Jin Xuehong, Li Xia, Zhang Hong, Yao Xiaohan, Gu Yongquan, Pei Shaofang, Hu Lan
Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China.
Department of Neurology, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China.
Front Neurol. 2024 Mar 8;15:1363358. doi: 10.3389/fneur.2024.1363358. eCollection 2024.
Minor ischemic stroke (MIS) is associated with early neurological deterioration (END) and poor prognosis. Here, we investigated whether argatroban administration can mitigate MIS-associated END and improve functional outcomes by monitoring activated partial thrombin time (APTT).
Data were collected for patients with MIS admitted to our hospital from January 2019 to December 2022. Patients were divided into a dual antiplatelet therapy (DAPT) group (aspirin + clopidogrel) and an argatroban group (aspirin + argatroban). Those in the latter group who achieved a target APTT of 1.5-3-fold that of baseline and <100 s at 2 h after argatroban infusion were included in the argatroban subgroup. The primary outcome was the END rate of the DAPT group versus that of the argatroban group or the argatroban subgroup. Secondary outcomes included the proportion of patients with modified Rankin Scale (mRS) 0-2 at 7 and 90 days. In addition, baseline date were compared between patients with and without END in the argatroban group.
363 patients were included in the DAPT group and 270 in the argatroban group. There were no significant differences in any above outcome between them. 207 pairs were included in the DAPT group and the argatroban subgroup after 1:1 propensity score matching (PSM). Significant differences were observed in the proportion of END (OR, 2.337; 95% CI, 1.200-4.550, = 0.011) and mRS 0-2 at 7 days (OR, 0.624; 95% CI, 0.415-0.939, = 0.023), but not in mRS 0-2 at 90 days or the hemorrhagic events between the two groups. In the argatroban group, univariate analysis showed that the rate of diabetes (OR, 2.316; 95% CI, 1.107-4.482, = 0.023), initial random blood glucose (OR, 1.235; 95% CI, 1.070-1.425, = 0.004), drinking history (OR, 0.445; 95% CI, 0.210-0.940, = 0.031) or those reaching the target APTT (OR, 0.418; 95% CI, 0.184-0.949, = 0.033) was significantly different among patients with and without END. However, there were no statistical differences in these parameters between them following multivariate analysis.
In patients with MIS, argatroban administration and reaching the target APTT can reduce the incidence of END and improve short-term functional prognosis.
轻度缺血性卒中（MIS）与早期神经功能恶化（END）及预后不良相关。在此，我们通过监测活化部分凝血活酶时间（APTT），研究阿加曲班给药是否能减轻与MIS相关的END并改善功能结局。
收集2019年1月至2022年12月我院收治的MIS患者的数据。患者分为双联抗血小板治疗（DAPT）组（阿司匹林+氯吡格雷）和阿加曲班组（阿司匹林+阿加曲班）。后者中在阿加曲班输注后2小时达到目标APTT为基线值的1.5 - 3倍且<100秒的患者被纳入阿加曲班亚组。主要结局是DAPT组与阿加曲班组或阿加曲班亚组的END发生率。次要结局包括7天和90天时改良Rankin量表（mRS）评分为0 - 2的患者比例。此外，比较了阿加曲班组中有和没有END的患者的基线数据。
DAPT组纳入363例患者，阿加曲班组纳入270例患者。两组上述任何结局均无显著差异。1:1倾向评分匹配（PSM）后，DAPT组和阿加曲班亚组纳入207对。两组在END发生率（OR，2.337；95%CI，1.200 - 4.550，P = 0.011）和7天时mRS 0 - 2比例（OR，0.624；95%CI，0.415 - 0.939，P = 0.023）上存在显著差异，但在90天时mRS 0 - 2或两组间出血事件方面无差异。在阿加曲班组中，单因素分析显示糖尿病发生率（OR，2.316；95%CI，1.107 - 4.482，P = 0.023）、初始随机血糖（OR，1.235；95%CI，1.070 - 1.425，P = 0.004）、饮酒史（OR，0.445；95%CI，0.210 - 0.940，P = 0.031）或达到目标APTT的患者（OR，0.418；95%CI，0.184 - 0.949，P = 0.033）在有和没有END的患者之间有显著差异。然而，多因素分析后这些参数在两组间无统计学差异。
在MIS患者中，给予阿加曲班并达到目标APTT可降低END的发生率并改善短期功能预后。
