MRI Findings of Intracranial Hemorrhages in ARCADIA-MRI: An Ancillary Study to the ARCADIA Trial
Hui Chen1, Maarten Lansberg2, Guangming Zhu3
1From the Department of Neuroradiology (H.C., M.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas.
Background And Purpose:
The ARCADIA-MRI study, an ancillary study to the randomized Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial, reported that the risk of incident nonlacunar covert infarcts was lower in the apixaban group than in the aspirin group. This article presents the additional, prespecified, exploratory outcomes beyond the primary article, specifically examining the effect of apixaban on hemorrhagic lesions on MRI.
Materials And Methods:
The ARCADIA-MRI study was conducted in conjunction with ARCADIA trial visits, with follow-up durations ranging from 4 months to 5.3 years (median, 27 months). It included randomized patients who were eligible for cognitive testing and lacked MRI contraindications. Two experienced raters, blinded to treatment assignments, independently evaluated the baseline and follow-up MRI scans. The radiologic end points of this analysis were incident intracranial hemorrhage (>10 mm), microbleeds (≤10 mm), and superficial siderosis.
Results:
MRI outcomes were compared between the 79 patients in the apixaban group and 95 in the aspirin group with both baseline and follow-up MRIs available. The treatment groups had similar baseline MRI findings. On the follow-up MRIs, the findings of incident bleeding events were similar between the treatment groups (all, P > .05): Intracranial hemorrhage occurred in 5.1% of patients in the apixaban group compared with 6.4% of patients in the aspirin group; microbleeds, 7.8% in the apixaban group and 10.8% in the aspirin group; and cortical superficial siderosis, in 7.7% of apixaban group and 12.9% in the aspirin group.
Conclusions:
In an exploratory analysis of the ARCADIA-MRI substudy, MRI findings of incident bleeding events were similar in patients randomized to receive apixaban and aspirin.
Insights
Apixaban and aspirin showed similar rates of incident bleeding events, including intracerebral hemorrhages and microbleeds, in patients following cryptogenic stroke. This exploratory analysis found no significant differences in MRI-detected hemorrhagic lesions between the two antithrombotic treatments.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- The ARCADIA-MRI study, an ancillary analysis of the ARCADIA trial, investigated antithrombotic therapies for secondary stroke prevention.
- Previous findings indicated a lower risk of non-lacunar covert infarcts with apixaban compared to aspirin.
Purpose of the Study:
- To explore the effect of apixaban versus aspirin on hemorrhagic lesions detected by MRI.
- To compare the incidence of intracerebral hemorrhages, microbleeds, and superficial siderosis between treatment groups.
Main Methods:
- MRI scans from ARCADIA-MRI participants (apixaban vs. aspirin) were evaluated by blinded raters.
- Radiological endpoints included incident intracerebral hemorrhages (>10 mm), microbleeds (≤10 mm), and superficial siderosis.
- Follow-up durations ranged from 4 months to 5.3 years (median 27 months).
Main Results:
- No significant differences were observed in the incidence of intracerebral hemorrhages (5.1% vs. 6.4%), microbleeds (7.8% vs. 10.8%), or superficial siderosis (7.7% vs. 12.9%) between the apixaban and aspirin groups.
- Baseline MRI findings were similar across both treatment arms.
- All p-values for bleeding events were greater than 0.05, indicating no statistically significant difference.
Conclusions:
- Exploratory analysis of the ARCADIA-MRI substudy revealed similar MRI findings for incident bleeding events in patients treated with apixaban and aspirin.
- These results suggest comparable safety profiles regarding hemorrhagic lesions between apixaban and aspirin in this patient population.
Related Concept Videos
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:17Hemorrhagic Stroke l: Introduction