Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy
The ARCADIA Randomized Clinical Trial. JAMA. 2024;331(7):573-581. doi:10.1001/jama.2023.27188

Cryptogenic stroke represents a complex clinical scenario where uncertainty remains about the proper therapeutic management. Previous studies showed association between atrial cardiopathy and the risk of ischemic stroke (considering also the interrelationship between atrial fibrillation and atrial cardiopathy), but there is no data on the possible benefit of antithrombotic therapy in preventing strokes in patients with atrial cardiopathy and no clinically evident atrial fibrillation (AF).

To answer this question, Kamel et al. enrolled 1015 patients with a recent cryptogenic stroke and evidence of atrial cardiopathy to be randomly assigned to Apixaban (5 mg or 2.5 mg twice daily) vs aspirin 81 mg once daily. The primary efficacy end point was recurrent stroke of any type. In the final analysis after reaching 80 events, hazard ratios (HR) laid within futility boundaries (HR, 1.00 [95% CI, 0.64-1.55]). The two secondary efficacy outcomes did not differ either (recurrent ischemic stroke or systemic embolism: HR, 0.92 [95% CI, 0.59-1.44]); recurrent stroke or death: HR, 1.08 [95% CI, 0.76-1.52]).

In conclusion, oral anticoagulants did not significantly reduce the risk of recurrent stroke in patients with atrial cardiopathy (even in those patients that eventually developed AF). More data are needed to access the potential thromboembolic risk of atrial cardiopathy.A