ARCADIA Trial on Atrial Cardiopathy and Stroke

In an earlier post on Embolic Stroke of Undetermined Source (ESUS), I had mentioned about ARCADIA trial (AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke) which was testing whether there is role for apixaban compared to aspirin for prevention of recurrent stroke in ESUS. The trial was sponsored by the National Institutes of Health, United States of America and the results have been published in February 2024. ARCADIA trial showed that in patients with cryptogenic stroke and atrial cardiopathy, apixaban did not reduce the risk of recurrent stroke compared with low dose aspirin. The study was conducted in patients with cryptogenic ischemic stroke and evidence of atrial cardiopathy, but without atrial fibrillation.

It was a multicenter, randomized, double blind, double dummy trial involving 1000 odd patients within 180 days of stroke and mean follow up period was 1.8 years. Median time post stroke to randomization was 50 days. Atrial cardiopathy was defined based on one or more of ECG, NT-ProBNP and indexed left atrial diameter criteria. In ECG, V1 P-terminal force more than 5000 µV·ms was the cut off. Serum NT-proBNP cut off was more than 250 pg/mL. Indexed left atrial diameter ≥3 cm/m² on transthoracic echocardiography was the echocardiographic criteria.