Evidence map›Paper›PMID 39788764›Full record

ArticleBMJ open2025

Importance of infarct topography in determination of stroke mechanism and recurrence risk: a post-hoc analysis of the dabigatran acute treatment of stroke trial.

Erol Cimen, Kelvin Ng, Brian H Buck, Thalia Field, Shelagh B Coutts, Laura C Gioia, Michael D Hill, Jodi Miller, Oscar R Benavente, Mukul Sharma and 1 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02295826 (Dabigatran Following Transient Ischemic Attack and Minor Stroke), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing 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.

NCT02295826 phase2completednot on this map

Dabigatran Following Transient Ischemic Attack and Minor Stroke

TypeinterventionalSponsorUniversity of AlbertaRan2015 to 2018Enrolled300ConditionsTransient Ischemic Attack, Minor Ischemic StrokeArmsDabigatran, Acetylsalicylic acid
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. 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

11 authors.

Erol CimenSchool of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
Kelvin NgPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Brian H BuckDepartment of Medicine, Univ Alberta, Edmonton, Alberta, Canada.ORCID http://orcid.org/0000-0002-7984-6062
Thalia FieldDepartment of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.ORCID http://orcid.org/0000-0002-1176-0633
Shelagh B CouttsDepartment of Clinical Neruosciences, University Calgary, Calgary, Alberta, Canada.
Laura C GioiaUniversity of Montreal, Montreal, Québec, Canada.
Michael D HillDepartment of Clinical Neruosciences, University Calgary, Calgary, Alberta, Canada.
Jodi MillerPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Oscar R BenaventeDepartment of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
Mukul SharmaPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Ken ButcherSchool of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia ken.butcher@unsw.edu.au.ORCID http://orcid.org/0000-0002-0590-7918

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the relationship between infarct pattern, inferred stroke mechanism and risk of recurrence in patients with ischaemic stroke. The question is clinically relevant to optimise secondary stroke prevention investigations and treatment.

designWe conducted a retrospective analysis of the dabigatran treatment of acute stroke II (DATAS II) trial (ClinicalTrials.gove NCT NCT02295826), in which patients underwent diffusion-weighted imaging (DWI) at baseline and 30 days after randomisation to one of two antithrombotic therapies. Patients were classified as embolic, isolated small subcortical infarcts or transient ischaemic attack TIA (no infarct) at baseline and day 30. Stroke mechanism was determined by traditional and modified (based on DWI lesion findings) Trial of Org 10 172 in Acute Stroke Treatment (TOAST) criteria (DWI-TOAST).

settingMulticentre (6) tertiary acute stroke treatment hospitals.

participants305 adults with minor ischaemic stroke (National Institutes of Health Stroke Scale (NIHSS) score≤9).

resultsOf 305 patients, 148 had embolic pattern infarcts, 93 were isolated small subcortical infarcts and 64 had no infarct on baseline MRI (TIA). In the absence of DWI, TOAST classification indicated the mechanism was cryptogenic in 147 patients (48.2%), and small-vessel occlusion in 127 (41.6%). Using, DWI-TOAST, the number of cryptogenic strokes decreased to 123 (40.3%), and the number of small-vessel occlusion strokes increased to 151 (49.5%). Recurrent infarcts were seen in 13% of patients with an MRI-defined embolic infarct pattern and cryptogenic mechanism on DWI-TOAST. The relative risk of recurrent infarction in patients with undetermined aetiology was increased compared with other categories (standardised coefficient=1.0 (0.1, 1.9), p=0.029). The topography of recurrent infarcts was most often embolic (60.9%), but in 39.1% an isolated small subcortical infarct was seen.

conclusionsDefinitive identification of infarct topography with DWI has a significant impact on infarct mechanism classification. The variable relationship between baseline infarct patterns, clinical presentation and recurrent infarct distribution is a challenge to both the lacunar and embolic stroke of uncertain source (ESUS) concepts. Irrespective of aetiological classification, patients with MRI-defined cryptogenic embolic pattern infarcts are at high risk for recurrent events. TRIAL REGISTRATION NUMBER: Linked to the DATAS II trial. CLINICALTRIALS: gov ID NCT02295826.

Indexed as

DabigatranDiffusion Magnetic Resonance ImagingIschemic StrokeRecurrenceAgedAged, 80 and overAntithrombinsClinical Trials, Phase II as TopicFemaleHumansIschemic Attack, TransientMaleMiddle AgedMulticenter Studies as TopicRandomized Controlled Trials as TopicRetrospective StudiesAntithrombinsDabigatranAnticoagulationMagnetic Resonance ImagingSTROKE MEDICINE

Identifiers

PMID39788764
PMCPMC11751999

What Socratic holds

Textmetadata
LicenceCC BY-NC
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 Socratic graph.