Apixaban versus Aspirin for Embolic Stroke of Undetermined Source
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View abstract on PubMed
Summary
This summary is machine-generated.Apixaban did not prove superior to aspirin in preventing new ischemic lesions in patients with embolic stroke of undetermined source (ESUS). This study found no significant benefit of apixaban over aspirin for stroke prevention in this population.
Area Of Science
- Neurology
- Cardiology
- Clinical Trials
Background
- Previous trials showed rivaroxaban and dabigatran were not superior to aspirin for embolic stroke of undetermined source (ESUS).
- The efficacy of apixaban compared to aspirin in ESUS patients with cardioembolic risk factors remained unknown.
Purpose Of The Study
- To evaluate if apixaban is superior to aspirin in preventing new ischemic lesions in ESUS patients with identified risk factors for cardioembolism.
- To compare rates of ischemic lesions and bleeding events between apixaban and aspirin treatments.
Main Methods
- A multicenter, randomized, open-label trial comparing apixaban (5 mg twice daily) with aspirin (100 mg once daily) in ESUS patients.
- Patients had at least one risk factor for atrial fibrillation or patent foramen ovale; cardiac monitoring was mandatory.
- The primary outcome was new ischemic lesions on brain MRI at 12-month follow-up.
Main Results
- Apixaban was not superior to aspirin; new ischemic lesions occurred in 13.6% of the apixaban group versus 16.0% of the aspirin group (aOR 0.79; 95% CI 0.42-1.48).
- Bleeding rates were similar between groups (cumulative incidences 2.9% for apixaban vs. 4.2% for aspirin).
- The trial was terminated early due to futility based on an interim analysis.
Conclusions
- Apixaban treatment demonstrated no superiority over cardiac monitoring-guided aspirin in preventing new ischemic lesions in an enriched ESUS population.
- The findings suggest that current anticoagulants may not offer additional benefits over aspirin in specific ESUS patient subgroups.
- Further research may be needed to identify optimal antithrombotic strategies for ESUS patients with specific risk factors.
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