The Argatroban and Tissue-Type Plasminogen Activator Stroke Study

Bath, Philip M.W.

doi:10.1161/strokeaha.111.640557

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…Therefore, it is necessary to explore whether adding Argatroban to patients with poor prognosis after thrombolytic therapy can improve patients’ situation. In addition, previous studies showed that Argatroban had a better effect on large artery occlusion-type cerebral infarction ( 20 , 31 ), while this study also included clinical trials with small artery occlusion-type cerebral infarction as the subject population, which may affect the research results to some extent. Although the results of the experiment were neutral, these studies indicated that it was safe and feasible to receive intravenous thrombolysis combined with Argatroban treatment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of Argatroban in patients with acute ischemic stroke: a systematic review and meta-analysis

Cheng,

Liu,

et al. 2024

Front. Neurol.

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ObjectiveArgatroban is a highly promising drug for the treatment of acute ischemic stroke (AIS), but there is currently insufficient strong evidence regarding the efficacy and safety of using Argatroban in the treatment of AIS. Therefore, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of Argatroban in the treatment of AIS.MethodsArticles on PubMed, Embase and the Cochrane Library databases were searched from these websites’ inceptions to 2th February 2023. Randomized controlled trials and observational studies on Argatroban therapy for acute ischemic stroke were included. Meta-analyses were conducted using a random-effects model.ResultsFourteen studies involving 10,315 patients were included in the meta-analysis. The results showed a significant reduction in the rate of early neurological deterioration (END) in the Argatroban group compared with the control group (OR = 0.47, 95% CI: 0.31–0.73, I2 = 15.17%). The rates of adverse events were no significant difference between the two groups (ICH: OR = 1.02, 95% CI: 0.68–1.51, I2 = 0.00%; major extracranial bleeding: OR = 1.22, 95% CI: 1.01–1.48, I2 = 0.00%; mortality: OR = 1.16, 95% CI: 0.84–1.59, I2 = 0.00%). However, the rates of mRS score of 0–1 (OR = 1.38, 95% CI: 0.71–2.67, I2 = 77.56%) and mRS score of 0–2 (OR = 1.18, 95% CI: 0.98–1.42, I2 = 0.00%) during the 90 days did not significantly improved in the Argatroban group. Subgroup analyses showed that the rate of END (OR = 0.41, 95% CI: 0.26–0.65, I2 = 2.77%) and mRS score of 0–2 (OR = 1.38, 95% CI: 1.06–1.81, I2 = 0.00%) had significantly improved when the intervention group adopted Argatroban plus Antiplatelet.ConclusionArgatroban can improve neurological deterioration, with a low incidence of adverse events such as bleeding and death, and general analysis showed no improvement in mRS. However, subgroup analysis suggests that compared to mono-antiplatelet therapy, combination therapy of Argatroban combined with antiplatelet therapy significantly reduced the incidence of END and improved mRS scores. After using Argatroban, there was no increase in the risk and mortality of intracranial hemorrhage and other bleeding sites.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of Argatroban in patients with acute ischemic stroke: a systematic review and meta-analysis

Cheng,

Liu,

et al. 2024

Front. Neurol.

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“…[22][23][24][25] Argatroban, a direct thrombin inhibitor, rapidly inhibits thrombosis, and its safety and efficacy in AIS patients have been confirmed by many clinical studies. [26][27][28][29][30] In some studies, BPV exhibited strong association with stroke prognosis, [31,32] especially SBP variability indicators in the first 24-hour from onset. [33,34] Initial 24-hour systolic BPV in AIS patients is a strong predictor of stroke outcomes, with higher systolic BPV indicating a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

Association between 24-hour blood pressure parameters and 90-day functional outcome in acute ischemic stroke patients with early anticoagulation

Hu,

Jin,

Qiao

et al. 2024

Medicine

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This study aimed to examine the relationship between blood pressure (BP) and blood pressure variability (BPV) during the first 24 hours from admission with 90-day functional outcomes in acute ischemic stroke (AIS) patients whose onset within 24 hours and receiving early argatroban treatment. The study recruited 214 AIS patients. BP was monitored using a cuff at 1-hour fixed intervals, and BP/BPV parameters [standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV)] were collected. Age, the National Institutes of Health Stroke Scale (NIHSS) score at admission, previous history of diabetes mellitus (DM), and infarction site (located in anterior circulation) were identified as independent factors affecting 90-day outcomes in multiple logistic regression. After adjusting for confounding variables, association between BP/BPV and 90-day modified Rankin Scale (mRS) was assessed using logistic regression models. In model 1 (adjusted for age and NIHSS score at admission), mean-systolic blood pressure (SBP) showed association with 90-day outcomes [1.068 (1.008, 1.131), P = .025]. In model 2 (adjusted for age, NIHSS score at admission, previous history of DM), mean-SBP [1.061 (1.001, 1.123), P = .045] and max-SBP [0.951 (0.906, 0.998), P = .040] showed relatively weak association with outcomes. In model 3 [adjusted for age, NIHSS score at admission, previous history of DM, infarct site (located in anterior circulation)], all BP values were not related with outcomes, meanwhile, none of the BPV parameters calculated from SBP, diastolic blood pressure and mean arterial pressure showed association with 90-day outcomes. Future prospective studies are required to assess the relationship between early BP/BPV parameters with 90-day outcomes and further clarify the reference values for BP parameters. This is important for effective BP/BPV management and improved patient prognosis.

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“…Argatroban is a direct thrombin inhibitor that can rapidly inhibit thrombosis, and its safety and effectiveness have been con rmed in many clinical studies [11][12][13][14][15]. Early venous anticoagulation is an important strategy for individualized treatment of AIS.…”

Section: Discussionmentioning

confidence: 99%

Correlation between 24-hour blood pressure and blood pressure variability and 90-day functional outcomes in patients with acute ischemic stroke after early anticoagulation with intravenous argatroban

Hu¹,

Jin

et al. 2022

Preprint

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Background: Blood pressure (BP) fluctuation is a common phenomenon in acute ischemic stroke (AIS), but the effect of fluctuations in BP during specific treatment on adverse events has received less attention. Therefore, we explored the relationship between both BP and 24-hour BP variation (BPV) and 90-day functional outcomes (assessed by modified Rankin Scale [mRS] score) in patients with AIS who underwent intravenous argatroban therapy within 24 hours of AIS onset. Methods: A total of 214 patients with AIS who were hospitalized with neurological deficiency within 24 hours and who underwent intravenous argatroban therapy were included. BP was monitored using a cuff at fixed intervals of 1 hour, and mean systolic blood pressure (mean-SBP), maximum SBP (max-SBP), minimum SBP (min-SBP), mean diastolic blood pressure (mean-DBP), maximum DBP (max-DBP), minimum DBP (min-DBP), mean arterial pressure (MAP), standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV) were calculated. The correlation between both BP and BPV and 90-day mRS score was evaluated by logistic regression after adjusting for confounding variables. Results: Two-hundred fourteen patients were included in the study, including 123 patients with a good prognosis (mRS score ≤ 2) (57.48%) and 91 patients with a poor prognosis (mRS score > 2) (42.52%). Age, National Institutes of Health Stroke Scale (NIHSS) score on admission, diabetes mellitus (DM), infarction location (anterior circulation), and prognosis were significantly related (P < 0.05). After one-way analysis of variance on BP and BPV, variables with a P value of <0.2 were used as conditions for a significant correlation with prognosis. BP and BPV parameters in the good prognosis group were higher than in the poor prognosis group. In the adjusted logistic regression model, mean-SBP in Model 1 (adjusted for age and NIHSS score) was significantly associated with 3-month mRS score (odds ratio [OR] = 1.068, 95% confidence interval [CI] 1.008 – 1.131, P = 0.025). In Model 2 (adjusted for age, NIHSS score, and DM), mean-SBP (OR = 1.061, 95% CI 1.001 – 1.123, P = 0.045) and max-SBP (OR = 0.951, 95% CI 0.906 – 0.998, P = 0.040) were associated with 3-month mRS score. In Model 3 (adjusted for age, NIHSS score, DM, and infarction location), max-SBP (OR = 0.952, 95% CI 0.906 – 1, P = 0.049) was associated with 3-month mRS score. There was no significant correlation between MAP or DBP and prognosis. Conclusion: Twenty-four-hour BPV parameters (SD/CV/SV/ARV) in patients with AIS undergoing early argatroban therapy were not ideal prognostic predictors of 90-day functional outcomes, but 24-hour max-SBP and mean-SBP showed predictive value. In the future, more prospective studies are needed to further explore the association between short-term BPV and 90-day functional outcomes in patients with AIS undergoing early anticoagulation therapy.

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The Argatroban and Tissue-Type Plasminogen Activator Stroke Study

Cited by 7 publications

References 15 publications

Efficacy and safety of Argatroban in patients with acute ischemic stroke: a systematic review and meta-analysis

Efficacy and safety of Argatroban in patients with acute ischemic stroke: a systematic review and meta-analysis

Association between 24-hour blood pressure parameters and 90-day functional outcome in acute ischemic stroke patients with early anticoagulation

Correlation between 24-hour blood pressure and blood pressure variability and 90-day functional outcomes in patients with acute ischemic stroke after early anticoagulation with intravenous argatroban

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