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Abstract Details

Results of the ARCADIA-CSI Cognition Study
Cerebrovascular Disease and Interventional Neurology
ES1 - Emerging Science 1 (11:57 AM-12:03 PM)
008

The ARCADIA trial (n=1015), a secondary stroke prevention study, evaluated the efficacy of apixaban vs aspirin in patients with CS and AC. We hypothesized that the rate of neurocognitive decline would be slower among subjects randomized to apixaban due to fewer silent infarcts.

To determine if apixaban prevents cognitive decline in patients with cryptogenic stroke (CS) and atrial cardiopathy (AC).

Subjects randomized in ARCADIA who were actively taking study drug were approached for enrollment into this ancillary study. Participants underwent serial neurocognitive testing administered centrally by telephone. The baseline was obtained >3 months after the index stroke and follow-up yearly thereafter. Testing consisted of a 5-test battery and patients’ overall cognitive functioning was summarized as a composite Z-score based on scores from the five tests. Patients with a baseline composite Z-score > 1.5 SDs below norms were excluded from the analyses. Trajectories of the composite Z-score and on each individual test were compared between treatment arms using a mixed-effect model.

Of the 310 enrolled in ARCADIA-CSI, 14 (5%) did not complete any neurocognitive batteries. Of the 296 subjects with baseline data, 47 (16%) were excluded due to impaired baseline scores. In the remaining 249 patients (apixaban 128, aspirin 121), 582 cognitive assessments were obtained. Baseline characteristics were balanced between the apixaban and aspirin arms. Mean age was 66.7 years, median mRS 1, 52% female and 19% black patients. During median follow-up of 378 days, the annual change in the overall standardized composite score was similar in the aspirin arm (0.08; 95% CI:0.02-0.15) and the apixaban arm (0.11; 95% CI:0.04-0.17). There were also no differences between treatment arms when comparing cognitive trajectories of each individual neurocognitive test.

Among patients with CS and AC, the rate of cognitive change was not improved with apixaban compared to aspirin.

Authors/Disclosures
Ronald Lazar (University of Alabama At Birmingham)
PRESENTER
Dr. Lazar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for DiaMedica Therapeutics Inc. . The institution of Dr. Lazar has received research support from National Institutes of Health. Dr. Lazar has received publishing royalties from a publication relating to health care.
George Howard (UAB School of Public Hlth) Dr. Howard has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
David Tirschwell (Harborview Medical Center) Dr. Tirschwell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Tirschwell has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for CARMAT. Dr. Tirschwell has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AbbVie. The institution of Dr. Tirschwell has received research support from Biogen. The institution of Dr. Tirschwell has received research support from Abbott. The institution of Dr. Tirschwell has received research support from NIH.
Kevin Sheth (Yale UniversityDivision of Neuro and Critical Care) Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
No disclosure on file
Michael Lyerly (University of Alabama At Birmingham) Dr. Lyerly has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for various private legal firms.
Robert Stanton (University of Cincinnati Neurology) The institution of Dr. Stanton has received research support from NIH.
Balaji Krishnaiah (University of Tennessee Health Sciences Center) Dr. Krishnaiah has received publishing royalties from a publication relating to health care.
Benjamin Miller (University of Minnesota) The institution of Dr. Miller has received research support from StrokeNET.
Hooman Kamel (Weill Cornell Medical College) Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
W. T. Longstreth (Harborview Medical Center) The institution of Dr. Longstreth has received research support from NIH.
Mitchell Elkind Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy. The institution of Dr. Elkind has received research support from BMS-Pfizer Alliance for Eliquis. The institution of Dr. Elkind has received research support from Roche. Dr. Elkind has received publishing royalties from a publication relating to health care. Dr. Elkind has a non-compensated relationship as a Officer with American Heart Association that is relevant to AAN interests or activities.
Joseph Broderick (University of Cincinnati) Dr. Broderick has received publishing royalties from a publication relating to health care.
Maarten Lansberg (Stanford Stroke Center) Dr. Lansberg has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novo Nordisk. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Richard & Connor. Dr. Lansberg has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Fraser Watson Croutch. Dr. Lansberg has received publishing royalties from a publication relating to health care.