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ISC 2023 | ATTICUS subgroup analyses indicate superiority of apixaban over aspirin

Sven Poli, MD, MSc, FESO, FWSO, FAHA, Eberhard-Karls University of Tübingen, Tübingen, Germany, shares key findings from subgroup analyses of the ATTICUS randomized, controlled trial (NCT02427126). ATTICUS compared the use of apixaban versus acetylsalicylic acid (ASA) for secondary prevention after embolic stroke of undetermined source (ESUS). All participants had at least one risk factor for atrial fibrillation (AF)/cardiac thromboembolism, including left atrial (LA) enlargement, spontaneous echo contrast in LA appendage, low LA appendage flow velocity, atrial high-rate episodes, or CHA2DS2-VASc ≥ 4. Additionally, all patients underwent continuous cardiac rhythm monitoring and any patients randomized to the ASA arm in whom AF was detected were switched to the apixaban arm. The trial concluded that there was no difference in the number of new ischemic lesions detected on MRI between the two arms. New data presented at the International Stroke Conference 2023 indicates that patients aged over 75 years old may benefit from direct apixaban treatment. The rates of a composite endpoint (recurrent stroke, myocardial infarction, and cardiovascular death) showed a trend towards benefit of apixaban in patients aged 75+, but this difference was not statistically significant. A similar finding of age-dependency was seen in the RE-SPECT ESUS trial. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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