ARCADIA-MRI
Trial question
What is the role of apixaban in patients with a recent cryptogenic ischemic stroke and atrial cardiopathy?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
48.0% female
52.0% male
N = 174
174 patients (83 female, 91 male).
Inclusion criteria: patients with a recent cryptogenic ischemic stroke and atrial cardiopathy.
Key exclusion criteria: contraindication on MRI; clear indication for therapeutic-dose anticoagulant therapy; need for antiplatelet therapy; history of spontaneous ICH; CKD; clinically significant bleeding diathesis; unresolved anemia or thrombocytopenia; clinically significant gastrointestinal bleeding within the past year; active hepatitis or hepatic insufficiency with Child-Pugh B or C.
Interventions
N=79 apixaban (at a dose of 5 mg).
N=95 aspirin (at a dose of 81 mg).
Primary outcome
Non-lacunar covert infarcts
5%
18%
18.0 %
13.5 %
9.0 %
4.5 %
0.0 %
Apixaban
Aspirin
Significant
decrease ▼
NNT = 7
Significant decrease in non-lacunar covert infarcts (5% vs. 18%; RR 0.29, 95% CI 0.1 to 0.83).
Secondary outcomes
Significant decrease in non-lacunar covert infarct or non-lacunar symptomatic stroke (9% vs. 26%; RR 0.36, 95% CI 0.17 to 0.79).
No significant difference in non-lacunar symptomatic stroke (4% vs. 8%; RR 0.52, 95% CI 0.15 to 1.77).
No significant difference in lacunar or non-lacunar covert infarcts (15% vs. 26%; RR 0.57, 95% CI 0.31 to 1.07).
Conclusion
In patients with a recent cryptogenic ischemic stroke and atrial cardiopathy, apixaban was superior to aspirin with respect to a non-lacunar covert infarcts.
Reference
Maarten G Lansberg, Max Wintermark, Hui Chen et al. Apixaban to Prevent Covert Infarcts After Cryptogenic Stroke in Patients With Atrial Cardiopathy: A Secondary Analysis of the ARCADIA Randomized Clinical Trial. JAMA Neurol. 2025 Jan 27. Online ahead of print.
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