Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke: An Updated Systematic Review and Meta-analysis.
Syeda Takreem Fatima, Ahmed Raza, Abdullah Javed et al.
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In 30 seconds
This systematic review and meta-analysis assessed argatroban added to antiplatelet therapy versus control in acute ischemic stroke. Across 17 studies, including 51,703 patients in the argatroban group and 18,759 in the control group, there was no significant difference in the primary outcomes of modified Rankin Scale (mRS) 0–2 or composite hemorrhage. Argatroban was associated with less early neurological deterioration (RR: 0.48, CI: 0.30-0.75, p < 0.05) and a higher likelihood of mRS 0–1. Randomized-trial subgroup analyses, however, found increased composite and intracranial hemorrhage.
Key findings
- For mRS 0–2, argatroban and control did not differ significantly (RR: 1.03, CI: 0.97-1.10, p = 0.26).
- Composite hemorrhage did not differ significantly overall (RR: 1.10, CI: 0.98-1.23, p = 0.11).
- Argatroban was associated with reduced early neurological deterioration (RR: 0.48, CI: 0.30-0.75, p < 0.05).
- The randomized controlled trial subgroup showed increased composite and intracranial hemorrhage with argatroban.
Why it matters
The findings distinguish early neurological deterioration and excellent functional outcome (mRS 0–1) from the primary functional outcome of mRS 0–2, which was not significantly improved. The hemorrhage signal in randomized-trial analyses also cautions against interpreting the overall pooled safety result as definitive. Together, these results highlight uncertainty about the balance of potential benefit and bleeding risk.
What to keep in mind
The review combined studies with evidence certainty ranging from very low to high; randomized-trial subgroup findings on hemorrhage differed from the overall pooled analysis.