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Updated: Mar 19, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Visual Aid Tool to Improve Decision Making in Anticoagulation for Stroke Prevention
Gustavo Saposnik1, Raed A Joundi2
1Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Neuroeconomics and Social Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
New oral anticoagulants (NOACs) reduce stroke and intracranial hemorrhage risk in atrial fibrillation (AF) patients compared to warfarin. However, NOACs increase gastrointestinal bleeding risk, necessitating careful patient-clinician discussion.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Atrial fibrillation (AF) patient stroke prevention management has evolved.
- New oral anticoagulants (NOACs) offer benefits but optimal agent selection remains challenging.
- Visual aids can assist clinicians and patients in choosing anticoagulants for stroke prevention.
Purpose of the Study:
- To provide a visual aid tool for selecting oral anticoagulants in AF patients.
- To compare the benefits and risks of NOACs versus warfarin for stroke prevention.
Main Methods:
- A meta-analysis of 58,541 participants was used.
- Visual plots (Cates plots) were generated to represent comparative benefits.
- Primary outcome was stroke or systemic embolism.
Main Results:
- NOACs reduced stroke/systemic embolism (31 vs. 38 per 1000) and intracranial hemorrhage (7 vs. 15 per 1000) compared to warfarin.
- NOACs increased gastrointestinal bleeding (25 vs. 20 per 1000) compared to warfarin.
- Risk reduction ratios (RR) and confidence intervals (CI) were calculated for each outcome.
Conclusions:
- NOACs prevent 7 additional strokes/systemic embolisms and 8 cerebral hemorrhages per 1000 AF patients versus warfarin.
- NOACs result in 5 additional gastrointestinal bleeding events per 1000 AF patients.
- Cates plots visually summarize these findings, aiding patient-clinician decision-making on anticoagulation therapy.
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