Evidence map›Paper›PMID 41906919›Full record

Trial reportInternational journal of stroke : official journal of the International Stroke Society2026

Early versus delayed anticoagulation in acute ischemic stroke with atrial fibrillation according to infarct volume and location: A prespecified subgroup analysis of the OPTIMAS randomized controlled trial.

Philip S Nash, Jonathan G Best, James Lyon, James K Ruffle, Thanyalak Amornpojnimman, Rom Mendel, Chris Foulon, Hakim-Moulay Dehbi, Norin Ahmed, Liz Arram and 30 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in International journal of stroke : official journal of the International Stroke Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing 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

2 citing papers in PubMed.

  1. Review
  2. Atrial fibrillation detected after stroke: Recent advances and future directions.International journal of stroke : official journal of the International Stroke Society · 2026
    Review
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

40 authors.

Philip S NashStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.ORCID 0000-0003-2428-1575
Jonathan G BestStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.ORCID 0000-0002-4243-5753
James LyonStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
James K RuffleHigh Dimensional Neurology Group, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
Thanyalak AmornpojnimmanStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.ORCID 0000-0002-8673-7040
Rom MendelStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
Chris FoulonHigh Dimensional Neurology Group, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
Hakim-Moulay DehbiComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Norin AhmedComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Liz ArramStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
Maryam BalogunComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Kate BennettComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Ekaterina BordeaComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.ORCID 0000-0002-3772-7049
Emilia CaverlyComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Marisa ChauComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Hannah CohenDepartment of Haematology, Cancer Institute, UCL, London, UK.
Mairead CullenComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Caroline J DoréComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.ORCID 0000-0001-9796-4970
Stefan T EngelterNeurology and Neurorehabilitation, University Department of Geriatric Medicine, FELIX PLATTER, University of Basel, Basel, Switzerland.ORCID 0000-0003-3855-6234
Robert FennerComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Gary A FordMedical Sciences Division, University of Oxford, Oxford, UK.
Aneet GillComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Rachael HunterComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Martin JamesRoyal Devon & Exeter Hospital, and University of Exeter Medical School, Exeter, UK.
Archana JayanthiComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Gregory Yh LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Sue MassinghamStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
Macey L MurrayMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.ORCID 0000-0001-6418-0854
Iwona MazurczakComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Amalia NdoutoumouComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Bo NorrvingDepartment of Clinical Sciences, Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
Jenny PhilipComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Hannah SimsComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Nikola SpriggStroke Trials Unit, Division of Mental Health and Clinical Neuroscience, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
Tishok VanniyasingamComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
Parashkev NachevHigh Dimensional Neurology Group, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
Nick FreemantleComprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, UCL, London, UK.
David DoigStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.
David J WerringStroke Research Centre, Department of Translational Neuroscience and Stroke, UCL Queen Square Institute of Neurology, London, UK.ORCID 0000-0003-2074-1861
OPTIMAS Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRandomized trials have demonstrated that early anticoagulation after acute atrial fibrillation-associated ischemic stroke is safe and non-inferior to delayed initiation. Whether anticoagulation should be delayed in people with larger infarcts is uncertain.

aimsTo investigate whether ischemic stroke infarct volume, measured precisely by segmentation, modifies the treatment effect of early anticoagulation with a direct oral anticoagulant (DOAC).

methodsWe did a prespecified secondary analysis of OPTIMAS (NCT: 03759938), a randomized, parallel-group, open-label trial with blinded outcome assessment which randomized people with acute ischemic stroke and atrial fibrillation to early initiation of any licensed DOAC, within 4 days of onset, or delayed initiation 7-14 days from onset. The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage (ICH), and systemic arterial embolism within 90 days. A central neuroimaging laboratory determined infarct volume using diffusion-weighted magnetic resonance imaging (MRI) using a validated deep learning segmentation model; on computed tomography (CT), infarcts were segmented manually. We modeled infarct volume as a continuous variable using restricted cubic splines and tested for an interaction with treatment allocation in mixed effects logistic regression.

resultsWe included 3572 participants (mean age = 78 ± 10 years, 45% female), 98.6% of the main trial population. The effect of early versus delayed anticoagulation did not vary with infarct volume (p

conclusionThe treatment effect of early anticoagulation with a DOAC in acute ischemic stroke associated with atrial fibrillation was not modified by infarct volume. Adverse outcomes were not increased with early anticoagulation in people with larger infarcts. Our results provide no evidence that anticoagulation initiation should be delayed beyond 4 days on the basis of infarct size.

Indexed as

AnticoagulantsAtrial FibrillationBrain IschemiaIschemic StrokeAgedAged, 80 and overDiffusion Magnetic Resonance ImagingFemaleHumansMaleTime FactorsTime-to-TreatmentTreatment DelayTreatment OutcomeAnticoagulantsanticoagulationAtrial fibrillationinfarct volumeintracranial hemorrhageischemic stroketiming

Identifiers

PMID41906919
PMCPMC13392158

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

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.