Evidence map›Paper›PMID 40785636›Full record

ArticleEuropean stroke journal2025

Once- versus twice-daily direct oral anticoagulants after ischemic stroke in atrial fibrillation - A post-hoc analysis of the ELAN trial.

Alexandros A Polymeris, Jean-Benoît Rossel, Masatoshi Koga, Daniel Strbian, Adhiyaman Vedamurthy, Manju Krishnan, Mattia Branca, Thomas Meinel, Espen Saxhaug Kristoffersen, Takeshi Yoshimoto and 18 more

Registry-linked trialAbstract read
In one paragraph

Article in European stroke journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03148457 (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-ischaemic Stroke Patients With Atrial fibrillatioN), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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.

NCT03148457 nacompletednot on this map

Early Versus Late Initiation of Direct Oral Anticoagulants in Post-ischaemic Stroke Patients With Atrial fibrillatioN (ELAN): an International, Multicentre, Randomised-controlled, Two-arm, Assessor-blinded Trial

TypeinterventionalSponsorInsel Gruppe AG, University Hospital BernRan2017 to 2023Enrolled2,013ConditionsIschaemic StrokeArmsEarly treatment with Rivaroxaban (Xarelto®), Dabigatran (Pradaxa®), Apixaban (Eliquis®) or Edoxaban (Lixiana®), Late treatment with Rivaroxaban (Xarelto®), Dabigatran (Pradaxa®), Apixaban (Eliquis®) or Edoxaban (Lixiana®)
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Alexandros A PolymerisDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0002-9475-2208
Jean-Benoît RosselDepartment of Clinical Research, University of Bern, Bern, Switzerland.ORCID 0000-0001-5803-3233
Masatoshi KogaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Daniel StrbianDepartment of Neurology, Helsinki University Hospital, Helsinki, Finland.ORCID 0000-0001-9095-2344
Adhiyaman VedamurthyGlan Clwyd Hospital, Betsi Cadwaladr University Local Health Board, Rhyl, UK.
Manju KrishnanStroke Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
Mattia BrancaDepartment of Clinical Research, University of Bern, Bern, Switzerland.
Thomas MeinelDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.ORCID 0000-0002-0647-9273
Espen Saxhaug KristoffersenDepartment of General Practice, University of Oslo, Oslo, Norway.ORCID 0000-0002-8999-5424
Takeshi YoshimotoDepartment of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.ORCID 0000-0003-3178-8171
Kanta TanakaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.ORCID 0000-0002-3291-5083
Takenobu KuniedaDepartment of Neurology, Kansai Medical University, Hirakata, Japan.
Yusuke YakushijiDepartment of Neurology, Kansai Medical University, Hirakata, Japan.
Jochen VehoffDepartment of Neurology, Health Ostschweiz (HOCH), Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Kosuke MatsuzonoDivision of Neurology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Peter SladeStroke Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
Jelle DemeestereKU Leuven, Department of Neurosciences, Experimental Neurology, and the Department of Neurology, University Hospitals Leuven, Leuven, Belgium.ORCID 0000-0001-8186-0237
Alexander SalernoDepartment of Neurology, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.ORCID 0000-0001-8494-5527
Nicoletta G CaraccioloDepartment of Human Neurosciences, University La Sapienza, Rome, Italy.
Dimitri HemelsoetDepartment of Neurology, Ghent University Hospital, Ghent, Belgium.
Stefan T EngelterDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0003-3855-6234
Elias AuerDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Thomas HorvathDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
David J SeiffgeDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.ORCID 0000-0003-3890-3849
Martina GoeldlinDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.ORCID 0000-0001-5800-116X
Jesse DawsonSchool of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, Glasgow, UK.ORCID 0000-0001-7532-2475
Urs FischerDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.ORCID 0000-0003-0521-4051
ELAN Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWhether the risk-benefit profile of once-daily versus twice-daily direct oral anticoagulants (DOAC) differs after atrial fibrillation(AF)-associated ischemic stroke is unclear. We explored this in a post-hoc analysis of ELAN trial data (NCT03148457). PATIENTS AND

methodsWe compared the risk of the primary outcome (recurrent ischemic stroke, systemic embolism, intracranial hemorrhage (ICH), major extracranial bleeding, vascular death) from treatment initiation to the trial's 90-day follow-up in participants treated with once-daily or twice-daily DOAC after AF-associated stroke using Firth's logistic and Cox proportional hazards regression in unadjusted, inverse-probability-of-treatment-weighted and augmented-inverse-probability-weighted models to address confounding. Secondary outcomes were the primary outcome components and non-major bleeding. We calculated the net clinical benefit (NCB) of twice-daily over once-daily DOAC by subtracting the weighted rate of excess bleeding attributable to twice-daily DOAC from the rate of excess ischemic events possibly prevented by twice-daily DOAC.

resultsWe analyzed 1890/2013 (94%) participants (median age 77 years, 45% female), of whom 384 (20%) received once-daily and 1506 (80%) twice-daily DOAC. The primary outcome occurred in 64 (3.4%) participants, and did not differ between DOAC types in logistic (OR DISCUSSION AND

conclusionThe risk-benefit profile of once-daily versus twice-daily DOAC after AF-associated ischemic stroke does not seem to differ.

Indexed as

atrial fibrillationDirect oral anticoagulantsischemic strokeonce-dailyregimentwice-daily

Identifiers

PMID40785636
PMCPMC12339485

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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.