Evidence map›Paper›PMID 41919368›Full record

Trial reportStroke2026

Early Versus Delayed Anticoagulation in Acute Ischemic Stroke According to Atrial Fibrillation Subtype and Time of Diagnosis: Subgroup Analysis of the OPTIMAS Randomized Controlled Trial.

James Lyon, Philip S Nash, Norin Ahmed, Liz Aram, Maryam Balogun, Kate Bennett, Jonathan G Best, Ekaterina Bordea, Emilia Caverly, Marisa Chau and 24 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03759938 (OPtimal TIMing of Anticoagulation After Acute Ischaemic Stroke), 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.

NCT03759938 naunknown statusnot on this map

OPtimal TIMing of Anticoagulation After Acute Ischaemic Stroke: a Randomised Controlled Trial

TypeinterventionalSponsorUniversity College, LondonRan2019 to 2024Enrolled3,648ConditionsStroke, Acute, Atrial FibrillationArmsDirect oral anticoagulant (DOAC)
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

34 authors.

James LyonStroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, United Kingdom (J.L., S.N.P., L.A., J.G.B., S.M., D.J.W.).ORCID 0009-0005-8823-6679
Philip S NashStroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, United Kingdom (J.L., S.N.P., L.A., J.G.B., S.M., D.J.W.).ORCID 0000-0003-2428-1575
Norin AhmedComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0000-0001-8798-5217
Liz AramStroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, United Kingdom (J.L., S.N.P., L.A., J.G.B., S.M., D.J.W.).
Maryam BalogunComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0009-0006-8006-0522
Kate BennettComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Jonathan G BestStroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, United Kingdom (J.L., S.N.P., L.A., J.G.B., S.M., D.J.W.).
Ekaterina BordeaComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0000-0002-3772-7049
Emilia CaverlyComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Marisa ChauComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Hannah CohenInstitute of Clinical Trials and Methodology (H.C.), University College London, United Kingdom.ORCID 0000-0003-2032-390X
Mairead CullenComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Hakim-Moulay DehbiComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0000-0002-0816-0178
Caroline J DoréComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0000-0001-9796-4970
Stefan T EngelterNeurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Switzerland (S.T.E.).ORCID 0000-0003-3855-6234
Robert FennerComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0000-0002-5819-9601
Gary A FordOxford University Hospitals NHS Foundation Trust, United Kingdom (G.A.F.).ORCID 0000-0001-8719-4968
Aneet GillComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Rachael HunterComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0000-0002-7447-8934
Martin JamesRoyal Devon and Exeter Hospital, United Kingdom (M.J.).ORCID 0000-0001-6065-6018
Archana JayanthiComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0009-0005-7339-7859
Sue MassinghamStroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, United Kingdom (J.L., S.N.P., L.A., J.G.B., S.M., D.J.W.).
Macey L MurrayMRC (Medical Research Council) Clinical Trials Unit at UCL, London, United Kingdom (M.L.M.).ORCID 0000-0001-6418-0854
Iwona MazurczakComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Amalia NdoutoumouComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Bo G NorrvingDepartment of Clinical Sciences and Department of Neurology, Skåne University Hospital, Lund Universityne University Hospital, Lund University, Sweden (B.G.N.).ORCID 0000-0002-8024-5096
Jenny PhilipComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Hannah SimsComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Nikola SpriggStroke Trials Unit, Division of Mental Health and Clinical Neuroscience, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom (N.S.).ORCID 0000-0002-5871-8168
Tishok VanniyasingamComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).ORCID 0009-0008-1719-9841
Nick FreemantleComprehensive Clinical Trials Unit at UCL, London, United Kingdom (N.A., M.B., K.B., E.B., E.C., M. Chau, M. Cullen, H.-M.D., C.J.D., R.F., A.G., R.H., A.J., I.M., A.N., J.P., H.S., T.V., N.F.).
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (G.Y.H.L.).ORCID 0000-0002-7566-1626
David J WerringStroke Research Centre, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, United Kingdom (J.L., S.N.P., L.A., J.G.B., S.M., D.J.W.).ORCID 0000-0003-2074-1861
OPTIMAS Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAfter acute ischemic stroke, it is uncertain whether the time of atrial fibrillation (AF) diagnosis (before or after stroke) or AF subtype (paroxysmal or permanent) modifies the treatment effect of early versus delayed direct oral anticoagulant (DOAC) initiation.

methodsOPTIMAS (Optimal Timing of Anticoagulation After Acute Ischemic Stroke) was a randomized, parallel-group, open-label trial with blinded outcome assessment. Participants with acute ischemic stroke and AF were randomized 1:1 to early (within 4 days) or delayed (day 7-14) DOAC initiation. The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, and systemic arterial embolism. In this trial subgroup analysis, the prespecified subgroup of interest was time of AF diagnosis, classified as before or after the qualifying stroke. We also investigated AF subtype classified as persistent or paroxysmal. We fitted mixed effects logistic regression models with interaction terms between each subgroup and treatment allocation. We also investigated associations between AF time of diagnosis or subtype and outcomes using multivariable logistic regression.

resultsWe included 3619 participants (mean age 78.0±9.9 years; 45.3% women). For AF diagnosed before stroke, 37 of 918 (4.0%) participants allocated to early DOAC had a primary outcome event versus 32 of 920 (3.5%) allocated to delayed DOAC, odds ratio, 1.17 (95% CI, 0.72-1.89), while for AF diagnosed after stroke the respective primary outcome rates were 22 of 895 (2.5%) and 27 of 886 (3.0%; odds ratio, 0.79 [95% CI, 0.45-1.40],

conclusionsWe found no evidence that AF time of diagnosis or subtype modify the effects of early DOAC treatment. Persistent AF was independently associated with approximately double the risk of the primary outcome compared with paroxysmal AF. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03759938.

Indexed as

AnticoagulantsAtrial FibrillationBrain IschemiaIschemic StrokeStrokeAgedAged, 80 and overFemaleHumansMaleTime FactorsTreatment DelayTreatment OutcomeAnticoagulantsanticoagulantsatrial fibrillationintracranial hemorrhage

Identifiers

PMID41919368
PMCPMC13196862

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.