Apixaban for Cryptogenic Stroke With Atrial Cardiopathy?

In a study of patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, the use of apixaban did not significantly reduce recurrent stroke risk compared with aspirin. The trial was stopped due to futility after enrolling 1015 of the planned 1100 patients. Recurrent stroke occurred at a similar rate in both groups, and there were no cases of symptomatic intracranial hemorrhage in the apixaban group. The study was published in JAMA and had limitations including a higher-than-expected withdrawal rate amid the COVID-19 pandemic. Authors suggest that despite the lack of statistical significance, apixaban could potentially be considered as the preferred therapy based on the higher numerical rates of intracranial hemorrhage with aspirin.

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