Abstract DP007: Individual Participant Data Meta-Analysis of Randomized Trials of Direct Oral Anticoagulants compared with Aspirin in Patients with Embolic Strokes of Undetermined Source
Rattachement africain : ca, de, us, au, jp. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: Anticoagulation did not reduce the risk of stroke recurrence compared with antiplatelet therapy in randomized controlled trial (RCT) participants with embolic stroke of undetermined source (ESUS). Subsequent analyses of individual RCTs suggested a benefit of anticoagulation in particular subgroups, but these findings have not been consistently replicated. We aimed to determine the effect of anticoagulation in ESUS patients and pre-specified subgroups using pooled RCT data. Methods: We performed an individual participant data meta-analysis (IPD-MA) of published RCTs comparing anticoagulation with antiplatelet therapy after ESUS on the primary outcomes of stroke recurrence and major bleeding, in addition to other secondary cardiovascular endpoints. The effect of anticoagulation on the risk for stroke recurrence compared with aspirin was further explored in subgroups predefined by baseline demographics, medical comorbidities, concomitant medication use, and echocardiographic and electrocardiographic parameters. Databases from individual RCTs were obtained and hazard ratios (HRs) with corresponding 95% confidence intervals (95%CIs) in the overall trial population and subgroups were estimated following adjustment for predefined covariates, using Cox proportional hazard models. Adjusted HRs were then combined into pooled estimates using the random-effects model. Differences between subgroups were assessed using Cochran's Q test of heterogeneity. The protocol of the IPD-MA is published in PROSPERO (CRD42025644724). Results: We included 4 RCTs with a total of 13,970 participants (mean age 66 years; 39% female). Baseline characteristics were well balanced between the treatment groups (Figure 1). Participants allocated to anticoagulant therapy (n=6,989) had comparable risks of stroke recurrence (adjusted HR=0.94, 95%CI: 0.78-1.14) and major bleeding (adjusted HR=1.21, 95%CI: 0.52-2.80) compared with participants allocated to antiplatelet therapy (n=6,981). We identified no significant difference in secondary efficacy or safety cardiovascular endpoints (Figure 2). We did not identify any predefined subgroup in which the effect of anticoagulation significantly differed from antiplatelet therapy (Figure 3). Conclusion: Anticoagulation did not reduce the risk for stroke recurrence or other cardiovascular events after ESUS when compared with antiplatelet therapy. None of the predefined subgroups benefitted from anticoagulation.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Abstract DP007: Individual Participant Data Meta-Analysis of Randomized Trials of Direct Oral Anticoagulants compared with Aspirin in Patients with Embolic Strokes of Undetermined Source
- Date Crossref
- 01/02/2026
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
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Population Health Research Institute pays non établi dans la noticeÉtablissement de santé
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University of Duisburg-Essen pays non établi dans la noticeUniversité ou école supérieure
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Population Health Research Institute, University of Duisburg-Essen et Cornell University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.