ARCADIA: apixaban for secondary stroke prevention in ESUS patients with atrial cardiopathy

David Tirschwell, MD, FAAN, University of Washington, Seattle, WA, presents results from the secondary analysis of the randomized, double-blind ARCADIA trial (NCT03192215), which compared the efficacy of antiplatelet to anticoagulant therapy for secondary stroke prevention in patients with recent embolic stroke of undetermined source (ESUS) with atrial cardiopathy. It was hypothesized that apixaban, an anticoagulant, would be superior to aspirin in improving outcomes for patients showing evidence of atrial cardiopathy. However, the trial was terminated prematurely due to futility, with the findings showing no significant differences between the two treatment approaches. Further investigation into whether apixaban’s efficacy correlated with the severity of atrial cardiopathy also yielded neutral results. It should be noted that early termination of the study could have affected the statistical power of the results, rendering the attainment of statistical significance more challenging. Prof. Tirschwell concludes that the standard of care for secondary stroke prevention in patients with recent ESUS remains as antiplatelet therapy. This interview took place at the World Stroke Congress (WSC) 2023 in Toronto, Canada.
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