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

TitleThe AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods.
Publication TypeJournal Article
Year of Publication2019
AuthorsKamel H, Longstreth WT, Tirschwell DL, Kronmal RA, Broderick JP, Palesch YY, Meinzer C, Dillon C, Ewing I, Spilker JA, Di Tullio MR, Hod EA, Soliman EZ, Chaturvedi S, Moy CS, Janis S, Elkind MSv
JournalInt J Stroke
Volume14
Issue2
Pagination207-214
Date Published2019 02
ISSN1747-4949
KeywordsAged, Aged, 80 and over, Aspirin, Biomarkers, Cardiomyopathies, Electrocardiography, Humans, Ischemia, Middle Aged, Pyrazoles, Pyridones, Recurrence, Stroke, Survival Analysis, Treatment Outcome, United States
Abstract

RATIONALE: Recent data suggest that a thrombogenic atrial substrate can cause stroke in the absence of atrial fibrillation. Such an atrial cardiopathy may explain some proportion of cryptogenic strokes.

AIMS: The aim of the ARCADIA trial is to test the hypothesis that apixaban is superior to aspirin for the prevention of recurrent stroke in subjects with cryptogenic ischemic stroke and atrial cardiopathy.

SAMPLE SIZE ESTIMATE: 1100 participants.

METHODS AND DESIGN: Biomarker-driven, randomized, double-blind, active-control, phase 3 clinical trial conducted at 120 U.S. centers participating in NIH StrokeNet.

POPULATION STUDIED: Patients ≥ 45 years of age with embolic stroke of undetermined source and evidence of atrial cardiopathy, defined as ≥ 1 of the following markers: P-wave terminal force >5000 µV × ms in ECG lead V, serum NT-proBNP > 250 pg/mL, and left atrial diameter index ≥ 3 cm/m on echocardiogram. Exclusion criteria include any atrial fibrillation, a definite indication or contraindication to antiplatelet or anticoagulant therapy, or a clinically significant bleeding diathesis. Intervention: Apixaban 5 mg twice daily versus aspirin 81 mg once daily. Analysis: Survival analysis and the log-rank test will be used to compare treatment groups according to the intention-to-treat principle, including participants who require open-label anticoagulation for newly detected atrial fibrillation.

STUDY OUTCOMES: The primary efficacy outcome is recurrent stroke of any type. The primary safety outcomes are symptomatic intracranial hemorrhage and major hemorrhage other than intracranial hemorrhage.

DISCUSSION: ARCADIA is the first trial to test whether anticoagulant therapy reduces stroke recurrence in patients with atrial cardiopathy but no known atrial fibrillation.

DOI10.1177/1747493018799981
Alternate JournalInt J Stroke
PubMed ID30196789
PubMed Central IDPMC6645380
Grant ListR01 NS030678 / NS / NINDS NIH HHS / United States
P50 NS044283 / NS / NINDS NIH HHS / United States
U01 NS086872 / NS / NINDS NIH HHS / United States
U01 NS095869 / NS / NINDS NIH HHS / United States
R01 NS036695 / NS / NINDS NIH HHS / United States
K23 NS082367 / NS / NINDS NIH HHS / United States

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