SynthesisNeurology2024
Anticoagulation vs Antiplatelets Across Subgroups of Embolic Stroke of Undetermined Source: A Meta-Analysis of Randomized Controlled Trials.
Abstract readMeta-AnalysisComparative Study
In one paragraph
Synthesis in Neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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.
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.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Outcomes of patent foramen ovale closure in patients over 60 years with cryptogenic stroke: A systematic review and meta-analysis.International journal of stroke : official journal of the International Stroke Society · 2026Pooled it
- Premature Atrial Contractions as a Marker of Atrial Cardiopathy: A Revised Analysis of the ARCADIA Randomized Trial.Journal of cardiovascular electrophysiology · 2025Trial
- Factor XI(a) Inhibition in Secondary Stroke Prevention: On the Cusp of a New Anticoagulation Paradigm.ACS pharmacology & translational science · 2026Article
- Factor XI Inhibition for Ischemic Stroke Secondary Prevention: Pharmacology, Clinical Evidence, and Future Directions.Journal of clinical pharmacology · 2026Review
- Symmetric Dimethylarginine for Risk Stratification of Cardioembolic Stroke.Translational stroke research · 2026Article
- Screening of Atrial Fibrillation in Cryptogenic Ischemic Stroke-Does Timing Make the Difference?European journal of neurology · 2026Article
- ESO annual stroke evidence update 2025.European stroke journal · 2026Review
- Biomarkers of Cardioembolic Stroke in Thrombus Composition: Diagnostic Value of DNA and Fibrin Content.European journal of neurology · 2026Article
- Migraine and patent foramen ovale: correlation, coexistence, dependence. A narrative review.Headache · 2026Review
- From Detection to Decision: Managing Device-Detected Atrial Fibrillation After Stroke.Current neurology and neuroscience reports · 2025Review
- Cryptogenic stroke: definitions and management.Hematology. American Society of Hematology. Education Program · 2025Review
- Cardioembolic stroke versus embolic stroke of undetermined source: early severity and long-term outcomes in a prospective cohort.BMC neurology · 2025Article
- Review
- Long-Term Detection of Subclinical Atrial Fibrillation in Cryptogenic Stroke Patients With Insertable Cardiac Monitors.European journal of neurology · 2025Article
- Challenges and Opportunities of Direct Oral Anticoagulant (DOAC) Therapy in Complex Clinical Scenarios: A Comprehensive Review and Practical Guide.Journal of clinical medicine · 2025Review
- Sex Differences in Embolic Stroke of Undetermined Source: Echocardiographic Features and Clinical Outcomes.European journal of neurology · 2025Observational
- Review
- Hotspots and frontiers in patent foramen ovale research: a bibliometric and visualization analysis from 2003 to 2023.Frontiers in cardiovascular medicine · 2025Article
- Predictive value of patent foramen ovale diameter for cryptogenic stroke and age-related differences.Frontiers in cardiovascular medicine · 2025Article
- Direct Oral Anticoagulants Versus Aspirin for Stroke Prevention After Embolic Stroke of Undetermined Source: An Updated Meta-Analysis of Randomized Controlled Trials.Journal of clinical medicine · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors.
Malik GhannamFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0003-2350-284X
Abdullah M Al-QudahFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0002-1880-6972
Qasem N AlshaerFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0003-3936-0292
Richard KronmalFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0002-9897-7076
George NtaiosFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0002-0629-9248
Christopher A ChildsFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
W T LongstrethFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0009-0007-9552-3603
Ashraf AlsawareahFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
Timea KellerFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
Lina M Serna-HiguitaFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
Tobias GeislerFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
Karen FurieFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0003-0065-3784
Jeffrey L SaverFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0001-9141-2251
Scott E KasnerFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0003-0418-6917
Mitchell S V ElkindFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0003-2562-1156
David TirschwellFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0002-8059-2901
Sven PoliFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
Hooman KamelFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0002-5745-0307
Shadi YaghiFrom the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.ORCID 0000-0003-0031-1004
Funding
AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenicstroke (ARCADIA)U01NS095869 · NINDS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI BRODERICK, JOSEPH PAUL, KAMEL, HOOMAN · 2017 to 2022
$22.0MNINDS NIH HHS U01 NS095869
Abstract
BACKGROUND AND
objectivesThe term "embolic stroke of undetermined source" (ESUS) encompasses a substantial but heterogeneous population of patients with ischemic stroke, underscoring the importance of identifying personalized treatment strategies. In subgroups of patients randomized in ESUS trials, we evaluated the effectiveness of anticoagulation compared with antiplatelet therapy in secondary ischemic stroke prevention.
methodsA study-level meta-analysis was conducted on randomized controlled trials of patients with ESUS, comparing anticoagulation with antiplatelet therapy. The primary efficacy outcome was recurrent ischemic stroke, and safety outcomes were major bleeding and death. Subgroups assessed were age, sex, presence of patent foramen ovale (PFO), left atrial enlargement (LAE), and atrial cardiopathy. Pooled risk ratios (RRs) were meta-analyzed. Cochrane Risk of Bias Tool 2.0 was used for risk-of-bias assessment.
resultsA total of 7 randomized controlled trials involving 14,804 patients were analyzed, with 7,406 patients treated with anticoagulation and 7,398 treated with antiplatelet therapy. Compared with antiplatelet therapy, anticoagulation was associated with a similar rate of recurrent ischemic stroke (RR 0.91, 95% CI 0.80-1.05; DISCUSSION: In this meta-analysis, an empiric anticoagulation approach is not beneficial for patients with ESUS. This finding highlights the importance of an individualized treatment strategy. Such a strategy should include prolonged cardiac monitoring for atrial fibrillation, particularly in patients with moderate-to-severe LAE. Anticoagulation treatment showed promise in patients with medically treated PFO. Other subgroups did not benefit from anticoagulation therapy. Large prospective studies within ESUS subgroups are needed to validate our findings.
Indexed as
AnticoagulantsEmbolic StrokePlatelet Aggregation InhibitorsHumansRandomized Controlled Trials as TopicAnticoagulantsPlatelet Aggregation Inhibitors
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