Apixaban versus aspirin in patients with cancer and cryptogenic stroke: post hoc analysis of a randomized trial

Approximately 10% to 15% of ischemic strokes are associated with cancer. Cancer-associated stroke, particularly when cryptogenic, is associated with high rates of recurrent stroke and major bleeding. In a secondary analysis of 1015 participants with cryptogenic stroke and atrial cardiopathy in the atrial cardiopathy and antithrombotic drugs in prevention after cryptogenic stroke (ARCADIA) randomized clincial trial, 137 participants had a history of cancer. Among this subgroup, the risk of major ischemic or major hemorrhagic events was nominally but not significantly lower with apixaban compared with aspirin (13.1% versus 21.1%; HR 0.61; 95% CI 0.26-1.43), but analyses were underpowered given small numbers. The authors conclude that among ARCADIA trial participants with a history of cancer, the risk of major ischemic or hemorrhagic events did not differ significantly with apixaban versus aspirin, but a clinically important benefit of apixaban could not be ruled out (visual abstract).