ASA: No Drop in Recurrent Stroke Seen With Apixaban After Cryptogenic Stroke

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No significant difference noted in recurrent stroke, symptomatic intracranial hemorrhage for patients receiving apixaban, aspirin

By Elana Gotkine HealthDay Reporter

FRIDAY, Feb. 16, 2024 (HealthDay News) — For patients with recent cryptogenic stroke and evidence of atrial cardiopathy, the risk for recurrent stroke is not reduced with apixaban versus aspirin, according to a study published online Feb. 7 in the Journal of the American Medical Association to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 7 to 9 in Phoenix.

Hooman Kamel, M.D., from Weill Cornell Medicine in New York City, and colleagues compared anticoagulation to antiplatelet therapy for secondary stroke prevention in a multicenter trial involving 1,015 participants with cryptogenic stroke and evidence of atrial cardiopathy. At the time of randomization, participants had no evidence of atrial fibrillation. Participants were randomly allocated to receive apixaban (5 mg or 2.5 mg) twice daily or aspirin (81 mg) once daily (507 and 508 patients, respectively).

After a planned interim analysis, the trial was stopped for futility after enrollment of 1,015 of the target 1,100 participants and at a mean follow-up of 1.8 years. The researchers found that recurrent stroke occurred in 40 patients in both groups (annualized rate, 4.4 percent in both groups). Symptomatic intracranial hemorrhage occurred in zero and seven patients taking apixaban and aspirin, respectively (annualized rate, 1.1 percent for patients taking aspirin); other major hemorrhages occurred in five patients in both groups (annualized rates, 0.7 and 0.8 percent for those taking apixaban and aspirin, respectively).

“Oral anticoagulant therapy with apixaban did not significantly reduce the risk of recurrent stroke compared with aspirin,” the authors write.

The BMS-Pfizer Alliance provided the in-kind study drug, and Roche Diagnostics provided ancillary funding for laboratory supplies.

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