Argatroban in Patients With Acute Ischemic Stroke With Early Neurological Deterioration

RCT (n=628) found argatroban with antiplatelet (AP) was associated with better neurological function at 90 days in patients with acute ischaemic stroke with early neurological deterioration vs AP alone (risk difference 7.2%, 95% CI 0.6%-14.0%; risk ratio 1.10; 1.01-1.20; P =0.04)

SPS commentary:

There was no difference in symptomatic intracranial haemorrhage between the argatroban and control group.

A related editorial discusses the history of anticoagulation and antithrombotic use in treating ischaemic stroke. It points out the lower argatroban dose used (60mg per day for the first 2 days followed by 20mg per day for an additional five days) compared with the previous largest trial (ARIAS). It ends by posing the question of whether treatment with this direct thrombin inhibitor would be even more effective if targeted at patients at high risk of deterioration before they worsen.

JAMA Neurology

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