{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:33:13Z","timestamp":1772253193166,"version":"3.50.1"},"reference-count":19,"publisher":"Sociedade Brasileira de Cardiologia","issue":"6","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Bras. Cardiol."],"abstract":"<jats:p>Resumo O acidente vascular cerebral (AVC) Emb\u00f3lico de Fonte Indeterminada (ESUS, do ingl\u00eas embolic stroke of undetermined source) corresponde a cerca de 20% dos AVCs isqu\u00eamicos. O tratamento ideal para a preven\u00e7\u00e3o secund\u00e1ria do ESUS ainda n\u00e3o est\u00e1 claro. Realizar uma revis\u00e3o sistem\u00e1tica e metan\u00e1lise de ensaios cl\u00ednicos randomizados (ECRs) comparando a seguran\u00e7a e a efic\u00e1cia dos anticoagulantes orais diretos (DOACs) versus aspirina em pacientes com ESUS. Foi realizada uma busca sistem\u00e1tica nas bases de dados PubMed, Embase, Cochrane e Web of Science para identificar ECRs eleg\u00edveis at\u00e9 mar\u00e7o de 2024. O desfecho prim\u00e1rio foi a recorr\u00eancia de AVC, e os desfechos de seguran\u00e7a inclu\u00edram sangramento maior e sangramento clinicamente relevante n\u00e3o maior (CRNMB, clinically relevant non-major bleeding). Foram calculadas raz\u00f5es de chance (HRs) e intervalos de confian\u00e7a (ICs) de 95% para a an\u00e1lise. Foram inclu\u00eddos quatro RCTs, envolvendo 13.970 pacientes, dos quais metade foi randomizada para o grupo de DOACs. Durante um acompanhamento m\u00e9dio de 16 meses, os DOACs n\u00e3o reduziram significativamente a recorr\u00eancia de AVC (HR: 0,95; IC 95%: 0,81-1,09; p=0,44), AVC isqu\u00eamico (HR: 0,91; IC 95%: 0,79-1,06; p=0,23), mortalidade por todas as causas (HR: 1,11; IC 95%: 0,87-1,42; p=0,40) ou sangramento maior (HR: 1,56; IC 95%: 0,85%-2,86; p=0,15) em compara\u00e7\u00e3o \u00e0 aspirina. No entanto, os DOACs foram associados a um risco significativamente maior de CRNMB (HR: 1,54; IC 95%: 1,23-1,92; p=0,0002). A an\u00e1lise de subgrupos n\u00e3o revelou diferen\u00e7as significativas na recorr\u00eancia de AVC entre pacientes com escores CHA2-DS2-VASc baixos ou altos. Os DOACs n\u00e3o demonstraram efic\u00e1cia superior \u00e0 aspirina na preven\u00e7\u00e3o da recorr\u00eancia de AVC em pacientes com ESUS e foram associados a um aumento do risco de CRNMB.<\/jats:p>","DOI":"10.36660\/abc.20240586","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T12:01:36Z","timestamp":1752235296000},"source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulantes Orais Diretos versus Aspirina para Preven\u00e7\u00e3o Secund\u00e1ria de Acidente Vascular Cerebral em Pacientes com Acidente Vascular Cerebral Emb\u00f3lico de Fonte Indeterminada: Revis\u00e3o Sistem\u00e1tica e Metan\u00e1lise Atualizada de Ensaios Cl\u00ednicos Randomizados"],"prefix":"10.36660","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2409-7675","authenticated-orcid":false,"given":"Juan Armando","family":"Talavera","sequence":"first","affiliation":[{"name":"Mount Sinai Medical Center,  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Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Catholic University of Bolivia,  Bol\u00edvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Healey","sequence":"additional","affiliation":[{"name":"McMaster University,  Canad\u00e1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana","family":"Armaganijan","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8587-875X","authenticated-orcid":false,"given":"Guilherme Dagostin de","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  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