Apixaban for preventing recurrence of ischemic stroke in patients with atrial cardiopathy: a systematic review and meta-analysis

Menegat, Ana Luiza Rocha Soares; Menegat, Brenda Luana Rocha Soares; Reis, Mariana Rachas; Dantas, Clara Rocha; Wagner, Pedro de Souza; Matheus, Gustavo Tadeu; Simões, Bárbara; Alves, Mylena; Bezerra, Ian; Almeida, Artur Menegaz de; Kelly, Francinny; Moraes, Francisco Cezar A de

INTRODUCTION:

Preventing ischemic strokes in patients with atrial cardiopathy is particularly challenging due to the elevated risks associated with the condition. While numerous studies have established the efficacy of anticoagulants in preventing stroke, their benefits for patients with atrial cardiopathy are not clearly understood. Herein, this systematic review and meta-analysis aims to assess the efficacy of Apixaban in preventing ischemic stroke recurrence in patients with atrial cardiopathy.

METHODS:

A database search of published studies at PubMed, Web of Science, Cochrane, and Scopus was performed. Randomized clinical trials and observational studies comparing the administration of Apixaban with a placebo in adult patients were included. Risk ratio (RR) was used for binary endpoints with 95% confidence intervals (CIs). Heterogeneity was evaluated with I statistics and p value < 0,05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.1 version.

RESULTS:

5 studies and 2593 patients were included. Among them, 1401 (54%) were allocated to receive Apixaban and 1192 (46%) were allocated to receive a placebo. The number of female and male patients was similar, with 1331 (51,3%) women and 1262 (48,7%) men. The recurrence of ischemic stroke (RR 0.89; 95% CI 0.64 to 1.23; P=0.479406; I =0%) did not present a statistically significant difference between groups. Similarly, mortality (RR 1.36; 95% CI 0.92 to 2.02; P=0.121981; I =0%) and recurrent fatal stroke (RR 0.31; 95% CI 0.07 to 1.38; P=0.123799; I =0%) also showed no statistical significant difference between Apixaban and control group.

CONCLUSION:

In this systematic review and meta-analysis, we analyzed patients with ischemic stroke and evidence of atrial cardiopathy. Apixaban did not present significant reduction in recurrent stroke risk, recurrent fatal stroke incidence or mortality when compared with a placebo. Despite this, potential efficacy of early initiation of Apixaban should be clarified from new larger randomized clinical trials.