ESOC 2021 | Biomarker-driven trials of anticoagulants vs antiplatelets for secondary stroke prevention

Mira Katan, MD, MSc, FESO, University Hospital of Zurich, Zurich, Switzerland, talks on the potential of novel blood biomarkers to guide secondary stroke prevention with anticoagulants. Several studies have demonstrated that atrial natriuretic peptide (ANP) may be a promising marker for the identification of patients with cryptogenic stroke with undiagnosed paroxysmal atrial fibrillation (AF) and other covert cardio-embolic sources of stroke who may benefit from direct oral anticoagulant use. For example, ANP has been associated with newly detected AF on follow-up. However, evidence is needed to show that using biomarkers like ANP to guide treatment leads to a clinical benefit. The MOSES trial (NCT03961334) and ARCADIA trial (NCT03192215) are large-scale biomarker-driven clinical studies investigating this. ARCADIA is assessing apixaban versus aspirin in patients who have evidence of atrial cardiopathy and a recent stroke of unknown cause and MOSES will assess direct oral anticoagulation versus antiplatelets as preventive treatment in ischemic stroke patients without known atrial fibrillation at admission, selected by a cut-off level of MRproANP concentration. This interview took place at the European Stroke Organisation Conference (ESOC), 2021.