APIXABAN has been shown to reduce the risk of nonlacunar covert infarcts in patients who have experienced a recent cryptogenic stroke and have atrial cardiopathy. This secondary analysis of the ARCADIA-MRI trial included 174 participants, with a median follow-up period of 27 months, and compared the effects of apixaban to aspirin in preventing covert infarcts.
The ARCADIA trial, which involved 310 participants, aimed to explore the efficacy of anticoagulants in preventing recurrent stroke in patients with cryptogenic ischemic stroke. However, it did not show any benefit of anticoagulation in preventing recurrent strokes. This new ancillary analysis sought to determine whether anticoagulation could help prevent covert infarcts in this population.
In the study, patients were randomized to receive either apixaban (79 participants) or aspirin (95 participants). The primary outcome was the incidence of nonlacunar covert infarcts, as identified by follow-up MRI scans. The results revealed a significant difference between the two treatment groups. In the apixaban group, 5.1% of participants experienced incident covert infarcts, compared to 17.9% in the aspirin group. This difference resulted in a weighted relative risk of 0.29, suggesting that apixaban was associated with a much lower risk of covert infarcts compared to aspirin.
The baseline characteristics between the two groups were well-matched, with a mean age of 66 years and a median modified Rankin Scale score of 1, indicating a relatively mild degree of disability. Notably, 52.3% of participants were male. The study findings suggest that apixaban is an effective alternative to aspirin for preventing covert infarcts in patients with atrial cardiopathy following a cryptogenic stroke.
These results support the potential role of apixaban in stroke prevention strategies, particularly for patients with cryptogenic stroke and atrial cardiopathy. Further studies are needed to explore the long-term implications and to confirm the benefits of apixaban over other treatments in this high-risk population.
Reference: Lansberg MG et al. Apixaban to Prevent Covert Infarcts After Cryptogenic Stroke in Patients With Atrial Cardiopathy. JAMA Neurol. 2025. doi:10.1001/jamaneurol.2024.4838.
Anaya Malik | AMJ
