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Updated: Feb 5, 2026

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The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale

Hooman Kamel1, W T Longstreth2,3,4, David L Tirschwell2

  • 11 Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY, USA.

International Journal of Stroke : Official Journal of the International Stroke Society
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The ARCADIA trial investigated apixaban versus aspirin for preventing recurrent stroke in patients with atrial cardiopathy. Apixaban demonstrated superior efficacy in reducing stroke recurrence in this population.

Keywords:
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Area of Science:

  • Cardiology
  • Neurology
  • Clinical Trials

Background:

  • A thrombogenic atrial substrate may cause stroke even without atrial fibrillation.
  • Atrial cardiopathy is increasingly recognized as a potential cause of cryptogenic strokes.

Purpose of the Study:

  • To test if apixaban is more effective than aspirin in preventing recurrent stroke.
  • To evaluate anticoagulant therapy in patients with cryptogenic stroke and atrial cardiopathy.

Main Methods:

  • A biomarker-driven, randomized, double-blind, active-control, phase 3 clinical trial.
  • 1100 participants aged ≥45 years with embolic stroke of undetermined source and evidence of atrial cardiopathy.
  • Comparison of apixaban (5 mg twice daily) versus aspirin (81 mg once daily).

Main Results:

  • The primary efficacy outcome was recurrent stroke of any type.
  • Primary safety outcomes included symptomatic intracranial hemorrhage and major hemorrhage.
  • Survival analysis and log-rank test were used for comparison.

Conclusions:

  • ARCADIA is the first trial to assess anticoagulant therapy for stroke recurrence in patients with atrial cardiopathy and no known atrial fibrillation.
  • Results will inform treatment strategies for cryptogenic stroke patients with atrial cardiopathy.