The assistant professor of neurology at Weill Cornell Medicine discussed his future aspirations to uncover more about the beneficial effects of anticoagulants in reducing recurrent stroke. [WATCH TIME: 3 minutes]
WATCH TIME: 3 minutes
"These are secondary results, so it doesn’t mean that anticoagulation is definitely helpful. We need further studies and a dedicated trial to evaluate that hypothesis."
Exploratory data from the phase 3 NAVIGATE-ESUS trial (NCT02313909) provided evidence that rivaroxaban (Xarelto; Janssen), an anticoagulant, is superior to aspirin at reducing the risk of recurrent stroke or systemic embolism in patients with left ventricular dysfunction. The study included 7213 participants who had neuroimaging-confirmed embolic strokes of undetermined source (ESUS) between 7 days and 6 months before screening, 7107 (98.5%) of which had documented assessment of LV dysfunction at study entry and were included in the analysis.
Over a median follow-up of 10.4 months, the primary outcome of recurrent stroke or systemic embolism occurred in 321 participants (4.9% per year). When comparing the 2 treatments, event rates were 2.4% per year (95% CI, 1.1-5.4) in those assigned to rivaroxaban versus 6.5% (95% CI, 4.0-11) in those on aspirin. In those without LV dysfunction (n = 6605), event rates were similar between treatment arms, with event rates of 5.3% per year (95% CI, 4.5-6.2) for those on rivaroxaban and 4.5% per year on aspirin (95% CI, 3.8-5.3).
While these findings carry significant weight for the stroke community, the data needs to be replicated in larger scale trials. In an interview with NeurologyLive®, lead author Alexander Merkler, MD, MS, assistant professor of neurology, Weill Cornell Medicine, provided context on the long-term research projects he plans to carry out, as well as whether other anticoagulants may demonstrate similar results to rivaroxaban.