Evidence map›Paper›PMID 37225430›Full record

ArticleNeurology2023

Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant.

Yiu Ming Bonaventure Ip, Kui Kai Lau, Ho Ko, Lucas Lau, Alan Yao, Grace Lai-Hung Wong, Terry Cheuk-Fung Yip, Xinyi Leng, Howard Chan, Helen Chan and 4 more

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

Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed, 1 pooled it
11.9field-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.

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

26 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.

  1. Pooled it
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  19. Atrial fibrillation: stroke prevention.The Lancet regional health. Europe · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 1 institution in 2 countries.

Yiu Ming Bonaventure IpFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0002-1619-4992
Kui Kai LauFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0002-8657-2418
Ho KoFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0002-0254-3274
Lucas LauFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.
Alan YaoFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.
Grace Lai-Hung WongFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0002-2863-9389
Terry Cheuk-Fung YipFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0002-1819-2464
Xinyi LengFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0001-7300-6647
Howard ChanFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.
Helen ChanFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.
Vincent MokFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.
Yannie O Y SooFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.
David SeiffgeFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland.ORCID 0000-0003-3890-3849
Thomas W LeungFrom the Department of Medicine and Therapeutics (Y.M.B.I., H.K., L.L., A.Y., G.L.-H.W., T.C.-F.Y., X.L., Howard Chan, Helen Chan, V.M., Y.O.Y.S., T.W.L.), Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong; Department of Medicine (K.K.L.), Queen Mary Hospital, University of Hong Kong; Li Ka Shing Institute of Health Sciences (H.K.), Faculty of Medicine; Medical Data Analytic Centre (G.L.-H.W., T.C.-F.Y.), The Chinese University of Hong Kong; and Department of Neurology (D.S.), Inselspital University Hospital Bern and University of Bern, Switzerland. drtleung@cuhk.edu.hk.ORCID 0000-0001-8193-0709
Chinese University of Hong Kong · HK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesIschemic stroke despite a direct oral anticoagulant (DOAC) is increasingly common and portends a high risk of subsequent ischemic stroke. The efficacy and safety of antithrombotic regimens after the condition are unclear. We aimed to compare the outcomes of patients with ischemic stroke despite DOACs with and without an alternative antithrombotic regimen and determine the risk factors of recurrent ischemic stroke while on anticoagulation.

methodsIn a population-based, propensity score-weighted, retrospective cohort study, we compared the clinical outcomes of DOAC-to-warfarin switch, DOAC-to-DOAC switch (DOAC

resultsDuring the 6-year study period, among 45,946 patients with AF on a DOAC as stroke prophylaxis, 2,908 patients developed ischemic stroke despite a DOAC. A total of 2,337 patients with NVAF were included in the final analyses. Compared with DOAC DISCUSSION: In patients with NVAF with ischemic stroke despite a DOAC, the increased risk of recurrent ischemic stroke with switching to warfarin called for caution against such practice, while the increased ischemic stroke with DOAC-to-DOAC switch demands further studies. Adjunctive antiplatelet agent did not seem to reduce ischemic stroke relapse. Because diabetes mellitus, the use of CYP/P-gp modulators, and LAD were predictors of recurrent ischemic stroke, further investigations should evaluate whether strict glycemic control, DOAC level monitoring, and routine screening for carotid and intracranial atherosclerosis may reduce ischemic stroke recurrence in these patients. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with NVAF experiencing an ischemic stroke while being treated with a DOAC, continuing treatment with that DOAC is more effective at preventing recurrent ischemic stroke than switching to a different DOAC or to warfarin.

Indexed as

Atrial FibrillationIschemic StrokeStrokeAdministration, OralAnticoagulantsFibrinolytic AgentsHumansPlatelet Aggregation InhibitorsRetrospective StudiesWarfarinAnticoagulantsFibrinolytic AgentsPlatelet Aggregation InhibitorsWarfarin

Identifiers

PMID37225430
PMCPMC10435051
OpenAlexW4377966438

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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.