Zhang Haiqi, Ma Aijuan, Ma Hongna, Chang Wansheng, Liu Hui, Chen Jianfei, Yin Jijun, Lin Feng, Xia Zhangyong
Department of Neurology, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing 252600, China.
Department of Neurology, The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Linqing 252600, China.
Clin Neurol Neurosurg. 2025 Mar;250:108786. doi: 10.1016/j.clineuro.2025.108786. Epub 2025 Feb 19.
This study aimed to evaluate the efficacy and safety of argatroban combined with dual antiplatelet therapy (DAPT) in managing early neurological deterioration (END) following stroke and to determine whether argatroban offers superior outcomes compared to DAPT alone.
Patients presenting with END after stroke between October 2022 and April 2024 were included and classified into two groups based on their treatment regimen during hospitalization: the argatroban group (argatroban + DAPT) and the control group (DAPT only). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission and on days 7, 14, and 90 ± 7 post-stroke. Functional outcomes were evaluated using the modified Rankin Scale (mRS), with scores of 0-2 indicating favorable prognosis based on follow-up records. The argatroban group comprised 30 patients, while the control group included 50 patients.
At 7 and 14 days post-treatment, The argatroban group demonstrated a statistically significant reduction in the NIHSS score compared to the control group (2.84 ± 1.32 vs. 3.56 ± 1.49, p = 0.024). Moreover, the reduction in NIHSS scores over the treatment period was significantly greater in the argatroban group than in the control group (p = 0.017). There were significant differences in the distribution of mRS scores at 90 ± 7 days between the two groups (χ = 6.162, p = 0.041), although the proportion of favorable outcome with mRS = 0-2 did not reach statistically significance (70 % vs. 62 %; p = 0.47). Gingival bleeding occurred in one patient (3.33 %) in the argatroban group, whereas no cases of bleeding or complications such as gastrointestinal hemorrhage, cerebral hemorrhage, or hepatic/renal dysfunction were observed in either group during the treatment and follow-up period.
Early administration of argatroban combined with DAPT was both safe and effective in improving clinical outcomes for patients with END after stroke. The argatroban group demonstrated superior efficacy compared to the control group.
本研究旨在评估阿加曲班联合双联抗血小板治疗（DAPT）对卒中后早期神经功能恶化（END）的疗效和安全性，并确定阿加曲班与单独使用DAPT相比是否能提供更好的治疗效果。
纳入2022年10月至2024年4月期间出现END的卒中患者，并根据其住院期间的治疗方案分为两组：阿加曲班组（阿加曲班+DAPT）和对照组（仅DAPT）。在入院时以及卒中后第7天、14天和90±7天使用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度。使用改良Rankin量表（mRS）评估功能结局，根据随访记录，mRS评分为0-2分表明预后良好。阿加曲班组包括30例患者，对照组包括50例患者。
治疗后第7天和14天，阿加曲班组的NIHSS评分与对照组相比有统计学意义的降低（2.84±1.32 vs. 3.56±1.49，p = 0.024）。此外，阿加曲班组在治疗期间NIHSS评分的降低幅度明显大于对照组（p = 0.017）。两组在90±7天时mRS评分分布存在显著差异（χ = 6.162，p = 0.041），尽管mRS = 0-2的良好结局比例未达到统计学意义（70% vs. 62%；p = 0.47）。阿加曲班组有1例患者（3.33%）出现牙龈出血，而在治疗和随访期间两组均未观察到出血或胃肠道出血、脑出血或肝/肾功能障碍等并发症。
早期给予阿加曲班联合DAPT对卒中后END患者改善临床结局是安全有效的。阿加曲班组与对照组相比疗效更佳。
