Anticoagulation Therapy Does Not Reduce Risk of Recurrent Stroke Compared with Aspirin in Those with Cryptogenic Stroke and Atrial Cardiopathy

Treatment with Eliquis (apixaban; Bristol Myers Squibb, New York, NY), an anticoagulant medication, did not significantly reduce the risk of recurrent stroke compared with aspirin therapy in people with cryptogenic stroke and evidence of atrial cardiopathy. The findings of the ARCADIA clinical trial (NCT03192215), which was conducted to compare anticoagulation to antiplatelet therapy, were presented at the American Stroke Association’s International Stroke Conference 2024 and published in JAMA Neurology.

ARCADIA was a multicenter, randomized, double-blind clinical trial that included 1015 participants aged ≥45 years with clinical diagnosis of cryptogenic ischemic stroke who had brain imaging to rule out hemorrhagic stroke and who had evidence of atrial cardiopathy. Participants were randomized 1:1 to receive either Eliquis at 5 mg twice daily and an aspirin placebo once daily, or aspirin at 81 mg once daily and an Eliquis placebo twice daily. The primary outcome of the study was incidence of recurrent stroke of any type.

Forty individuals in the Eliquis group (annualized rate, 4.4%) and 40 individuals in the aspirin group (annualized rate, 4.4%) experienced recurrent stroke (hazard ratio [HR], 1.00; 95% CI, 0.64 to 1.55). This finding suggests that anticoagulation therapy using Eliquis was not superior to antiplatelet therapy using aspirin, in terms of reducing the risk of recurrent stroke in this patient population. According to safety outcomes measured, Eliquis therapy did not increase the risk of intracranial hemorrhage, other major bleeding, or death compared with aspirin therapy.

The study authors are affiliated with Weill Cornell Medicine, the University of Washington, Columbia University, the University of Cincinnati College of Medicine, the Medical University of South Carolina, Wake Forest School of Medicine, the Sunnybrook Health Sciences Centre, McMaster University, the University of Maryland, Baltimore VA Hospital, the University of Tennessee Health Sciences Center, Emory University, the University of Pennsylvania, the Lethbridge Neurologic Research Center, Oregon Health & Science University, and the University of Minnesota.