ISC 2026 | ARCADIA-CSI study: apixaban versus aspirin to reduce cognitive decline after stroke
Ronald M. Lazar, PhD, FAAN, FAHA, University of Alabama, Birmingham, AL, discusses findings from ARCADIA-CSI (ARCADIA-Cognition and Silent Infarction), an ancillary study of the Phase III ARCADIA trial (NCT03192215), examining apixaban versus aspirin to prevent cognitive decline and silent brain infarcts in patients with cryptogenic stroke and atrial cardiopathy. Although the trial was stopped early for futility, imaging results suggested fewer silent infarcts with apixaban. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
So in ARCADIA parent trial, they were comparing apixaban versus aspirin in secondary stroke prevention for individuals who had atrial cardopathy, which has been felt to be one of the mechanisms for embolic stroke separate from atrial fibrillation. So the main trial turned out to be stopped for futility, but we had the opportunity to test cognition with the thought that this atrial cardiopathy may produce some strokes, but the number of small silent infarcts would be much greater and therefore might impact cognition...
So in ARCADIA parent trial, they were comparing apixaban versus aspirin in secondary stroke prevention for individuals who had atrial cardopathy, which has been felt to be one of the mechanisms for embolic stroke separate from atrial fibrillation. So the main trial turned out to be stopped for futility, but we had the opportunity to test cognition with the thought that this atrial cardiopathy may produce some strokes, but the number of small silent infarcts would be much greater and therefore might impact cognition. But when the trial ended early, so did ARCADIA-CSI. As a result, we didn’t find a treatment effective result of one medication for the other. However, looking at the imaging component, there in fact were fewer silent infarcts on apixaban than aspirin, but what the cognitive implications of that have yet to be established.
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