Rivaroxaban and dabigatran were not superior to aspirin in trials of patients with embolic stroke of undetermined source (ESUS). The ATTICUS trial evaluated whether apixaban is superior to aspirin in patients with ESUS and additional risk factors for cardioembolism.  
 

Geisler & Poli conducted a multicenter, randomized, open-label, blinded-outcome trial of apixaban (5mg twice daily) compared with aspirin (100mg once daily) initiated within 28 days after ESUS in patients with at least one predictive factor for atrial fibrillation or a patent foramen ovale. Cardiac monitoring was mandatory, and aspirin treatment was switched to apixaban in case of atrial fibrillation detection.
 

The primary outcome was any new ischemic lesion on brain magnetic resonance imaging (MRI) during 12-month follow-up. Secondary outcomes included major and clinically relevant nonmajor bleeding. 

Check out the full article in NEJM Evidence: eviden.cc/3Nets3V

PD Dr. Sven Poli

Copyright: UKT Tübingen