Argatroban plus dual antiplatelet therapy: Preliminary evidence for managing early neurological deterioration after lacunar stroke

Background

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.

Methods

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.

Results

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 (χ² = 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. Conclusions: 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.