Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation

Hart, Robert G.; Pearce, Lesly A.; Aguilar, Maria I.

doi:10.7326/0003-4819-146-12-200706190-00007

Cited by 4,793Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation

Hart, Robert G., Pearce, Lesly A., Aguilar, Maria I.·2007·Annals of Internal Medicine

DOI 10.7326/0003-4819-146-12-200706190-00007

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Abstract

BACKGROUND: Atrial fibrillation is a strong independent risk factor for stroke. PURPOSE: To characterize the efficacy and safety of antithrombotic agents for stroke prevention in patients who have atrial fibrillation, adding 13 recent randomized trials to a previous meta-analysis. DATA SOURCES: Randomized trials identified by using the Cochrane Stroke Group search strategy, 1966 to March 2007, unrestricted by language. STUDY SELECTION: All published randomized trials with a mean follow-up of 3 months or longer that tested antithrombotic agents in patients who have nonvalvular atrial fibrillation. DATA EXTRACTION: Two coauthors independently extracted information regarding interventions; participants; and occurrences of ischemic and hemorrhagic stroke, major extracranial bleeding, and death. DATA SYNTHESIS: Twenty-nine trials included 28,044 participants (mean age, 71 years; mean follow-up, 1.5 years). Compared with the control, adjusted-dose warfarin (6 trials, 2900 participants) and antiplatelet agents (8 trials, 4876 participants) reduced stroke by 64% (95% CI, 49% to 74%) and 22% (CI, 6% to 35%), respectively. Adjusted-dose warfarin was substantially more efficacious than antiplatelet therapy (relative risk reduction, 39% [CI, 22% to 52%]) (12 trials, 12 963 participants). Other randomized comparisons were inconclusive. Absolute increases in major extracranial hemorrhage were small (< or =0.3% per year) on the basis of meta-analysis. LIMITATION: Methodological features and quality varied substantially and often were incompletely reported. CONCLUSIONS: Adjusted-dose warfarin and antiplatelet agents reduce stroke by approximately 60% and by approximately 20%, respectively, in patients who have atrial fibrillation. Warfarin is substantially more efficacious (by approximately 40%) than antiplatelet therapy. Absolute increases in major extracranial hemorrhage associated with antithrombotic therapy in participants from the trials included in this meta-analysis were less than the absolute reductions in stroke. Judicious use of antithrombotic therapy importantly reduces stroke for most patients who have atrial fibrillation.

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Oral anticoagulation with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants markedly reduces stroke and mortality in AF patients.
“Oral anticoagulation (OAC) with vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) markedly reduces stroke and mortality in AF patients.38,39”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [38]
OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.
“OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [38]
Controlled trials studying oral anticoagulation in AF patients have been enriched for patients at high risk of stroke.
“Controlled trials studying OAC in AF patients have been enriched for patients at high risk of stroke, 38,39,42,194,201,329,351,352”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [38]
There is strong evidence that patients with a CHA2DS2-VASc risk score of 2 or more in men, and 3 or more in women, benefit from oral anticoagulation.
“and hence there is strong evidence that patients with a CHA 2 DS 2 -VASc risk score of 2 or more in men, and 3 or more in women benefit from OAC.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [38]
Vitamin K antagonist therapy reduces risk of stroke by two-thirds and mortality by one-quarter compared with control (aspirin or no therapy).
“VKA therapy reduces risk of stroke by two-thirds and mortality by one-quarter compared with control (aspirin or no therapy).38”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [38]

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
“OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.(38,39,42,194,201,329,350) – 352 It is superior”
Influential
2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Journal of Heart Failure · doi:10.1002/ejhf.592 · Cited by 5,866 · see citing works
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,875 · see citing works
2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., et al. (2013) · Journal of Hypertension · doi:10.1097/01.hjh.0000431740.32696.cc · Cited by 5,655 · see citing works
Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Kernan, W. N., Ovbiagele, B., Black, H. R., Bravata, D. M., Chimowitz, M. I., Ezekowitz, M. D., Fang, M. C., Fisher, M., Furie, K. L., Heck, D. V., et al. (2014) · Stroke · doi:10.1161/str.0000000000000024 · Cited by 5,170 · see citing works
Edoxaban versus warfarin in patients with atrial fibrillation
Giugliano, R. P., Ruff, C. T., Braunwald, E., Murphy, S. A., Wiviott, S. D., Halperin, J. L., Waldo, A. L., Ezekowitz, M. D., Weitz, J. I., Špinar, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1310907 · Cited by 5,164 · see citing works
Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials
Ruff, C. T., Giugliano, R. P., Braunwald, E., Hoffman, E. B., Deenadayalu, N., Ezekowitz, M. D., Camm, A. J., Weitz, J. I., Lewis, B. S., Parkhomenko, A., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)62343-0 · Cited by 5,051 · see citing works
A Novel User-Friendly Score (HAS-BLED) To Assess 1-Year Risk of Major Bleeding in Patients With Atrial Fibrillation
Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J. G. M., & Lip, G. Y. H. (2010) · CHEST Journal · doi:10.1378/chest.10-0134 · Cited by 4,517 · see citing works
2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS)
Aboyans, V., Ricco, J.-B., Bartelink, M.-L. E. L., Björck, M., Brodmann, M., Cohnert, T., Collet, J.-P., Czerny, M., De Carlo, M., Debus, S., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehx095 · Cited by 3,293 · see citing works
Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Johnson, C. O., Nguyen, M., Roth, G. A., Nichols, E. L., Alam, S., Abate, D., Abd-Allah, F., Abdelalim, A., Abraha, H. N., Abu-Rmeileh, N. M., et al. (2019) · The Lancet Neurology · doi:10.1016/s1474-4422(19)30034-1 · Cited by 3,324 · see citing works
2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
Gelder, I. C. V., Rienstra, M., Bunting, K. V., Casado-Arroyo, R., Caso, V., Crijns, H. J. G. M., Potter, T. J. R. D., Dwight, J., Guasti, L., Hanke, T., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae176 · Cited by 3,338 · see citing works
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A. M., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 2,989 · see citing works
2023 ESC Guidelines for the management of cardiomyopathies
Arbelo, E., Protonotarios, A., Gimeno, J. R., Arbustini, E., Villa, R. B., Basso, C., Bezzina, C. R., Biagini, E., Blom, N. A., de Boer, R. A., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad194 · Cited by 2,947 · see citing works
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons
January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000665 · Cited by 2,744 · see citing works
Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
Meschia, J. F., Bushnell, C., Boden-Albala, B., Braun, L. T., Bravata, D. M., Chaturvedi, S., Creager, M. A., Eckel, R. H., Elkind, M. S. V., Fornage, M., et al. (2014) · Stroke · doi:10.1161/str.0000000000000046 · Cited by 2,650 · see citing works
Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008
The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee (2008) · Cerebrovascular Diseases · doi:10.1159/000131083 · Cited by 2,475 · see citing works
Apixaban in patients with atrial fibrillation
Connolly, S. J., Eikelboom, J., Joyner, C., Diener, H.-C., Hart, R., Golitsyn, S., Flaker, G., Avezum, A., Hohnloser, S. H., Diaz, R., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1007432 · Cited by 2,483 · see citing works
Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial
Holmes, D. R., Reddy, V. Y., Turi, Z. G., Doshi, S. K., Sievert, H., Buchbinder, M., Mullin, C. M., & Sick, P. B. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61343-x · Cited by 2,242 · see citing works
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Calkins, H. G., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.01.011 · Cited by 2,237 · see citing works
Effect of clopidogrel added to aspirin in patients with atrial fibrillation
The ACTIVE Investigators (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0901301 · Cited by 2,102 · see citing works
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000040 · Cited by 2,056 · see citing works
“Evaluate renal function prior to initiation of direct thrombin or factor Xa inhibitors, and re-evaluate when clinically indicated and at least annually I B (80-82)”
Influential
Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy
Holmes, D. R., Kar, S., Price, M. J., Whisenant, B. K., Sievert, H., Doshi, S. K., Huber, K., & Reddy, V. Y. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.04.029 · Cited by 1,850 · see citing works
“This pathophysiology led to the widespread application of anticoagulant therapy, initially with warfarin, which has been proven superior to aspirin for stroke prevention (22).”
Background
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · EP Europace · doi:10.1093/europace/euq350 · Cited by 1,749 · see citing works
2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
Marx, N., Federici, M., Schütt, K., Müller-Wieland, D., Ajjan, R. A., Antunes, M. J., Christodorescu, R. M., Crawford, C., Di Angelantonio, E., Eliasson, B., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad192 · Cited by 1,642 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
Guidelines for the Primary Prevention of Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Goldstein, L. B., Bushnell, C. D., Adams, R. J., Appel, L. J., Braun, L. T., Chaturvedi, S., Creager, M. A., Culebras, A., Eckel, R. H., Hart, R. G., et al. (2011) · Stroke · doi:10.1161/str.0b013e3181fcb238 · Cited by 1,306 · see citing works
Atrial fibrillation in patients with cryptogenic stroke
Gladstone, D. J., Spring, M., Dorian, P., Panzov, V., Thorpe, K. E., Hall, J., Vaid, H., O'Donnell, M., Laupacis, A., Côté, R., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311376 · Cited by 1,276 · see citing works
Stroke
Hankey, G. J. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30962-x · Cited by 1,248 · see citing works
Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation
Lopes, R. D., Heizer, G., Aronson, R., Vora, A. N., Massaro, T., Mehran, R., Goodman, S. G., Windecker, S., Darius, H., Li, J., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1817083 · Cited by 1,228 · see citing works
Atrial Fibrillation
Stærk, L., Sherer, J. A., Ko, D., Benjamin, E. J., & Helm, R. H. (2017) · Circulation Research · doi:10.1161/circresaha.117.309732 · Cited by 1,224 · see citing works
The Clinical Profile and Pathophysiology of Atrial Fibrillation
Andrade, J. G., Khairy, P., Dobrev, D., & Nattel, S. (2014) · Circulation Research · doi:10.1161/circresaha.114.303211 · Cited by 1,206 · see citing works
Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation
Lip, G. Y. H., Frison, L., Halperin, J. L., & Lane, D. A. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.09.024 · Cited by 1,077 · see citing works
5-Year Outcomes After Left Atrial Appendage Closure
Reddy, V. Y., Doshi, S. K., Kar, S., Gibson, D. N., Price, M. J., Huber, K., Horton, R., Buchbinder, M., Neužil, P., Gordon, N. T., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.10.021 · Cited by 1,039 · see citing works
“NOAC = nonwarfarin oral anticoagulation F or decades, oral anticoagulation (OAC) (initially warfarin, and more recently, the nonwarfarin oral anticoagulants [NOACs]) has been the therapeutic mainstay for stroke prophylaxis in atrial fibrillation (AF) (1,2).”
Background
Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source
Hart, R. G., Sharma, M., Mundl, H., Kasner, S. E., Bangdiwala, S. I., Berkowitz, S. D., Swaminathan, B., Lavados, P. M., Wang, Y., Wang, Y., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1802686 · Cited by 1,032 · see citing works
Percutaneous Left Atrial Appendage Closure vs Warfarin for Atrial Fibrillation: A Randomized Clinical Trial
Reddy, V. Y., Sievert, H., Halperin, J., Doshi, S. K., Buchbinder, M., Neuzil, P., Huber, K., Whisenant, B., Kar, S., Swarup, V., et al. (2014) · JAMA · doi:10.1001/jama.2014.15192 · Cited by 1,018 · see citing works
“Carl Jacobs (Piedmont Hospital, Atlanta [2]); Rajesh Dave (Harrisburg Hospital, Harrisburg, Pennsylvania [1]); John Young (Lindner Clinical Trial Center, Cincinnati, Ohio [1]); David Lasorda (Allegheny General Hospital, Pittsburgh [1]).”
Background
Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial
Wallentin, L. C., Yusuf, S., Ezekowitz, M. D., Alings, M., Flather, M. D., Franzosi, M. G., Pais, P. S., Dans, A., Eikelboom, J. W., Oldgren, J., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(10)61194-4 · Cited by 1,011 · see citing works
Editor's Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)
Aboyans, V., Ricco, J., Bartelink, M.-L. E. L., Björck, M., Brodmann, M., Cohnert, T. U., Collet, J., Czerny, M., Carlo, M. D., Debus, S., et al. (2017) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2017.07.018 · Cited by 1,006 · see citing works
Antithrombotic Therapy for Atrial Fibrillation
Lip, G. Y. H., Banerjee, A., Boriani, G., Chiang, C. E., Fargo, R. A., Freedman, B., Lane, D. A., Ruff, C. T., Turakhia, M. P., Werring, D. J., et al. (2018) · CHEST Journal · doi:10.1016/j.chest.2018.07.040 · Cited by 952 · see citing works
Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO)
Herzog, C. A., ASINGER, R. W., Berger, A. K., Charytan, D. M., Dı́ez, J., Hart, R. G., Eckardt, K., Kasiske, B. L., McCullough, P. A., PASSMAN, R. S., et al. (2011) · Kidney International · doi:10.1038/ki.2011.223 · Cited by 918 · see citing works
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis
Odutayo, A., Wong, C. X. J., Hsiao, A. J., Hopewell, S., Altman, D. G., & Emdin, C. A. (2016) · BMJ · doi:10.1136/bmj.i4482 · Cited by 888 · see citing works
Safety of Percutaneous Left Atrial Appendage Closure
Reddy, V. Y., Holmes, D. R., Doshi, S. K., Neužil, P., & Kar, S. (2011) · Circulation · doi:10.1161/circulationaha.110.976449 · Cited by 863 · see citing works
A New Risk Scheme to Predict Warfarin-Associated Hemorrhage
Fang, M. C., Go, A. S., Chang, Y., Borowsky, L. H., Pomernacki, N. K., Udaltsova, N. V., & Singer, D. E. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.03.031 · Cited by 853 · see citing works
Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Goldstein, L. B., Bushnell, C., Adams, R. J., Appel, L. J., Braun, L. T., Chaturvedi, S., Creager, M. A., Culebras, A., Eckel, R. H., Hart, R. G., et al. (2011) · Stroke · Cited by 745 · see citing works
Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke
Whitlock, R. P., Belley‐Côté, E. P., Paparella, D., Healey, J. S., Brady, K., Sharma, M., Reents, W., Budera, P., Baddour, A. J., Fila, P., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2101897 · Cited by 741 · see citing works
The 2015 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension
Daskalopoulou, S. S., Rabi, D. M., Zarnke, K. B., Dasgupta, K., Nerenberg, K. A., Cloutier, L., Gelfer, M., Lamarre-Cliché, M., Milot, A., Bolli, P., et al. (2015) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2015.02.016 · Cited by 678 · see citing works
Percutaneous Left Atrial Appendage Closure for Stroke Prophylaxis in Patients With Atrial Fibrillation
Reddy, V. Y., Doshi, S. K., Sievert, H., Buchbinder, M., Neužil, P., Huber, K., Halperin, J. L., & Holmes, D. R. (2013) · Circulation · doi:10.1161/circulationaha.112.114389 · Cited by 677 · see citing works
The 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in Collaboration With the European Society for Vascular Surgery (ESVS)
Halliday, A. W., & Bax, J. J. (2018) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2018.03.004 · Cited by 654 · see citing works
Cardiovascular, bleeding, and mortality risks in elderly medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation
Graham, D. J., Reichman, M. E., Wernecke, M., Zhang, R., Southworth, M. R., Levenson, M., Sheu, T.-C., Mott, K., Goulding, M. R., Houstoun, M., et al. (2015) · Circulation · doi:10.1161/circulationaha.114.012061 · Cited by 644 · see citing works
Guidelines on oral anticoagulation with warfarin – fourth edition
Keeling, D. M., Baglin, T. P., Tait, R. C., Watson, H. G., Perry, D. J., Baglin, C., Kitchen, S., & Makris, M. (2011) · British Journal of Haematology · doi:10.1111/j.1365-2141.2011.08753.x · Cited by 584 · see citing works
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.021 · Cited by 574 · see citing works
Incidence and Prevalence of Atrial Fibrillation and Associated Mortality Among Medicare Beneficiaries: 1993–2007
Piccini, J. P., Hammill, B. G., Sinner, M. F., Jensen, P. N., Hernandez, A. F., Heckbert, S. R., Benjamin, E. J., & Curtis, L. H. (2012) · Circulation: Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.111.962688 · Cited by 565 · see citing works
The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation
Andrade, J. G., Aguilar, M., Atzema, C. L., Bell, A., Cairns, J. A., Cheung, C. C., Cox, J. L., Dorian, P., Gladstone, D. J., Healey, J. S., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.09.001 · Cited by 568 · see citing works
Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial
Svendsen, J. H., Diederichsen, S. Z., Højberg, S., Krieger, D. W., Graff, C., Kronborg, C., Olesen, M. S., Nielsen, J. B., Holst, A. G., Brandes, A., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01698-6 · Cited by 550 · see citing works
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Bénétos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwab154 · Cited by 565 · see citing works
Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug
Tzikas, A., Shakir, S., Gafoor, S. A., Omran, H., Berti, S. L., Santoro, G., Kefer, J., Landmesser, U., Nielsen‐Kudsk, J. E., Cruz‐González, I., et al. (2016) · EuroIntervention · doi:10.4244/eijy15m01_06 · Cited by 545 · see citing works
Screening for Atrial Fibrillation
Freedman, B., Camm, A. J., Calkins, H. G., Healey, J. S., Rosenqvist, M., Wang, J., Albert, C. M., Anderson, C. S., Antoniou, S., Benjamin, E. J., et al. (2017) · Circulation · doi:10.1161/circulationaha.116.026693 · Cited by 548 · see citing works
“For AF, OACs have a major impact on reducing stroke, systemic embolism and all-cause mortality.(31) The non-vitamin-K antagonist OACs (NOACs) further improve outcomes with less intracranial bleeding.”
Background
Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial
Steinhubl, S. R., Waalen, J., Edwards, A. M., Ariniello, L. M., Mehta, R. R., Ebner, G. S., Carter, C., Baca-Motes, K., Felicione, E., Sarich, T., et al. (2018) · JAMA · doi:10.1001/jama.2018.8102 · Cited by 539 · see citing works
New Antithrombotic Drugs
Weitz, J. I., Eikelboom, J. W., & Samama, M. M. (2012) · CHEST Journal · doi:10.1378/chest.11-2294 · Cited by 533 · see citing works
Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control
Skanes, A. C., Healey, J. S., Cairns, J. A., Dorian, P., Gillis, A. M., McMurtry, M. S., Mitchell, L. B., Verma, A., & Nattel, S. (2012) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2012.01.021 · Cited by 494 · see citing works
Identifying Patients at High Risk for Stroke Despite Anticoagulation
Lip, G. Y. H., Frison, L., Halperin, J. L., & Lane, D. A. (2010) · Stroke · doi:10.1161/strokeaha.110.590257 · Cited by 493 · see citing works
The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study
Hijazi, Z., Oldgren, J., Lindbäck, J., Alexander, J. H., Connolly, S. J., Eikelboom, J. W., Ezekowitz, M. D., Held, C., Hylek, E. M., Lopes, R. D., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00741-8 · Cited by 490 · see citing works
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Effectiveness and safety of warfarin and anti-platelet drugs for the primary prevention of stroke in patients with non-valvular atrial fibrillation: a meta-analysis.
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Authors: Hart, R. G., Pearce, L. A., & Aguilar, M. I.
Affiliations: Mayo Clinic (US)
ORCID: Hart, Robert G.
Pearce, Lesly A.
Aguilar, Maria I.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2007-06-19
Volume: 146
Issue: 12
Pages: 857-867
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-146-12-200706190-00007
OpenAlex: W1999468381
Cited by: 4,793
References: 58
Citations by year: 2026: 90 · 2025: 145 · 2024: 198 · 2023: 248 · 2022: 234 · 2021: 288 · 2020: 295 · 2019: 298 · 2018: 324 · 2017: 373 · 2016: 390 · 2015: 352 · 2014: 332 · 2013: 354 · 2012: 331
FWCI: 16.38
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords: non-valvular atrial fibrillation, stroke prevention, antithrombotic therapy, warfarin, antiplatelet agents, hemorrhagic stroke, ischemic stroke, extracranial bleeding, anticoagulation
MeSH terms: Aged, Anticoagulants, Atrial Fibrillation, Fibrinolytic Agents, Hemorrhage, Humans, Platelet Aggregation Inhibitors, Warfarin, Stroke

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Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation

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