Evidence map›Paper›PMID 42839308›Full record

ArticleAnnals of clinical and translational neurology2026

Anticoagulation Treatment Response Among Phenotypic ESUS Clusters: Evidence From CASPR.

Elena Badillo Goicoechea, Patrick Ellsworth, James E Siegler, James R Brorson, Christina M Lineback, Frank G Conyers, Deborah Kerrigan, Kelsey Eklund, Shadi Yaghi, Farid Khasiyev and 44 more

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In one paragraph

Article in Annals of clinical and translational neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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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

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3 · Its place in the literature

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4 · The record

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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

54 authors.

Elena Badillo GoicoecheaDepartment of Neurology, University of Chicago, Chicago, Illinois, USA.
Patrick EllsworthDepartment of Neurology, Yale Hospital, New Haven, Connecticut, USA.ORCID https://orcid.org/0009-0008-9280-0588
James E SieglerDepartment of Neurology, University of Chicago, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0003-0287-3967
James R BrorsonDepartment of Neurology, University of Chicago, Chicago, Illinois, USA.ORCID https://orcid.org/0000-0003-4137-2444
Christina M LinebackDepartment of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Frank G ConyersDepartment of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Deborah KerriganDepartment of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kelsey EklundDepartment of Neurology, University of Colorado, Aurora, Colorado, USA.
Shadi YaghiDepartment of Neurology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune City, New Jersey, USA.ORCID https://orcid.org/0000-0003-0031-1004
Farid KhasiyevDepartment of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0000-0002-3127-0973
Emiliya MelkumovaDepartment of Neurology, Tufts Medical Center, Boston, Massachusetts, USA.
Collin J CulbertsonDepartment of Neurology, Lahey Clinic, Burlington, Massachusetts, USA.
Marissa D'SouzaDepartment of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Dinesh V JillellaDepartment of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
Patrick GloverDepartment of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
Hassan Aboul-NourDepartment of Neurology, Trinity Health, Ann Arbor, Michigan, USA.ORCID https://orcid.org/0000-0002-6698-5848
Fadi NahabDepartment of Neurology, Emory University, Atlanta, Georgia, USA.
Mahan ShahrivariDepartment of Neurology, University of Texas at Houston, Houston, Texas, USA.
Simona NedelcuDepartment of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
David S LiebeskindDepartment of Neurology, University of California at Los Angeles, Los Angeles, California, USA.ORCID https://orcid.org/0000-0002-5109-8736
Matthew M SmithDepartment of Neurology, University of Chicago, Chicago, Illinois, USA.
Aaron RothsteinDepartment of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Anna BowmanDepartment of Neurology, University of Colorado, Aurora, Colorado, USA.
Alicia ZhaDepartment of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Narendra KalaDepartment of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Ahmad Abu QdaisDepartment of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
Sami Al KasabDepartment of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
Mudassir FarooquiDepartment of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.ORCID https://orcid.org/0000-0003-3697-5697
Diana Rojas-SotoDepartment of Neurology, Dartmouth Medical Center, Lebanon, New Hampshire, USA.
Yasmin AzizDepartment of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.ORCID https://orcid.org/0000-0002-3515-4005
Franziska HerpichDepartment of Neurology, Christiana Care Hospital, Newark, Delaware, USA.ORCID https://orcid.org/0000-0003-0800-8536
Jean-Philippe DanielDepartment of Neurology, Sentara Norfolk General Hospital, Norfolk, Virginia, USA.ORCID https://orcid.org/0000-0001-7870-6837
Sean L ThompsonDepartment of Neurology, Emory University, Atlanta, Georgia, USA.
Vivek PatelDepartment of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Thanh N NguyenDepartment of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA.
Siddharth SehgalDepartment of Neurology, Lahey Clinic, Burlington, Massachusetts, USA.
Wenzheng YuDepartment of Neurology, Tufts Medical Center, Boston, Massachusetts, USA.
Wayneho KamDepartment of Neurology, Duke University Hospital, Durham, North Carolina, USA.
Russel Van CoeveringDepartment of Neurology, University of Colorado, Aurora, Colorado, USA.
Oana M DumitrascuDepartment of Neurology, Mayo Clinic, Scottsdale, Arizona, USA.
Muhammad AlviDepartment of Neurology, West Virginia University, Morgantown, West Virginia, USA.
Balaji KrishnaiahDepartment of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Setareh Salehi OmranDepartment of Neurology, University of Colorado, Aurora, Colorado, USA.ORCID https://orcid.org/0000-0002-3184-5327
Guillermo LinaresDepartment of Neurology, St. Louis University Hospital, St. Louis, Missouri, USA.
Eesha SinghDepartment of Neurology, University of Chicago, Chicago, Illinois, USA.
Hamid AliDepartment of Neurology, Wellstar MCG Health, Augusta University, Augusta, Georgia, USA.
Mary PenckoferDepartment of Neurology, Cooper University Hospital, Camden, New Jersey, USA.
Jesse M ThonDepartment of Neurology, Cooper University Hospital, Camden, New Jersey, USA.
Shani MannionDepartment of Neurology, University of Michigan, Ann Arbor, Michigan, USA.ORCID https://orcid.org/0000-0002-3984-410X
Dalia ChahienDepartment of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Lucia ChenDepartment of Neurology, University of Colorado, Aurora, Colorado, USA.
Fawad TalatDepartment of Neurology, Tufts Medical Center, Boston, Massachusetts, USA.
Mehdi AbbasiDepartment of Neurology, Yale Hospital, New Haven, Connecticut, USA.ORCID https://orcid.org/0000-0001-6978-2563
Richa SharmaDepartment of Neurology, Yale Hospital, New Haven, Connecticut, USA.

Funding

MedtronicPhilips
6 · The paper itself

Abstract

objectiveTo evaluate treatment effect heterogeneity across phenotypic clusters of patients with cryptogenic embolic stroke using causal inference methods.

methodsFrom a retrospective, multicenter cohort of patients with cryptogenic embolic stroke, we estimated the treatment effect of anticoagulation versus antiplatelet therapy in patients with ESUS in two ways: (1) Partitioning Around Medoids and (2) causal survival forest modeling. We assessed cluster-level associations with time to primary outcome (recurrent stroke, major bleeding, or death) using Kaplan-Meier survival analysis to assess cluster differences. We then extracted SHapley Additive exPlanations (SHAP) feature importances from the causal forest model to identify candidate effect modifiers from the causal forest.

resultsAmong 1869 patients with ESUS, three phenotypically distinct clusters were extracted with significant differences in event-free survival across clusters (log-rank p < 0.0001). There was no significant population-level benefit of anticoagulation over antiplatelet therapy (p = 0.23). SHAP feature importance analysis identified several candidate effect modifiers; however, only higher LVEF (β = -327, 95% CI: -580 to -74, p = 0.011) and cancer history (β = -226, 95% CI: -441 to -11, p = 0.039) were independent predictors of response to antiplatelet over anticoagulation using best linear projections. Phenotypic cluster assignment did not significantly predict treatment effect heterogeneity.

interpretationThree distinct phenotypic clusters of cryptogenic stroke patients emerged with a differential risk of the composite outcome, but they did not predict responsiveness to anticoagulation. LVEF and cancer history, however, showed differential outcomes across antithrombotic strategies. These findings demonstrate the potential of causal inference methods for identifying effect heterogeneity and individualizing treatment strategies.

Indexed as

methodologyphenotypingstroke

Identifiers

PMID42839308
PMCPMC13642850

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