Evidence map›Paper›PMID 37952187›Full record

SynthesisCirculation2024

Direct Oral Anticoagulants for Stroke Prevention in Patients With Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials.

William F McIntyre, Alexander P Benz, Nina Becher, Jeffrey S Healey, Christopher B Granger, Lena Rivard, A John Camm, Andreas Goette, Antonia Zapf, Marco Alings and 3 more

Registry-linked trialAbstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Circulation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07713615 (Device-Detected Atrial Fibrillation - Haemostatic Profile and Echocardiographic Variables), which is not on this map. Cited by 116 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
116citing papers in PubMed, 4 pooled it
45.9field-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.

NCT07713615 recruitingnot on this mapstarted 2026, after this paper: background citation

Device-Detected Atrial Fibrillation - Haemostatic Profile and Echocardiographic Variables

Typeobservational_patient_registrySponsorAndreas Sjøholm-ChristensenRan2026 to 2037Enrolled222ConditionsDevice-detected Atrial Fibrillation, Subclinical Atrial Fibrillation, Atrial High Rate Episodes
3 · Its place in the literature

Who cites it

116 citing papers in PubMed, 4 syntheses or guidelines pooled it, 210 citations in OpenAlex.

  1. Pooled it
  2. Atrial fibrillation burden in clinical practice, research, and technology development: a clinical consensus statement of the European Society of Cardiology Council on Stroke and the European Heart Rhythm Association.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 · 2025
    Guideline
  3. Pooled it
  4. Guideline
  5. Inflammation and day-to-day occurrence of atrial fibrillation.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 · 2026
    Trial
  6. Trial
  7. Trial
  8. The impact of screening-detected atrial fibrillation and associated outcomes on quality of life.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2025
    Trial
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. Closed loop stimulation reduces the incidence of atrial high-rate episodes compared with conventional rate-adaptive pacing in patients with sinus node dysfunctions.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
    Trial
  14. Article
  15. Article
  16. Identifying patients at low risk for atrial fibrillation after cryptogenic stroke: the PAVA score.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 · 2026
    Observational
  17. Article
  18. Article
  19. Review
  20. Residual thromboembolic risk and outcomes of oral anticoagulation discontinuation after atrial fibrillation ablation: a target trial emulation.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 · 2026
    Article

56 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 5 countries.

William F McIntyreMcMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.).ORCID 0000-0001-6082-7542
Alexander P BenzMcMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.).ORCID 0000-0003-2555-1266
Nina BecherDepartment of Cardiology, University Heart and Vascular Center Hamburg, Germany (N.B., P.K.).ORCID 0000-0002-4476-1341
Jeffrey S HealeyMcMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.).ORCID 0000-0003-1216-7580
Christopher B GrangerDuke Clinical Research Institute, Duke University, Durham, NC (C.B.G., R.D.L.).ORCID 0000-0002-0045-3291
Lena RivardMontreal Heart Institute, Canada (L.R.).ORCID 0000-0002-1340-0850
A John CammSt George's University of London and Imperial College London, United Kingdom (A.J.C.).ORCID 0000-0002-2536-2871
Andreas GoetteDepartment of Cardiology and Intensive Care Medicine, St Vincenz Hospital Paderborn, Germany (A.G.).ORCID 0000-0002-8223-7209
Antonia ZapfInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (A.Z.).ORCID 0000-0002-8467-0508
Marco AlingsAmphia Ziekenhuis, Breda, Netherlands (M.A.).ORCID 0000-0003-2090-4683
Stuart J ConnollyMcMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.).ORCID 0000-0002-7377-335X
Paulus KirchhofDepartment of Cardiology, University Heart and Vascular Center Hamburg, Germany (N.B., P.K.).ORCID 0000-0002-1881-0197
Renato D LopesDuke Clinical Research Institute, Duke University, Durham, NC (C.B.G., R.D.L.).ORCID 0000-0003-2999-4961
Population Health Research Institute · CADuke University · USOhio Heart & Vascular Center · USAmphia Ziekenhuis · NLMontreal Heart Institute · CASt George's, University of London · GBSt. Vincenz-Krankenhaus Limburg · DEUniversität Hamburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDevice-detected atrial fibrillation (also known as subclinical atrial fibrillation or atrial high-rate episodes) is a common finding in patients with an implanted cardiac rhythm device and is associated with an increased risk of ischemic stroke. Whether oral anticoagulation is effective and safe in this patient population is unclear.

methodsWe performed a systematic review of MEDLINE and Embase for randomized trials comparing oral anticoagulation with antiplatelet or no antithrombotic therapy in adults with device-detected atrial fibrillation recorded by a pacemaker, implantable cardioverter defibrillator, cardiac resynchronization therapy device, or implanted cardiac monitor. We used random-effects models for meta-analysis and rated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). The review was preregistered (PROSPERO CRD42023463212).

resultsFrom 785 citations, we identified 2 randomized trials with relevant clinical outcome data: NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes; 2536 participants) evaluated edoxaban, and ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; 4012 participants) evaluated apixaban. Meta-analysis demonstrated that oral anticoagulation with these agents reduced ischemic stroke (relative risk [RR], 0.68 [95% CI, 0.50-0.92]; high-quality evidence). The results from the 2 trials were consistent (I

conclusionsThe results of the NOAH-AFNET 6 and ARTESiA trials are consistent with each other. Meta-analysis of these 2 large randomized trials provides high-quality evidence that oral anticoagulation with edoxaban or apixaban reduces the risk of stroke in patients with device-detected atrial fibrillation and increases the risk of major bleeding.

Indexed as

AnticoagulantsAtrial FibrillationEmbolismIschemic StrokeStrokeAdministration, OralHemorrhageHumansPyridinesRandomized Controlled Trials as TopicThiazolesTreatment OutcomeAnticoagulantsedoxabanPyridinesThiazolesanticoagulantsatrial fibrillationdefibrillatorsFactor Xa inhibitorspacemaker, artificialstroke

Identifiers

PMID37952187
OpenAlexW4388609166

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.