citations, we selected randomized trials allocating patients with AF to antiplatelet therapy vs. control. We applied random-effects models for meta-analysis and assessed potential effect modification with background anticoagulation use. Eighteen trials including 21 518 participants met our prespecified eligibility criteria. In 10 studies without background anticoagulation, antiplatelets reduced all-cause stroke [486/6165 (events/patients) vs. 621/6061; risk ratio (RR) 0.77, 95% confidence interval (CI) 0.69-0.86, I2 = 0%]. In eight studies with background anticoagulation, there was a signal for an increase in all-cause stroke with antiplatelets (97/4608 vs. 72/4684; RR 1.33, 95% CI 0.98-1.79, I2 = 0%, P-value for interaction <0.001). A similar pattern emerged for ischaemic stroke. Irrespective of background anticoagulation use, antiplatelets increased major bleeding (509/10 402 vs. 328/10 496; RR 1.54, 95% CI 1.35-1.77, I2 = 0%) and intracranial haemorrhage (107/10 221 vs. 65/10 232; RR 1.64, 95% CI 1.20-2.24, I2 = 0%), and reduced myocardial infarction (201/9679 vs. 260/9751; RR 0.79, 95% CI 0.65-0.94, I2 = 0%, all P-values for interaction ≥0.36). Antiplatelets did not affect mortality (1221/10 299 vs. 1211/10 287; RR 1.02, 95% CI 0.89-1.17, I2 = 29%, P-value for interaction = 0.23).

conclusionsIn patients with AF not receiving oral anticoagulation, antiplatelet therapy modestly reduced stroke. There was a corresponding signal for harm when used on top of anticoagulation. Irrespective of background anticoagulation use, antiplatelet therapy significantly increased bleeding, moderately reduced myocardial infarction, and did not affect mortality.

Indexed as

Atrial FibrillationBrain IschemiaMyocardial InfarctionStrokeAnticoagulantsHemorrhageHumansPlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicAnticoagulantsPlatelet Aggregation InhibitorsAntiplateletAspirinAtrial fibrillationBleedingP2Y12 inhibitorStroke

Identifiers

PMID34142118
PMCPMC11905745
OpenAlexW3166286424

What OpenQuestion holds

Textmetadata
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.