Evidence map›Paper›PMID 36975022›Full record

ArticleAnnals of neurology2023

Atrial Fibrillation Detected before or after Stroke: Role of Anticoagulation.

Flurina Lyrer, Annaelle Zietz, David J Seiffge, Masatoshi Koga, Bastian Volbers, Duncan Wilson, Bruno Bonetti, Sabine Schaedelin, Henrik Gensicke, Sohei Yoshimura and 28 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
4.2field-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

9 citing papers in PubMed, 19 citations in OpenAlex.

  1. Article
  2. Article
  3. CHAAnnals of clinical and translational neurology · 2024
    Article
  4. Article
  5. Observational
  6. Article
  7. Review
  8. Association between antithrombotic therapy after stroke in patients with atrial fibrillation and the risk of net clinical outcome: an observational cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Observational
  9. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

38 authors at 11 institutions in 8 countries.

Flurina LyrerDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0002-5861-705X
Annaelle ZietzDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
David J SeiffgeDepartment of Neurology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.ORCID 0000-0003-3890-3849
Masatoshi KogaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.ORCID 0000-0002-6758-4026
Bastian VolbersDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.ORCID 0000-0003-0453-1530
Duncan WilsonStroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
Bruno BonettiStroke Unit - Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Sabine SchaedelinClinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
Henrik GensickeDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0002-0949-2422
Sohei YoshimuraDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.ORCID 0000-0002-4751-3538
Kosmas MachaDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
Gareth AmblerDepartment of Statistical Science, University College London, London, UK.
Sebastian ThilemannDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Tolga DittrichDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Manabu InoueDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kaori MiwaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Ruihao WangDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
Gabriela SiedlerDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
Luise BiburgerDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
Martin M BrownStroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
Rolf H JägerLysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK.
Keith MuirInstitute of Neuroscience & Psychology, University of Glasgow and Queen Elizabeth University Hospital, Glasgow, UK.
Christopher TraenkaDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Kanta TanakaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.ORCID 0000-0002-3291-5083
Masayuki ShiozawaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Leo H BonatiDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Nils PetersDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Philippe A LyrerDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Manuel CappellariStroke Unit - Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Kazunori ToyodaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.ORCID 0000-0002-8346-9845
Bernd KallmünzerDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
Stefan SchwabDepartment of Neurology, University Hospital Erlangen, Erlangen, Germany.
David J WerringStroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
Stefan T EngelterDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Gian Marco De MarchisDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0002-0342-9780
Alexandros A PolymerisDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0002-9475-2208
NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, SAMURAI-NVAF and Verona Registry collaborators
University of Basel · CHNational Cerebral and Cardiovascular Center · JPUniversitätsklinikum Erlangen · DEAzienda Ospedaliera Universitaria Integrata Verona · ITNational Hospital for Neurology and Neurosurgery · GBNeurological Research Institute · USNew Zealand Brain Research Institute · NZQueen Elizabeth University Hospital · GBUniversity College London · GBUniversity of Bern · CHUniversity of Liverpool · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAtrial fibrillation (AF) known before ischemic stroke (KAF) has been postulated to be an independent category with a recurrence risk higher than that of AF detected after stroke (AFDAS). However, it is unknown whether this risk difference is confounded by pre-existing anticoagulation, which is most common in KAF and also indicates a high ischemic stroke recurrence risk.

methodsIndividual patient data analysis from 5 prospective cohorts of anticoagulated patients following AF-associated ischemic stroke. We compared the primary (ischemic stroke recurrence) and secondary outcome (all-cause death) among patients with AFDAS versus KAF and among anticoagulation-naïve versus previously anticoagulated patients using multivariable Cox, Fine-Gray models, and goodness-of-fit statistics to investigate the relative independent prognostic importance of AF-category and pre-existing anticoagulation.

resultsOf 4,357 patients, 1,889 (43%) had AFDAS and 2,468 (57%) had KAF, while 3,105 (71%) were anticoagulation-naïve before stroke and 1,252 (29%) were previously anticoagulated. During 6,071 patient-years of follow-up, we observed 244 recurrent strokes and 661 deaths. Only pre-existing anticoagulation (but not KAF) was independently associated with a higher hazard for stroke recurrence in both Cox and Fine-Gray models. Models incorporating pre-existing anticoagulation showed better fit than those with AF category; adding AF-category did not result in better model fit. Neither pre-existing anticoagulation nor KAF were independently associated with death.

conclusionOur findings challenge the notion that KAF and AFDAS are clinically relevant and distinct prognostic entities. Instead of attributing an independently high stroke recurrence risk to KAF, future research should focus on the causes of stroke despite anticoagulation to develop improved preventive treatments. ANN NEUROL 2023;94:43-54.

Indexed as

Atrial FibrillationIschemic StrokeStrokeAnticoagulantsHumansProspective StudiesRisk FactorsAnticoagulants

Identifiers

PMID36975022
PMCPMC10953352
OpenAlexW4361190967

What OpenQuestion holds

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Registered trials

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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.