Evidence map›Paper›PMID 40494580›Full record

ArticleJournal of stroke2025

Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis.

Alexandros A Polymeris, Masatoshi Koga, Daniel Strbian, Adhiyaman Vedamurthy, Manju Krishnan, Mattia Branca, Thomas Horvath, Martina Goeldlin, Gek Shim, Christoph Gumbinger and 16 more

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

Article in Journal of stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03148457 (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-ischaemic Stroke Patients With Atrial fibrillatioN), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing 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.

NCT03148457 nacompletednot on this map

Early Versus Late Initiation of Direct Oral Anticoagulants in Post-ischaemic Stroke Patients With Atrial fibrillatioN (ELAN): an International, Multicentre, Randomised-controlled, Two-arm, Assessor-blinded Trial

TypeinterventionalSponsorInsel Gruppe AG, University Hospital BernRan2017 to 2023Enrolled2,013ConditionsIschaemic StrokeArmsEarly treatment with Rivaroxaban (Xarelto®), Dabigatran (Pradaxa®), Apixaban (Eliquis®) or Edoxaban (Lixiana®), Late treatment with Rivaroxaban (Xarelto®), Dabigatran (Pradaxa®), Apixaban (Eliquis®) or Edoxaban (Lixiana®)
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
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

26 authors.

Alexandros A PolymerisDepartment of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Masatoshi KogaDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Daniel StrbianDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Adhiyaman VedamurthyGlan Clwyd Hospital, Betsi Cadwaladr University Local Health Board, Rhyl, UK.
Manju KrishnanStroke Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
Mattia BrancaDepartment of Clinical Research, Clinical Trial Unit (CTU) Bern, University of Bern, Bern, Switzerland.
Thomas HorvathDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Martina GoeldlinDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Gek ShimUniversity Hospital of North Durham, Durham, UK.
Christoph GumbingerDepartment of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
Liqun ZhangDepartment of Neurology, St George's University Hospital, London, UK.
Espen Saxhaug KristoffersenDepartment of Neurology, Akershus University Hospital, Lørenskog, Norway.
Philippe DesfontainesStroke Unit, Department of Neurology, CHC-Groupe Santé, Liège, Belgium.
Peter VanackerDepartment of Neurology, AZ Groeninge, Kortrijk, Belgium.
Angelika AlonsoDepartment of Neurology, University Medical Center Mannheim and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Sven PoliDepartment of Neurology & Stroke, Eberhard Karls University Tübingen, Tübingen, Germany.
Ana Paiva NunesInternal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Nicoletta G CaraccioloDepartment of Human Neurosciences, University La Sapienza, Rome, Italy.
Markus KneihslDepartment of Neurology, Medical University of Graz, Graz, Austria.
Timo KahlesDepartment of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Daria GiudiciInternal, Vascular, and Emergency Medicine, Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Silja RätyDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Marjaana TiainenDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Jesse DawsonSchool of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
Urs FischerDepartment of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
ELAN Investigators

Funding

Cardiovascular Diseases of the National Cerebral and Cardiovascular Center 20-4-5Stroke Association in the United Kingdom 2017/02Swiss Heart FoundationSwiss National Science Foundation 32003B_169975Swiss National Science Foundation 32003B_197009
6 · The paper itself

Abstract

background and purposeAntiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach.

methodsA post-hoc analysis of ELAN (Early versus Late Initiation of Direct Oral Anticoagulants in Post-ischemic Stroke Patients with Atrial Fibrillation) trial data (NCT03148457) was conducted to compare the risk of recurrent ischemic stroke, systemic embolism, major bleeding (extracranial or intracranial hemorrhage [ICH]), and vascular death within 30 days (as a composite and as individual outcomes) in participants treated with and without antiplatelets before DOAC initiation after an AF-associated ischemic stroke. We used both logistic and cause-specific Cox proportional hazards regression in inverse probability of treatment weighted models to account for confounding. We calculated the net benefit of antiplatelet use by subtracting the weighted rate of excess bleeding events attributable to antiplatelets from the rate of excess ischemic events possibly prevented by antiplatelets.

resultsAmong 2,013 participants (median age 77 years, 45.5% female), 1,090 (54.1%) used antiplatelets, and 70 (3.5%) experienced the composite outcome. Antiplatelet use was not associated with the composite outcome (inverse probability of treatment weighted odds ratio [ORweighted] 1.06, 95% confidence interval [CI] 0.66-1.72; inverse probability of treatment weighted hazard ratio [HRweighted] 1.06, 95% CI 0.65-1.72), but showed a lower risk of ischemic stroke recurrence (ORweighted 0.58 [0.30-1.08], HRweighted 0.57 [0.30-1.10]), and a higher risk of major bleeding (ORweighted 1.76 [0.56-6.63], HRweighted 1.88 [0.56-6.39]). Its net benefit was +0.57 (95% CI -1.25 to +2.34) to +0.30 (-1.82 to +2.27) weighted events/100 person-months for ICH weights 1.5 to 3.1.

conclusionFollowing an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.

Indexed as

AnticoagulantsAntiplatelet bridgingAntiplateletsAtrial fibrillationIschemic strokeTiming

Identifiers

PMID40494580
PMCPMC12152450

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.