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April 23, 2025European Stroke JournalOpen Access

Anticoagulation reduces stroke recurrence ~53% in DDAF post-stroke or TIA but increases major bleeding.

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Why the study?

While anticoagulation reduces thromboembolic risk in clinical AF, its benefit-risk profile for secondary stroke prevention in device-detected atrial fibrillation remains uncertain.

Does anticoagulation reduce any stroke recurrence in patients with device-detected atrial fibrillation post-stroke or TIA?

Population

599 patients with DDAF post stroke or TIA across 2 RCTs

Comparison

Anticoagulation vs no-anticoagulation

Design

Systematic review and meta-analysis of RCTs

Key result

Anticoagulation significantly reduced any stroke recurrence (RR 0.47; 95% CI 0.23-0.94; p=0.034) but increased major bleeding risk (RR 2.30) in patients with DDAF post-stroke or TIA.

Authors

LPLina PalaiodimouAKAristeidis H. KatsanosKMKonstantinos Melanis

Discussion

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Member takes

Overview

Requires individualized risk stratification for anticoagulation in device-detected AF post-stroke/TIA; challenges weak prior consensus against benefit.

Study Design

Type

Meta-Analysis (n=599)

Structured PICO

Does anticoagulation reduce any stroke recurrence in patients with device-detected atrial fibrillation post-stroke or TIA?

P
Population
599 patients with device-detected atrial fibrillation (DDAF) post stroke or transient ischemic attack (TIA) from 2 RCTs
I
Intervention
Anticoagulation
C
Comparator
No-anticoagulation
O
Outcome
Any stroke recurrencehard clinical

Main Result

Effect estimate: RR 0.47 (95% CI 0.23-0.94)

p-value: p=0.034

Anticoagulation in patients with device-detected AF post-stroke/TIA reduces stroke recurrence but increases major bleeding risk, highlighting the need for individualized risk stratification.

Cite This Study

Palaiodimou et al. (2025) conducted a meta-analysis in Device-detected atrial fibrillation post stroke or transient ischemic attack (n=599). Anticoagulation vs. No-anticoagulation was evaluated on Any stroke recurrence (RR 0.47, 95% CI 0.23-0.94, p=0.034). Anticoagulation significantly reduced any stroke recurrence (RR 0.47; 95% CI 0.23-0.94; p=0.034) but increased major bleeding risk (RR 2.30) in patients with DDAF post-stroke or TIA.

synapsesocial.com/papers/6a0ed925fca5c6c9f447a804https://doi.org/10.1177/23969873251334278
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy of anticoagulation in atrial fibrillation: evidence from 36 years of randomized controlled trials - a meta-analysis2025
  2. 2Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials2024 · 37 citations
  3. 3Anticoagulation versus no anticoagulation after intracranial hemorrhage in patients with atrial fibrillation: an updated systematic review and meta-analysis2025 · 1 citations
  4. 4Anticoagulation in Patients With Device‐Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH‐AFNET 6 Trial2024 · 30 citations
  5. 5Recurrent stroke due to atrial fibrillation: perspectives on an unsolved problem2023 · 1 citations