Outcomes of Argatroban Treatment in Patients With Atherothrombotic Stroke

Abstract

Background and Purpose-Argatroban, a selective thrombin inhibitor, is recommended for the use in patients with atherothrombotic stroke by the Japanese Guidelines for the Management of Patients with Acute Ischemic Stroke. We performed a nationwide Japanese study to investigate whether argatroban improved early stroke outcomes in patients with acute atherothrombotic stroke. Methods-This retrospective observational study, using the Diagnosis Procedure Combination database in Japan, included patients who were hospitalized from July 1, 2010, to March 31, 2012, with a diagnosis of atherothrombotic stroke within 1 day of stroke onset. Patients were divided into 2 groups: those receiving argatroban on admission (argatroban group), and those who did not receive argatroban during hospitalization (control group). To balance the baseline characteristics and concomitant treatments during hospitalization between the 2 groups, one-to-one propensity-score matching analyses were performed. The main outcomes were the modified Rankin Scale score at discharge and the occurrence of hemorrhagic complications during hospitalization. An ordinal logistic regression analysis evaluated the association between argatroban use and modified Rankin Scale at discharge. Results-After propensity-score matching, 2289 pairs of patients were analyzed. There were no significant differences in modified Rankin Scale at discharge between the argatroban and the control groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.88-1.16). The occurrence of hemorrhagic complications did not differ significantly between the argatroban and the control groups (3.5% versus 3.8%; P=0.58). Conclusions-The present study suggested that argatroban was safe, but had no added benefit in early outcomes after acute atherothrombotic stroke. The aim of the present study was to investigate whether argatroban was effective and safe in patients with acute ischemic stroke, using a database of Japanese inpatients. Methods Study Design and SettingThis was a retrospective observational cohort study using data from a nationwide administrative claims and discharge abstract database in Japan, the Diagnosis Procedure Combination database. The Diagnosis Procedure Combination database has been described in detail previously. 9 In brief, >1000 hospitals, including all 82 academic hospitals in Japan, contribute to the Diagnosis Procedure Combination database. The annual number of cases added to the database is ≈7 000 000 and encompasses ≈50% of all hospital admissions in Japan.The Diagnosis Procedure Combination database contains the following information for each patient: patient demographics, a unique hospital identifier, diagnoses, outcomes, drugs used, procedures performed, healthcare costs, and several disease-specific data. Diagnoses include the main diagnosis on admission, preexisting comorbidities, and postadmission complications, which are recorded separately with International Classification of Diseases-10th revision codes and text data in Japanese. Drugs and procedures ar...

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