Department of Neurology, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Traditional Chinese Medicine University of Guangzhou, Foshan, Guangdong, 528200, PR China.
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, PR China.
Clin Neurol Neurosurg. 2020 Nov;198:106233. doi: 10.1016/j.clineuro.2020.106233. Epub 2020 Sep 13.
Argatroban in acute noncardioembolic stroke ineligible for intravenous thrombolysis (IVT) or endovascular treatment (EVT) remains unclear. This study aimed to evaluate whether argatroban improved early and long-term outcomes compared with antiplatelet treatment.
This retrospective observational study, using the prospective stroke database from our hospital, included all consecutive patients who hospitalized from January 1, 2017 to December 31, 2019, with a diagnosis of acute non-cardioembolic stroke within 48 hours of stroke onset but not receiving IVT and EVT. Patients were divided into 2 groups: the argatroban group and the control group without argatroban. Outcome assessment with early neurological deterioration (END), National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), bleeding complications, and mortality were compared between the 2 groups in all cases and different stroke subtypes. An ordinal logistic regression analysis evaluated the association between argatroban use and mRS score at 90 days.
Of 1325 patients were enrolled, 519 patients in the argatroban group and 806 in the control. Baseline characteristics, hospital bleeding complications, and 90-day mortality were similar for the 2 groups. The argatroban group showed lower END, larger improvement of 7-day NIHSS score and higher percentage of a 90-day mRS score of 02. Similar results were found in subgroup analysis with large-artery atherosclerosis, anterior circulation infarction, and moderate stroke. Also, argatroban use was significantly associated with an excellent long-term stroke outcome (mRS ≤ 2).
The current study suggested that argatroban was safe and effective for improving short and long-term outcomes in noncardioembolic stroke patients.
对于不适合静脉溶栓（IVT）或血管内治疗（EVT）的急性非心源性卒中患者，使用阿加曲班的效果尚不清楚。本研究旨在评估与抗血小板治疗相比，阿加曲班是否能改善早期和长期预后。
本回顾性观察性研究使用我院前瞻性卒中数据库，纳入 2017 年 1 月 1 日至 2019 年 12 月 31 日期间发病 48 小时内的急性非心源性卒中且未接受 IVT 和 EVT 的连续患者。患者分为阿加曲班组和未使用阿加曲班组。比较两组之间的早期神经功能恶化（END）、国立卫生研究院卒中量表（NIHSS）、改良 Rankin 量表（mRS）、出血并发症和死亡率，包括所有病例和不同的卒中亚型。有序逻辑回归分析评估了阿加曲班使用与 90 天 mRS 评分之间的关系。
共纳入 1325 例患者，其中阿加曲班组 519 例，对照组 806 例。两组患者的基线特征、院内出血并发症和 90 天死亡率相似。阿加曲班组的 END 较低，7 天 NIHSS 评分改善更大，90 天 mRS 评分 0-2 分的比例更高。大动脉粥样硬化、前循环梗死和中度卒中的亚组分析也得到了类似的结果。此外，阿加曲班的使用与良好的长期卒中预后（mRS≤2）显著相关。
本研究表明，阿加曲班对非心源性卒中患者的短期和长期预后安全有效。
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