Apixaban, aspirin equally good at preventing ischaemic, bleeding events in patients with cancer history

The risk of major ischaemic and haemorrhagic events in patients with a history of cancer and cryptogenic stroke appears to be similar between those on apixaban and those on aspirin, according to a post hoc analysis of the ARCADIA* trial.

The analysis included 1,015 patients (median age 68 years, 54.3 percent female) with a recent cryptogenic stroke and biomarker evidence of atrial cardiopathy in the ARCADIA trial. Of these, 137 had a history of cancer (median age 74 years, 54.7 percent female), including 76 who received aspirin at 81 mg once daily and 61 who received apixaban at 5 mg (or 2.5 mg) twice daily.

For the outcomes, major ischaemic events included recurrent ischaemic stroke, myocardial infarction, systemic embolism, and symptomatic deep vein thrombosis or pulmonary embolism. Major haemorrhagic events were symptomatic intracranial haemorrhage and any major extracranial haemorrhage.

Over a median follow-up of 1.5 years, the primary outcome of the risk of major ischaemic or major haemorrhagic events was 73 percent higher among patients with vs without a history of cancer (hazard ratio [HR], 1.73, 95 percent confidence interval [CI], 1.10–2.71).

Among those with history of cancer, a major ischaemic or major haemorrhagic event occurred in 13.1 percent of patients on apixaban and 21.1 percent of those on aspirin, with the difference not reaching statistical significance (HR, 0.61, 95 percent CI, 0.26–1.43).

However, compared with the aspirin subgroup, the apixaban subgroup had a numerically lower proportion of patients who had recurrent stroke (8.2 percent vs 11.8 percent), major ischaemic events (11.5 percent vs 18.4 percent), and major haemorrhagic events (1.6 percent vs 2.6 percent).

*Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke