ARCADIA-MRI
(2025)Objective
Evaluate whether apixaban reduces incident nonlacunar covert infarcts compared to aspirin in patients with cryptogenic stroke and atrial cardiopathy.
Study Summary
• In this MRI substudy of the ARCADIA trial, apixaban was associated with a significantly lower rate of incident non-lacunar covert infarcts than aspirin in patients with cryptogenic stroke and atrial cardiopathy. While the parent trial found no reduction in recurrent clinical stroke, this finding suggests a possible neuroprotective role of apixaban in reducing subclinical brain injury in this population.
Intervention
Ancillary MRI substudy to the ARCADIA trial. N=174 participants with cryptogenic stroke and atrial cardiopathy, randomized to: • Apixaban 5 mg BID • Aspirin 81 mg daily MRI obtained at baseline (index stroke) and at study completion. Primary outcome: incident nonlacunar covert infarct identified by blinded readers.
Study Design
Arms: Array
Outcome
• Incident nonlacunar covert infarct: 5.1% (apixaban) vs. 17.9% (aspirin)
• Weighted relative risk: 0.29; 95% CI 0.10–0.83
• Median follow-up: 811 days
• Age: mean 66 years; mRS median 1; 52.3% male
• Baseline characteristics were balanced between arms
• Suggests apixaban may reduce subclinical brain injury even in absence of clinical stroke reduction
• Weighted relative risk: 0.29; 95% CI 0.10–0.83
• Median follow-up: 811 days
• Age: mean 66 years; mRS median 1; 52.3% male
• Baseline characteristics were balanced between arms
• Suggests apixaban may reduce subclinical brain injury even in absence of clinical stroke reduction