Apixaban vs aspirin in patients with cancer and cryptogenic stroke

New Orleans - Ochsner Health physicians Dr. Richard Zweifler and Dr. Joseph Tarsia are co-authors on a post hoc analysis carried out in the ARCADIA randomized clinical trial, comparing the effectiveness of apixaban versus aspirin in preventing adverse clinical outcomes in patients with a history of cancer and cryptogenic stroke. The research found no significant difference in the risk of major ischemic and hemorrhagic events between those taking apixaban and aspirin. The study was published in the JAMA Neurol journal and registered under ClinicalTrials.gov.

The ARCADIA study was a multicenter, double-blind, randomized clinical trial conducted between 2017 and 2020. The primary outcome measure was a composite of major ischemic and hemorrhagic events, including ischemic stroke, systemic embolism, myocardial infarction, or vascular death. A total of 1015 participants were enrolled in the trial and followed up for a median duration of 11.1 months.

Participants in the study were adults with recent cryptogenic stroke and biomarker evidence of atrial cardiopathy, such as an enlarged left atrium or high levels of natriuretic peptides. They also had a history of cancer within the past ten years.

The findings of this post hoc analysis suggest that both apixaban and aspirin may be effective in preventing adverse clinical outcomes in patients with a history of cancer and cryptogenic stroke. However, further studies are needed to confirm these results and determine the optimal treatment for this patient population.

"Our findings from the ARCADIA trial provide important insights into the impact of apixaban and aspirin on patients with a history of cancer and cryptogenic stroke. Although we did not observe a significant difference in the risk of major ischemic and hemorrhagic events, this is only the beginning. Moving forward, we plan larger studies that will provide greater power to evaluate potential differences in antithrombotic strategies in cryptogenic stroke patients with a cancer history.” said Dr. Richard Zwiefler.

Moreover, it is essential to note that this post hoc analysis was not pre-specified in the original study protocol and should be interpreted with care.