Can anticoagulation lower the risk of covert brain infarcts in patients with atrial cardiopathy after cryptogenic stroke? A study published in JAMA Neurology reports a benefit with apixaban compared with aspirin.

The ARCADIA-MRI ancillary study to the ARCADIA randomized clinical trial enrolled patients with recent cryptogenic ischemic stroke and atrial cardiopathy from 75 US sites between November 14, 2019, and December 2, 2022. Of 1,015 ARCADIA participants, 310 (31%) joined ARCADIA-MRI. The analysis included 174 individuals (mean age 66 years; 52.3% male; median modified Rankin Scale score 1) who had adequate-quality baseline and follow-up magnetic resonance imaging (MRI). The study team obtained baseline scans during the index stroke evaluation or replaced them with a new research MRI if the original was unavailable or inadequate. They performed a follow-up MRI at the end of trial participation. 

The apixaban group (n = 79) recorded a 5.1% rate of incident nonlacunar covert infarcts, compared with 17.9% in the aspirin group (n = 95), yielding a weighted relative risk of 0.29 (95% CI, 0.10–0.83). Baseline characteristics remained balanced between groups.