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Apixaban and Recurrent Stroke Risk With Left Ventricular Dysfunction: A Secondary Analysis of the ARCADIA Trial.
Richa Sharma1, Dinesh Jillella2, Cenai Zhang3
1Department of Neurology, Yale School of Medicine, New Haven, CT (R.S.).
Stroke
|September 2, 2025
Summary
Apixaban significantly reduced recurrent stroke risk in patients with left ventricular (LV) systolic dysfunction compared to aspirin. This finding is crucial for secondary stroke prevention strategies in this patient group.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Uncertainty exists regarding the link between left ventricular (LV) systolic dysfunction, recurrent stroke, and optimal antithrombotic therapy for secondary stroke prevention.
- Left ventricular systolic dysfunction is a potential risk factor for stroke, necessitating tailored prevention strategies.
Purpose of the Study:
- To investigate the association between LV systolic dysfunction and recurrent ischemic stroke risk.
- To compare the efficacy of apixaban versus aspirin in preventing recurrent ischemic stroke in patients with and without LV systolic dysfunction.
Main Methods:
- Post hoc analysis of the ARCADIA randomized trial data.
- Definition of LV systolic dysfunction based on echocardiographic parameters (LV fractional shortening <25%, LV ejection fraction <50%, or LV wall motion abnormality).
- Cox proportional hazard models were used to assess stroke risk and treatment effects.
Main Results:
- 17.1% of patients (165/964) exhibited LV systolic dysfunction.
- LV systolic dysfunction was not significantly associated with recurrent stroke risk after covariate adjustment (HR, 1.3; 95% CI, 0.7-2.4).
- Apixaban significantly reduced recurrent ischemic stroke risk compared to aspirin in patients with LV systolic dysfunction (HR, 0.24; 95% CI, 0.07-0.87; Pinteraction=0.028).
Conclusions:
- Apixaban demonstrated superior efficacy over aspirin in preventing recurrent ischemic stroke among patients with LV systolic dysfunction.
- These findings suggest a personalized approach to antithrombotic therapy based on LV systolic function in stroke patients.
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