Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis
Abstract Objective Previous studies suggest the benefit of dual antiplatelet therapy (DAPT) for acute ischemic stroke with large artery atherosclerosis (LAA) etiology, but there is no study about the effect of DAPT plus anticoagulant in this population. Methods A prospective single arm trial was per...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-07-01
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| Series: | Brain and Behavior |
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| Online Access: | https://doi.org/10.1002/brb3.2664 |
| _version_ | 1811288621542539264 |
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| author | Xiao‐Qiu Li Xiao‐Wen Hou Yu Cui Xiao‐Fu Tian Xin‐Hong Wang Zhong‐He Zhou Hui‐Sheng Chen |
| author_facet | Xiao‐Qiu Li Xiao‐Wen Hou Yu Cui Xiao‐Fu Tian Xin‐Hong Wang Zhong‐He Zhou Hui‐Sheng Chen |
| author_sort | Xiao‐Qiu Li |
| collection | DOAJ |
| description | Abstract Objective Previous studies suggest the benefit of dual antiplatelet therapy (DAPT) for acute ischemic stroke with large artery atherosclerosis (LAA) etiology, but there is no study about the effect of DAPT plus anticoagulant in this population. Methods A prospective single arm trial was performed to determine the effect of DAPT combined with argatroban on acute mild to moderate ischemic stroke patients with LAA, which was compared with historical populations. The main outcome was the proportion of early neurological deterioration (END). The secondary outcomes included scores of 0 to 1 and 0 to 2 on the modified Rankin Scale (mRS) at 90 days, and changes in National Institutes of Health Stroke Scale (NIHSS) from baseline to day 7 after admission. The safety outcomes included intracranial hemorrhage at 7 days, organ hemorrhage, and all‐cause mortality at 90 days. Results A total of 120 patients with argatroban plus DAPT were prospectively enrolled and 529 patients with only DAPT were retrospectively collected. There was no significant difference in baseline characteristics between groups. Compared with control group, combined treatment group had lower proportion of END (4.2% vs. 10.0%, adjusted p = .046), more reduction in NIHSS score from the baseline to day 7 after admission (1.06 ± 2.03 vs. 0.39 ± 1.97, adjusted p = .003), and higher proportion of mRS (0–2) at 90 days (87.5% vs. 79.2%, adjusted p = .048). No intracranial hemorrhage was found between groups. Conclusions This is the first report that short‐term argatroban combined with DAPT seems to be safe and may effectively prevent END and improve neurological prognosis for acute mild to moderate ischemic stroke patients with LAA; however, interpretation of the conclusion required caution due to nonrandomized controlled trial with medium sample size. |
| first_indexed | 2024-04-13T03:40:31Z |
| format | Article |
| id | doaj.art-9f1b43046e084311a47464e6e9f445c9 |
| institution | Directory Open Access Journal |
| issn | 2162-3279 |
| language | English |
| last_indexed | 2024-04-13T03:40:31Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Brain and Behavior |
| spelling | doaj.art-9f1b43046e084311a47464e6e9f445c92022-12-22T03:04:10ZengWileyBrain and Behavior2162-32792022-07-01127n/an/a10.1002/brb3.2664Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosisXiao‐Qiu Li0Xiao‐Wen Hou1Yu Cui2Xiao‐Fu Tian3Xin‐Hong Wang4Zhong‐He Zhou5Hui‐Sheng Chen6Department of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaDepartment of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaDepartment of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaDepartment of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaDepartment of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaDepartment of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaDepartment of Neurology General Hospital of Northern Theater Command Shenyang P.R. ChinaAbstract Objective Previous studies suggest the benefit of dual antiplatelet therapy (DAPT) for acute ischemic stroke with large artery atherosclerosis (LAA) etiology, but there is no study about the effect of DAPT plus anticoagulant in this population. Methods A prospective single arm trial was performed to determine the effect of DAPT combined with argatroban on acute mild to moderate ischemic stroke patients with LAA, which was compared with historical populations. The main outcome was the proportion of early neurological deterioration (END). The secondary outcomes included scores of 0 to 1 and 0 to 2 on the modified Rankin Scale (mRS) at 90 days, and changes in National Institutes of Health Stroke Scale (NIHSS) from baseline to day 7 after admission. The safety outcomes included intracranial hemorrhage at 7 days, organ hemorrhage, and all‐cause mortality at 90 days. Results A total of 120 patients with argatroban plus DAPT were prospectively enrolled and 529 patients with only DAPT were retrospectively collected. There was no significant difference in baseline characteristics between groups. Compared with control group, combined treatment group had lower proportion of END (4.2% vs. 10.0%, adjusted p = .046), more reduction in NIHSS score from the baseline to day 7 after admission (1.06 ± 2.03 vs. 0.39 ± 1.97, adjusted p = .003), and higher proportion of mRS (0–2) at 90 days (87.5% vs. 79.2%, adjusted p = .048). No intracranial hemorrhage was found between groups. Conclusions This is the first report that short‐term argatroban combined with DAPT seems to be safe and may effectively prevent END and improve neurological prognosis for acute mild to moderate ischemic stroke patients with LAA; however, interpretation of the conclusion required caution due to nonrandomized controlled trial with medium sample size.https://doi.org/10.1002/brb3.2664anticoagulantdual antiplateletearly neurological deteriorationischemic strokelarge artery atherosclerosis |
| spellingShingle | Xiao‐Qiu Li Xiao‐Wen Hou Yu Cui Xiao‐Fu Tian Xin‐Hong Wang Zhong‐He Zhou Hui‐Sheng Chen Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis Brain and Behavior anticoagulant dual antiplatelet early neurological deterioration ischemic stroke large artery atherosclerosis |
| title | Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis |
| title_full | Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis |
| title_fullStr | Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis |
| title_full_unstemmed | Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis |
| title_short | Safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis |
| title_sort | safety and preliminary efficacy of argatroban plus dual antiplatelet therapy for acute mild to moderate ischemic stroke with large artery atherosclerosis |
| topic | anticoagulant dual antiplatelet early neurological deterioration ischemic stroke large artery atherosclerosis |
| url | https://doi.org/10.1002/brb3.2664 |
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