September 10, 2018International Journal of Stroke382 citations
The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods
Key Points
- To evaluate whether apixaban is superior to aspirin for preventing recurrent stroke in patients with cryptogenic ischemic stroke and biomarker-confirmed atrial cardiopathy.
- Biomarker-driven, randomized, double-blind, active-control, phase 3 clinical trial across 120 U.S. centers within NIH StrokeNet (target N=1100).
Structured PICO
Does apixaban reduce recurrent stroke compared to aspirin in patients with cryptogenic ischemic stroke and atrial cardiopathy without atrial fibrillation?
P
Population
Estimated 1100 participants with cryptogenic ischemic stroke and atrial cardiopathy. Exclusion criteria include any atrial fibrillation, a definite indication or contraindication to antiplatelet or anticoagulant therapy, or a clinically significant bleeding diathesis.
I
Intervention
Apixaban 5 mg twice daily
C
Comparator
Aspirin 81 mg once daily (active control)
O
Outcome
Recurrent stroke of any typehard clinical
The ARCADIA trial will provide the first evidence on whether anticoagulation with apixaban is superior to aspirin for secondary stroke prevention in patients with atrial cardiopathy but no known atrial fibrillation.
Abstract
RATIONALE: Recent data suggest that a thrombogenic atrial substrate can cause stroke in the absence of atrial fibrillation. Such an atrial cardiopathy may explain some proportion of cryptogenic strokes. AIMS: The aim of the ARCADIA trial is to test the hypothesis that apixaban is superior to aspirin for the prevention of recurrent stroke in subjects with cryptogenic ischemic stroke and atrial cardiopathy. SAMPLE SIZE ESTIMATE: 1100 participants. METHODS AND DESIGN: Biomarker-driven, randomized, double-blind, active-control, phase 3 clinical trial conducted at 120 U.S. centers participating in NIH StrokeNet. POPULATION STUDIED: on echocardiogram. Exclusion criteria include any atrial fibrillation, a definite indication or contraindication to antiplatelet or anticoagulant therapy, or a clinically significant bleeding diathesis. Intervention: Apixaban 5 mg twice daily versus aspirin 81 mg once daily. Analysis: Survival analysis and the log-rank test will be used to compare treatment groups according to the intention-to-treat principle, including participants who require open-label anticoagulation for newly detected atrial fibrillation. STUDY OUTCOMES: The primary efficacy outcome is recurrent stroke of any type. The primary safety outcomes are symptomatic intracranial hemorrhage and major hemorrhage other than intracranial hemorrhage. DISCUSSION: ARCADIA is the first trial to test whether anticoagulant therapy reduces stroke recurrence in patients with atrial cardiopathy but no known atrial fibrillation.