Tomoki Wada1, Hideo Yasunaga2, Hiromasa Horiguchi2, Takehiro Matsubara2, Kiyohide Fushimi2, Susumu Nakajima2, Naoki Yahagi2. 1. From the Departments of Emergency and Critical Care Medicine (T.W., T.M., S.N., N.Y.) and Clinical Epidemiology and Health Economics, School of Public Health (H.Y.), The University of Tokyo, Tokyo, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan (H.H.); and Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan (K.F.). wadat-eme@h.u-tokyo.ac.jp. 2. From the Departments of Emergency and Critical Care Medicine (T.W., T.M., S.N., N.Y.) and Clinical Epidemiology and Health Economics, School of Public Health (H.Y.), The University of Tokyo, Tokyo, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan (H.H.); and Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan (K.F.).
Abstract
BACKGROUND AND PURPOSE: Argatroban, a selective thrombin inhibitor, is recommended for the use in patients with atherothrombotic stroke by the Japanese Guidelines for the Management of Patients with Acute Ischemic Stroke. We performed a nationwide Japanese study to investigate whether argatroban improved early stroke outcomes in patients with acute atherothrombotic stroke. METHODS: This retrospective observational study, using the Diagnosis Procedure Combination database in Japan, included patients who were hospitalized from July 1, 2010, to March 31, 2012, with a diagnosis of atherothrombotic stroke within 1 day of stroke onset. Patients were divided into 2 groups: those receiving argatroban on admission (argatroban group), and those who did not receive argatroban during hospitalization (control group). To balance the baseline characteristics and concomitant treatments during hospitalization between the 2 groups, one-to-one propensity-score matching analyses were performed. The main outcomes were the modified Rankin Scale score at discharge and the occurrence of hemorrhagic complications during hospitalization. An ordinal logistic regression analysis evaluated the association between argatroban use and modified Rankin Scale at discharge. RESULTS: After propensity-score matching, 2289 pairs of patients were analyzed. There were no significant differences in modified Rankin Scale at discharge between the argatroban and the control groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.88-1.16). The occurrence of hemorrhagic complications did not differ significantly between the argatroban and the control groups (3.5% versus 3.8%; P=0.58). CONCLUSIONS: The present study suggested that argatroban was safe, but had no added benefit in early outcomes after acute atherothrombotic stroke.
BACKGROUND AND PURPOSE:Argatroban, a selective thrombin inhibitor, is recommended for the use in patients with atherothrombotic stroke by the Japanese Guidelines for the Management of Patients with Acute Ischemic Stroke. We performed a nationwide Japanese study to investigate whether argatroban improved early stroke outcomes in patients with acute atherothrombotic stroke. METHODS: This retrospective observational study, using the Diagnosis Procedure Combination database in Japan, included patients who were hospitalized from July 1, 2010, to March 31, 2012, with a diagnosis of atherothrombotic stroke within 1 day of stroke onset. Patients were divided into 2 groups: those receiving argatroban on admission (argatroban group), and those who did not receive argatroban during hospitalization (control group). To balance the baseline characteristics and concomitant treatments during hospitalization between the 2 groups, one-to-one propensity-score matching analyses were performed. The main outcomes were the modified Rankin Scale score at discharge and the occurrence of hemorrhagic complications during hospitalization. An ordinal logistic regression analysis evaluated the association between argatroban use and modified Rankin Scale at discharge. RESULTS: After propensity-score matching, 2289 pairs of patients were analyzed. There were no significant differences in modified Rankin Scale at discharge between the argatroban and the control groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.88-1.16). The occurrence of hemorrhagic complications did not differ significantly between the argatroban and the control groups (3.5% versus 3.8%; P=0.58). CONCLUSIONS: The present study suggested that argatroban was safe, but had no added benefit in early outcomes after acute atherothrombotic stroke.
Authors: Mirjam Bachler; Lars M Asmis; Jürgen Koscielny; Thomas Lang; Hartmuth Nowak; Patrick Paulus; Jens-Christian Schewe; Christian von Heymann; Dietmar Fries Journal: Blood Coagul Fibrinolysis Date: 2022-06-08 Impact factor: 1.061