Summary
Apixaban has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Stroke (Ischaemic / Cerebrovascular Disease) would be drug repurposing rather than first-in-human development. This does not mean it is approved for Stroke (Ischaemic / Cerebrovascular Disease). ClinicalTrials.gov lists 8 registered trials linking Apixaban to Stroke (Ischaemic / Cerebrovascular Disease): 1 is currently recruiting; 2 are active or not yet recruiting; 2 have completed; 3 are terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT07237308). The largest enrolment is 3739 participants (NCT04099238). Registration activity spans 2014 to 2025. The literature layer holds 13 publications for this pair: 5 Cochrane reviews, 3 meta-analyses and 5 clinical trial publications. Publication years run from 2025 to 2026. Because at least one synthesis-level source exists (systematic review, meta-analysis or Cochrane review), this pair has been assessed beyond single studies, although the synthesis may concern a different indication.
The RepurpOS disease-intelligence file for Ischemic Stroke ranks 577 candidate therapeutics from Open Targets, ChEMBL, DGIdb and PubMed; only a minority carry direct clinical evidence, and this page covers one of those. Spontaneous remission context recorded for the condition: Spontaneous early neurological improvement in 10-20% within 24 hours of ischaemic stroke without intervention; functional independence at 3 months in only 40-50% without revascularisation; 15% 30-day mortality untreated.
Evidence table
| Evidence tier | A · Strong |
|---|---|
| Evidence score | 73.5 (trials 23.5, literature 30.0, tier 15, approved bonus 5.0) |
| Registered trials | 8 total: 1 recruiting, 2 active / not yet recruiting, 2 completed, 3 other |
| Linked publications | 13 (5 Cochrane reviews, 5 clinical trial publications, 3 meta-analyses) |
| Agent type | Drug (Small molecule) |
| Development stage (any indication) | Approved |
| Mechanism / class | Not recorded |
| Data sources | Open Targets, ChEMBL |
How the evidence score is calculated
- Each registered trial scores by status (recruiting / active / enrolling 3, completed 2.5, not yet recruiting 2, unknown 1, terminated / withdrawn / suspended 0.5) plus a phase bonus (phase 3-4 +2, phase 2 +1, phase 1 +0.5). The trial component is capped at 30.
- Each literature item scores by design (Cochrane review 5, meta-analysis 4, systematic review 3, RCT 3, clinical trial publication 2, curated reference 1.5, other PubMed record 1). The literature component is capped at 30.
- The existing evidence tier adds 15 (A / Strong), 10 (B / Moderate), 5 (C / Preliminary) or 0 (D / Anecdotal).
- Agents approved for any indication (max clinical phase 4) add 5, because an approved agent has an established safety profile that lowers the barrier to repurposing trials.
- The score ranks what has been studied, not what works. It does not read effect sizes or directions of effect.
Registered clinical trials
| NCT ID | Title | Status | Phase | Enrolment |
|---|---|---|---|---|
| NCT07237308 | BEACON-AA: Apixaban With or Without Clopidogrel in Stroke Patients With Atrial Fibrillation and Cerebral Atherosclerosis 2025 | not yet recruiting | Phase 4 | 586 |
| NCT06212674 | Single-stage Pulmonary Vein Isolation Combined With Percutaneous Left Atrial Appendage Occluder Implantation in Patients With Recent Onset Ischemic Stroke and Atrial Fibrillation 2025 | recruiting | Phase 4 | 240 |
| NCT03062319 | Optimal Antithrombotic Therapy in Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation and Atherothrombosis 2017 | terminated | Phase 4 | 321 |
| NCT05825573 | Anticoagulation Therapy in Non-device-related Intra-cardiac Thrombus 2023 | active, not recruiting | Phase 3 | 340 |
| NCT04099238 | Burden of Ischemic Stroke and Intake of Oral Anticoagulants in Patients With Atrial Fibrillation in the UK Primary Care 2019 | completed | Not applicable | 3,739 |
| NCT02818868 | Impact of Apixaban on Clinical Outcome of the Patients With Large Vessel Occlusion or Stenosis Trial 2016 | completed | Not applicable | 700 |
| NCT02309970 | Perfusion Computer Tomography: Imaging and Clinical Validation Following Reperfusion Therapy in Acute Ischaemic Stroke 2014 | status unknown | Not applicable | 90 |
| NCT02635230 | What is the Optimal antiplatElet and Anticoagulant Therapy in Patients With Oral Anticoagulation Undergoing revasculariSaTion 2. 2014 | status unknown | Not applicable | 2,200 |
Published literature
- Clinical trial publication Hypertension With High-Risk Features in Cryptogenic Stroke: An Exploratory Analysis of the ARCADIA Randomized Clinical TrialRidha M, Hailat R, Stanton R et al. · JAMA neurology · 2026 · PMID 42008258
- Clinical trial publication Early versus delayed DOAC after ischaemic stroke in atrial fibrillation: 1-year outcomes in the TIMING study and in concurrent practiceFasth O, Oldgren J, Ghukasyan Lakic T et al. · European stroke journal · 2026 · PMID 41758561
- Clinical trial publication Apixaban Versus Aspirin and Risk of Hemorrhage in the ARCADIA TrialKamel H, Longstreth WT Jr, Tirschwell DL et al. · Annals of neurology · 2026 · PMID 41741942
- Clinical trial publication Multiterritory Brain Infarcts, Anticoagulation, and Recurrence After Cryptogenic Stroke: A Subgroup Analysis of the ARCADIA TrialGologorsky R, Lansberg MG, Wintermark M et al. · Stroke · 2026 · PMID 41347300
- Cochrane review Comparative efficacy and safety of apixaban and rivaroxaban versus warfarin in atrial fibrillation patients with end-stage renal disease: a systematic review and meta-analysisWu X, Meng J, Yang Y et al. · Renal failure · 2026 · PMID 42128628
- Cochrane review Direct oral anticoagulants versus vitamin K antagonists for postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trialsAhmed OAO, Abbas M, Ahmed AAO et al. · BMC cardiovascular disorders · 2026 · PMID 41634587
- Meta-analysis Efficacy and Safety of DOACs in Patients with Atrial Fibrillation and History of Falls or Risk of Falls: The Liverpool AF-Falls Project. A Systematic Review and Bayesian Network Meta-analysisGalvain T, Hill R, Donegan S et al. · Drugs & aging · 2026 · PMID 41845167
- Meta-analysis Direct oral anticoagulants for stroke prevention in patients with atrial fibrillation: A network meta-analysis of randomized trialsSrivastava M, Gulia A, Patel KK et al. · Indian heart journal · 2026 · PMID 41380911
- Meta-analysis Switching From Aspirin Monotherapy After Noncardioembolic Stroke: A Systematic Review and Network Meta-AnalysisRothstein A, Khazaal O, Messe SR et al. · Stroke · 2026 · PMID 41347302
- Clinical trial publication Major Bleeding With Apixaban vs Aspirin: A Subanalysis of the ARTESiA Randomized Clinical TrialSiegal DM, Sticherling C, Healey JS et al. · JAMA cardiology · 2025 · PMID 41222953
- Cochrane review Direct oral anticoagulants versus vitamin K antagonists in concurrent hypertrophic cardiomyopathy and atrial fibrillation: a meta-analysisAboutorabi M, Ahmad M, Flora K et al. · Expert review of cardiovascular therapy · 2025 · PMID 40740155
- Cochrane review Effect of oral anticoagulant therapy on adverse outcomes in patients with atrial fibrillation after intracranial hemorrhageKaisaier W, Guan C, Ye M et al. · Heart rhythm · 2025 · PMID 40544904
- Cochrane review Rapid assessment of direct oral anticoagulants in acute stroke-An educational systematic reviewMbroh J, Birschmann I, Ebner M et al. · European stroke journal · 2025 · PMID 40401656
Mechanism and notes
No mechanism of action is recorded for this pair in the source databases.
OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in Open Targets and ChEMBL. The tier describes how well the drug-disease link is documented, not how well the drug works.
Frequently asked questions
Is Apixaban approved for Stroke (Ischaemic / Cerebrovascular Disease)?
Apixaban has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Stroke (Ischaemic / Cerebrovascular Disease) would be drug repurposing rather than first-in-human development. This does not mean it is approved for Stroke (Ischaemic / Cerebrovascular Disease). Approval status for the specific indication should always be confirmed with the relevant regulator and prescribing information.
Is Apixaban in clinical trials for Stroke (Ischaemic / Cerebrovascular Disease)?
ClinicalTrials.gov lists 8 registered trials linking Apixaban to Stroke (Ischaemic / Cerebrovascular Disease): 1 is currently recruiting; 2 are active or not yet recruiting; 2 have completed; 3 are terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT07237308). The largest enrolment is 3739 participants (NCT04099238). Registration activity spans 2014 to 2025.
What does the evidence show for Apixaban in Stroke (Ischaemic / Cerebrovascular Disease)?
Apixaban has both completed registered trials and synthesis-level publications linked to Stroke (Ischaemic / Cerebrovascular Disease). That is the strongest profile in this database, but the summaries here do not extract effect sizes, so read the linked reviews for direction and magnitude of benefit. OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in Open Targets and ChEMBL. The tier describes how well the drug-disease link is documented, not how well the drug works.
Cite this page
Data: ClinicalTrials.gov, PubMed, Open Targets, ChEMBL, DGIdb and the OSMF therapeutic agent database. Last updated 2026-07-05. Page built 2026-10-07.