Abstract
Abstract 103: Anticoagulation versus Antiplatelets Across Subgroups of Embolic Stroke of Undetermined Source: A Meta-Analysis of Seven Randomized Controlled Trials
Stroke (1970), Vol.56(Suppl_1)
02/2025
DOI: 10.1161/str.56.suppl_1.103
Abstract
Abstract only Background: The term embolic stroke of undetermined source (ESUS) encompasses a substantial but heterogeneous population of patients with ischemic stroke, underscoring the importance of identifying personalized treatment strategies. In subgroups of patients randomized in ESUS trials, we evaluated the effectiveness of anticoagulation compared to antiplatelet therapy in secondary ischemic stroke prevention. Methods: A study-level meta-analysis was conducted of randomized controlled trials of patients with ESUS, comparing anticoagulation to antiplatelet therapy. The primary efficacy outcome was recurrent ischemic stroke and safety outcomes were major bleeding and death. Subgroups assessed were age, sex, presence of patent foramen ovale (PFO), left atrial enlargement (LAE), and atrial cardiopathy. Pooled relative risks (RRs) were meta-analyzed. Cochrane Risk of Bias Tool 2.0 (RoB 2) was used for risk of bias assessment. Results: A total of seven randomized controlled trials involving 14,804 patients were analyzed, with 7,406 patients treated with anticoagulation, and 7,398 treated with antiplatelet therapy. Compared with antiplatelet therapy, anticoagulation was associated with a similar rate of recurrent ischemic stroke (RR 0.91, 95% CI 0.80-1.05; I2 = 0%). In ESUS with PFO, anticoagulation was associated with significantly lower risk of ischemic stroke (RR 0.59, 95% CI 0.35-0.98; I2 = 0%). Heterogeneity was present in those with LAE: antiplatelet therapy was superior in trials allowing cardiac monitoring after randomization (RR 6.65, 95% CI 1.26-35.08; I2 = 0%), but anticoagulation was superior in trials prohibiting cardiac monitoring after randomization (RR 0.25 95% CI 0.07-0.89). Subgroups based on age, sex, or presence of atrial cardiopathy did not benefit from anticoagulation over antiplatelet therapy. Conclusions: In this meta-analysis, an empiric anticoagulation approach is not beneficial for patients with ESUS. This finding highlights the importance of an individualized treatment strategy. Such a strategy should include prolonged cardiac monitoring for atrial fibrillation, particularly in patients with moderate to severe LAE. Anticoagulation treatment showed promise in patients with medically treated PFO. Other subgroups did not benefit from anticoagulation therapy. Large prospective studies within ESUS subgroups are needed to validate our findings.
Details
- Title: Subtitle
- Abstract 103: Anticoagulation versus Antiplatelets Across Subgroups of Embolic Stroke of Undetermined Source: A Meta-Analysis of Seven Randomized Controlled Trials
- Creators
- Malik Ghannam - University of IowaAbdullah Al-Qudah - University of Pittsburgh Medical CenterQasem Alshaer - University of IowaRichard Kronmal - University of WashingtonGeorge Ntaios - University of ThessalyW Longstreth - Harborview Medical CenterKaren Furie - Brown UniversityJeffrey Saver - University of California, Los AngelesSCOTT Kasner - Penn Center for AIDS ResearchMitchell Elkind - American Heart Association, New York, New York, United StatesDavid Tirschwell - Harborview Medical CenterSven Poli - University of TübingenHooman Kamel - Cornell UniversityShadi Yaghi - Brown University
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.56(Suppl_1)
- DOI
- 10.1161/str.56.suppl_1.103
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Date published
- 02/2025
- Academic Unit
- Neurology
- Record Identifier
- 9984786280802771
Metrics
13 Record Views