Argatroban Increased the Basal Vein Drainage and Improved Outcomes in Acute Paraventricular Ischemic Stroke Patients

Abstract

Background Since venous drainage in acute arterial ischemic stroke has not been thoroughly researched, we evaluate the effect of argatroban, a selective direct thrombin inhibitor, as a therapy to increase the rate of basal vein Rosenthal (BVR) drainage and improve patients’ post-stroke outcomes. Material/Methods In this multicenter clinical trial, 60 eligible patients at 4.5 to 48 hours after the stroke onset were recruited. After being randomly allocated into 2 groups, they were treated with standard therapy either alone or with argatroban. Results Compared to the contralateral brain hemisphere, the mean flow velocity (MFV) in BVR drainage was significantly reduced in the stroke-afflicted ipsilateral hemisphere. After treatment with argatroban for 7 days, the MFV from BVR of the ipsilateral hemisphere in the argatroban treated group was significantly increased when compared to the control group. At 90 days after the onset of stroke, the MFV of BVR in the ipsilateral hemisphere was similar in both groups. Compared with controls, the argatroban-treated patients had smaller lesions from baseline to 7 days. Argatroban also improved National Institutes of Health Stroke Scale (NIHSS) scores on day 7 after the onset of stroke. Furthermore, the argatroban group’s neurological functions were superior to those of their untreated counterparts after 90 days. No difference was found in the incidence of adverse reactions between the 2 groups. Conclusions These observations indicate that vein drainage change may contribute to the acute phase of brain edema and the outcomes of ischemic stroke patients. Clinical Trial Registration URL- http://www.chictr.org Unique identifier: ChiCTR-IPR-16008663

Efficacy and safety of Argatroban in patients with acute ischemic stroke: a systematic review and meta-analysis

“…The included studies were from different countries: eight from China ( 11–16 , 19 , 22 ), two from Japan ( 18 , 21 ), one from Korea ( 17 ), two from the USA ( 20 , 23 , 24 ) and one from the UK ( 20 ). Among the included studies, six studies were RCTs ( 11 , 14 , 16 , 20 , 22 , 24 ) and eight studies were observational studies ( 12 , 13 , 15 , 17–19 , 21 , 23 ). In the intervention group, four studies adopted Argatroban alone ( 16 , 18 , 21 , 24 ), six studies adopted Argatroban combined with MAPT or DAPT ( 12–15 , 19 , 22 ), three studies adopted Argatroban combined with alteplase ( 11 , 20 , 23 ) and one study adopted Argatroban combined with MT ( 17 ).…”

“…The quality evaluation of included RCTs was presented in Table 2 . Of the six RCTs included, four trials were judged at low risk of bias ( 11 , 14 , 20 , 24 ). Another two were considered low risk in the incomplete outcome data, selective reporting and overall risk of bias ( 16 , 22 ).…”

“…We chose mRS score of 0–1 and mRS score of 0–2 at 90 days to evaluate the good functional outcome after stroke. Five studies reported the rate of mRS score of 0–1 ( 11 , 12 , 14 , 20 , 22 ) and mRS score of 0–2 at 90 days ( 11 , 15 , 17 , 22 , 24 ), respectively. The rates of mRS score of 0–1 (OR = 1.38, 95% CI: 0.71–2.67, I 2 = 77.56%) and mRS score of 0–2 (OR = 1.18, 95% CI: 0.98–1.42, I 2 = 0.00%) at 90 days did not significantly improve in the Argatroban group compared with the control group ( Figure 3 ).…”

“…In this study, adverse events included ICH, major extracranial bleeding and mortality. A total of 12 studies reported the rate of ICH ( 11–15 , 17–20 , 22 , 23 ), 10 studies reported the rate of major extracranial bleeding ( 11–18 , 20 , 24 ) and 7 studies reported the rate of mortality ( 14 , 15 , 17 , 20 , 21 , 23 , 24 ). As shown in Figure 4 , the adverse event rates of Argatroban group were no significantly different from that of the control group (ICH: OR = 1.02, 95% CI: 0.68–1.51, I 2 = 0.00%; major extracranial bleeding: OR = 1.22, 95% CI: 1.01–1.48, I 2 = 0.00%; mortality: OR = 1.16, 95% CI: 0.84–1.59, I 2 = 0.00%).…”

Efficacy and Prognosis of Adjuvant Argatroban Treatment in Acute Ischemic Stroke Patients with Early Neurological Deterioration

“…Besides, a few studies focusing on arga-troban efficacy in the treatment of stroke have now been conducted. Liu et al (2020) [13] found that when treating acute paraventricular IS patients based following American Heart Association guidelines, the conventional treatment combined use of argatroban significantly increased the basal vein Rosenthal drainage rate and improved patients' outcome after stroke. A meta-analysis reported that argatroban was not more effective than the conventional AIS treatment, but it did not increase bleeding risk [14].…”