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AAN 2024 | ARCADIA-CSI: aspirin vs apixaban for the prevention of covert infarcts and cognitive decline

Ronald M. Lazar, PhD, FAHA, FAAN, University of Alabama at Birmingham, Birmingham, AL, provides a reminder of the randomized, double-blind ARCADIA trial (NCT03192215), which compared the efficacy of antiplatelet and anticoagulant therapy for secondary stroke prevention in patients with cryptogenic stroke with atrial cardiopathy, and introduces the ARCADIA-CSI (Cognition and Silent Infarcts) ancillary study. This study investigated whether aspirin or apixaban would be superior in protecting against very small strokes, known as silent or covert infarcts, which are not clinically significant but may aggregate over time to produce cognitive dysfunction. Cognition of participants was measured at baseline and followed up yearly with a reliable and valid telephone-based cognitive battery. Unfortunately, as the parent study was stopped due to futility, the follow-up for the CSI ancillary study is insufficiently powered to reach conclusions about the protective ability of the treatments. Prof. Lazar highlights the need for future studies to investigate approaches for the primary prevention of covert infarctions and subsequent cognitive decline, as this could contribute to a significant decrease in the incidence of dementia. This interview took place at the American Academy of Neurology (AAN) Annual Meeting 2024 in Denver, CO.

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