Evidence map›Paper›PMID 40888630›Full record

Trial reportEuropean heart journal. Quality of care & clinical outcomes2025

Effects of anticoagulation in patients with device-detected atrial fibrillation and multiple stroke risk factors: a win ratio analysis of the NOAH-AFNET 6 trial.

Nina Becher, Gina Köllner, Emanuele Bertaglia, Carina Blomstrom-Lundqvist, Axel Brandes, Vincent Beuger, Melanie Calvert, A John Camm, Nuno Cabanelas, Gregory Chlouverakis and 24 more

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in European heart journal. Quality of care & clinical outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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.

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

1 citing paper in PubMed.

  1. Article
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

34 authors.

Nina BecherDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0002-4476-1341
Gina KöllnerFaculty of Electrical Engineering and Computer Science, Stralsund University of Applied Sciences, Stralsund 18435, Germany.
Emanuele BertagliaCardiology Unit, Camposampiero Hospital-AULSS Euganea, Padua 35012, Italy.ORCID 0000-0002-3878-2904
Carina Blomstrom-LundqvistDepartment of Medical Science, Uppsala University, Uppsala 75185, Sweden.
Axel BrandesDepartment of Cardiology, Esbjerg Hospital-University Hospital of Southern Denmark, Esbjerg 6700, Denmark.ORCID 0000-0001-9145-6887
Vincent BeugerAtrial Fibrillation NETwork (AFNET), Muenster 48149, Germany.ORCID 0009-0008-8599-808X
Melanie CalvertCentre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.ORCID 0000-0002-1856-837X
A John CammCity St George's University of London, London EC1V 0HB, United Kingdom.
Nuno CabanelasCardiology Department, Fernando Fonseca Hospital, Amadora 2720-276, Portugal.
Gregory ChlouverakisBiostatistics Lab, School of Medicine, University of Crete, Heraklion 71003, Greece.
Gheorghe-Andrei DanAcademy of the Romanian Scientists, 'Carol Davila' University of Medicine, Bucharest 050474, Romania.ORCID 0000-0001-9867-2582
Wolfgang DichtlDepartment of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, Innsbruck 6020, Austria.
Hans Christoph DienerDepartment of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen 45147, Germany.
Alexander FierenzInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.ORCID 0000-0002-5233-215X
Andreas GoetteAtrial Fibrillation NETwork (AFNET), Muenster 48149, Germany.
Joris R de GrootHeart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.
Lieven Nils KennesDepartment of Economics and Business Administration, University of Applied Sciences Stralsund, Stralsund 18435, Germany.
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, United Kingdom.
Andrzej LubinskiDepartment of Cardiology and Internal Diseases, Medical University of Gdańsk, Gdańsk 80-120, Poland.
Eloi MarijonCardiology Division, European Georges Pompidou Hospital, Paris 75908, France.ORCID 0000-0001-7227-3428
Béla MerkelyHeart and Vascular Centre, Semmelweis University, Budapest 1085, Hungary.
Lluís MontHospital Clinic, Universtitat de Barcelona, Barcelona, Catalonia 08036, Spain.
Kim RajappanCardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX39DU, United Kingdom.ORCID 0000-0001-8996-2983
Ursula RohrerDepartment of Cardiology, University Heart Center, Medical University Graz, Graz 8036, Austria.
Andrea SarkozyHeart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels 1090, Belgium.
Ulrich SchottenAtrial Fibrillation NETwork (AFNET), Muenster 48149, Germany.ORCID 0000-0003-1532-3315
Susanne SehnerInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.ORCID 0000-0002-2415-9302
Emmanuel SimantirakisDepartment of Cardiology, Heraklion University Hospital, Heraklion, Crete 71500, Greece.ORCID 0000-0001-9615-6293
Tobias ToennisDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0002-7351-0621
Panos VardasDepartment of Cardiology, Heraklion University Hospital, Heraklion, Crete 71500, Greece.
Vasil VelchevCardiology Clinic, St. Anna University Hospital, Medical University Sofia, Sofia 1709, Bulgaria.ORCID 0009-0008-2550-835X
Dan WichterleDepartment of Cardiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czechia.ORCID 0000-0002-0448-5143
Antonia ZapfInstitute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.ORCID 0000-0002-8467-0508
Paulus KirchhofDepartment of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.ORCID 0000-0002-1881-0197

Funding

AFFECT-EU 847770BMBFBritish Heart Foundation AA/18/2/34218Daiichi Sankyo EuropeDZHK 81X2800182DZHK 81Z0710110DZHK 81Z0710116European Union 633196German Research Foundation 509167694MAESTRIA 965286
6 · The paper itself

Abstract

aimsPatients with device-detected atrial fibrillation (DDAF) have a lower stroke risk than those with ECG-diagnosed AF, requiring careful evaluation of oral anticoagulation benefits vs. its inherent bleeding risk. METHODS AND

resultsAn unmatched win ratio analysis was performed of the NOAH-AFNET 6 trial dataset, using components of the primary efficacy and safety outcomes of the trial. The primary analysis used this hierarchical order: (1) all-cause death, (2) stroke, (3) systemic or pulmonary embolism/myocardial infarction, and (4) major bleeding. Two additional analyses replaced all-cause death with cardiovascular death or included patient-reported outcomes. Win odds were calculated to account for undecided comparisons. Among 2534 patients 77 ± 7 years old, 947 (37%) women, median CHA2DS2-VA score 3 [interquartile range (IQR), 3-4], median follow-up 21 months (IQR, 10-38) 1 605 280 win ratio pairs were analyzed. The win ratio comparing edoxaban to no anticoagulation was 0.87 (95% CI: 0.68-1.10; P = 0.23). Most comparisons resulted in no clear winner (undecided pairs 84.9%). In the remaining comparisons, edoxaban won in 46% of the cases, placebo in 54%. Death and major bleeding were the most common events. The win odds was 0.98 (95% CI: 0.94-1.01; P = 0.23).

conclusionsThis hypothesis-generating win ratio analysis, integrating death, thrombotic events, and major bleeds with and without quality of life, did not find an advantage of anticoagulation with edoxaban over no anticoagulation in patients with DDAF. The most common events were death and major bleeding.

Indexed as

AnticoagulantsAtrial FibrillationStrokeAgedAged, 80 and overElectrocardiographyFemaleFollow-Up StudiesHemorrhageHumansMalePyridinesRisk AssessmentRisk FactorsThiazolesAnticoagulantsedoxabanPyridinesThiazolesDevice-detected atrial fibrillationMajor bleedingNOAH-AFNET 6Oral anticoagulationStroke riskWin ratio

Identifiers

PMID40888630
PMCPMC12714391

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.