Findings from the PACIFIC-Stroke trial

Valeria Caso, MD, PhD, FESO, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy, gives an insight to the recent PACIFIC-Stroke trial (NCT04304508) and discusses the implications of the findings. PACIFIC-Stroke was a randomized, double-blind, placebo controlled, Phase IIb trial assessing the safety of factor XIa inhibition with asundexian after acute non-cardioembolic ischemic stroke. It was hypothesized that asundexian add-on therapy may improve secondary prevention of recurrent stroke beyond the use of antiplatelet therapy alone. Patients with acute (within 48 h) non-cardioembolic ischemic stroke were recruited from across nearly 200 hospitals and were randomized to once daily oral asundexian 10 mg, 20 mg, or 50 mg, or placebo, in addition to usual antiplatelet therapy. It was demonstrated that after 26 weeks, asundexian did not increase the risk of major or clinically relevant non-major bleeding, compared with placebo. No difference was seen in the rates of covert brain infarction or ischemic stroke between the placebo and treatment arms. However there was a trend towards reduction in recurrent ischemic stroke or transient ischemic attack for patients who received 50 mg of asundexian, particularly those with atherosclerotic stroke. This interview took place at the World Stroke Congress 2022 in Singapore.
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