Evidence map›Paper›PMID 41036269›Full record

ArticleFrontiers in neurology2025

Anticoagulant versus antiplatelet treatment for secondary stroke prevention in patients with active cancer.

Moritz C Kielkopf, Jayan Göcmen, Selina B Venzin, Fabienne Steinauer, Mattia Branca, Anna Boronylo, Martina B Göldlin, Johannes Kaesmacher, Adnan Mujanovic, Gianluca Costamagna and 14 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Frontiers in neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–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 synthesis or guideline pooled it.

  1. Pooled it
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

24 authors.

Moritz C KielkopfDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Jayan GöcmenDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Selina B VenzinDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Fabienne SteinauerDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Mattia BrancaCTU Bern, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Anna BoronyloDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Martina B GöldlinDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Johannes KaesmacherInstitute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Adnan MujanovicInstitute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Gianluca CostamagnaDepartment of Clinical Neurosciences, Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Thomas R MeinelDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
David J SeiffgeDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Philipp BückeDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Mirjam R HeldnerDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Ava L LibermanClinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States.
Hooman KamelClinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States.
Urs FischerDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Marcel ArnoldDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Thomas PabstDepartment of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Martin D BergerDepartment of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Simon JungDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Adrian ScutelnicDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Babak B Navi *Clinical and Translational Neuroscience Unit, Department of Neurology, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States.
Morin Beyeler *Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Approximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention. Methods: We identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS. Results: Among 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72 years; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495 days (IQR, 57-1,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75 years), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536 μg/L versus 1,010 μg/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36-1.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08-2.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39-1.72, Conclusion: Factors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy.

Indexed as

acute ischemic strokeantithrombotic drugscancerembolic stroke of unknown source (ESUS)secondary prevention

Identifiers

PMID41036269
PMCPMC12479245

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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.