Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis

Abstract Background Patients with acute non-lacunar single subcortical infarct (SSI) associated with mild intracranial atherosclerosis (ICAS) have a relatively high incidence of early neurological deterioration (END), resulting in unfavorable functional outcomes. Whether the early administration of...

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Autores principales:	Peng-Fei Wang, Zhuo-Ran Sun, Jin-Chao Yu, Na Geng, Ling-Yun Liu, Li-Na Zhu, Jing Li, Hai-Cheng Yuan, Guo-chen Zhao, Zhen-Guang Li
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Argatroban Anticoagulation Single subcortical infarction Intracranial atherosclerosis Early neurological deterioration Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/883d3f3f9ba5480891671d91c74fb2e2
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spelling	oai:doaj.org-article:883d3f3f9ba5480891671d91c74fb2e22021-11-14T12:13:28ZEarly argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis10.1186/s12883-021-02435-x1471-2377https://doaj.org/article/883d3f3f9ba5480891671d91c74fb2e22021-11-01T00:00:00Zhttps://doi.org/10.1186/s12883-021-02435-xhttps://doaj.org/toc/1471-2377Abstract Background Patients with acute non-lacunar single subcortical infarct (SSI) associated with mild intracranial atherosclerosis (ICAS) have a relatively high incidence of early neurological deterioration (END), resulting in unfavorable functional outcomes. Whether the early administration of argatroban and aspirin or clopidogrel within 6–12 h after symptom onset is effective and safe in these patients is unknown. Methods A review of the stroke database of Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University and Qingdao Center Hospital, Qingdao University Medical College in China was undertaken from May 2017 to January 2020 to identify all patients with non-lacunar SSI caused by ICAS within 6–12 h of symptom onset based on MRI screening. Patients were divided into two groups, one comprising those who received argatroban and mono antiplatelet therapy with aspirin or clopidogrel on admission (argatroban group), and the other those who received dual antiplatelet therapy (DAPT) with aspirin and clopidogrel during hospitalization (DAPT group). The primary outcome was recovery by 90 days after stroke based on a modified Rankin scale (mRS) score (0 to 1). The secondary outcome was END incidence within 120 h of admission. Safety outcomes were intracranial hemorrhage (ICH) and major extracranial bleeding. The probability of clinical benefit (mRS score 0–1 at 90 days) was estimated using multivariable logistic regression analysis. Results A total of 304 acute non-lacunar SSI associated with mild ICAS patients were analyzed. At 90 days, 101 (74.2%) patients in the argatroban group and 80 (47.6%) in the DAPT group had an mRS score that improved from 0 to 1 (P < 0.001). The relative risk (95% credible interval) for an mRS score improving from 0 to 1 in the argatroban group was 1.50 (1.05–2.70). END occurred in 10 (7.3%) patients in the argatroban group compared with 37 (22.0%) in the DAPT group (P < 0.001). No patients experienced symptomatic hemorrhagic transformation. Conclusions Early combined administration of argatroban and an antiplatelet agent (aspirin or clopidogrel) may be beneficial for patients with non-lacunar SSI associated with mild ICAS identified by MRI screening and may attenuate progressive neurological deficits. Trial registration Our study is a retrospectively registered trial.Peng-Fei WangZhuo-Ran SunJin-Chao YuNa GengLing-Yun LiuLi-Na ZhuJing LiHai-Cheng YuanGuo-chen ZhaoZhen-Guang LiBMCarticleArgatrobanAnticoagulationSingle subcortical infarctionIntracranial atherosclerosisEarly neurological deteriorationNeurology. Diseases of the nervous systemRC346-429ENBMC Neurology, Vol 21, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Argatroban Anticoagulation Single subcortical infarction Intracranial atherosclerosis Early neurological deterioration Neurology. Diseases of the nervous system RC346-429
spellingShingle	Argatroban Anticoagulation Single subcortical infarction Intracranial atherosclerosis Early neurological deterioration Neurology. Diseases of the nervous system RC346-429 Peng-Fei Wang Zhuo-Ran Sun Jin-Chao Yu Na Geng Ling-Yun Liu Li-Na Zhu Jing Li Hai-Cheng Yuan Guo-chen Zhao Zhen-Guang Li Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
description	Abstract Background Patients with acute non-lacunar single subcortical infarct (SSI) associated with mild intracranial atherosclerosis (ICAS) have a relatively high incidence of early neurological deterioration (END), resulting in unfavorable functional outcomes. Whether the early administration of argatroban and aspirin or clopidogrel within 6–12 h after symptom onset is effective and safe in these patients is unknown. Methods A review of the stroke database of Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University and Qingdao Center Hospital, Qingdao University Medical College in China was undertaken from May 2017 to January 2020 to identify all patients with non-lacunar SSI caused by ICAS within 6–12 h of symptom onset based on MRI screening. Patients were divided into two groups, one comprising those who received argatroban and mono antiplatelet therapy with aspirin or clopidogrel on admission (argatroban group), and the other those who received dual antiplatelet therapy (DAPT) with aspirin and clopidogrel during hospitalization (DAPT group). The primary outcome was recovery by 90 days after stroke based on a modified Rankin scale (mRS) score (0 to 1). The secondary outcome was END incidence within 120 h of admission. Safety outcomes were intracranial hemorrhage (ICH) and major extracranial bleeding. The probability of clinical benefit (mRS score 0–1 at 90 days) was estimated using multivariable logistic regression analysis. Results A total of 304 acute non-lacunar SSI associated with mild ICAS patients were analyzed. At 90 days, 101 (74.2%) patients in the argatroban group and 80 (47.6%) in the DAPT group had an mRS score that improved from 0 to 1 (P < 0.001). The relative risk (95% credible interval) for an mRS score improving from 0 to 1 in the argatroban group was 1.50 (1.05–2.70). END occurred in 10 (7.3%) patients in the argatroban group compared with 37 (22.0%) in the DAPT group (P < 0.001). No patients experienced symptomatic hemorrhagic transformation. Conclusions Early combined administration of argatroban and an antiplatelet agent (aspirin or clopidogrel) may be beneficial for patients with non-lacunar SSI associated with mild ICAS identified by MRI screening and may attenuate progressive neurological deficits. Trial registration Our study is a retrospectively registered trial.
format	article
author	Peng-Fei Wang Zhuo-Ran Sun Jin-Chao Yu Na Geng Ling-Yun Liu Li-Na Zhu Jing Li Hai-Cheng Yuan Guo-chen Zhao Zhen-Guang Li
author_facet	Peng-Fei Wang Zhuo-Ran Sun Jin-Chao Yu Na Geng Ling-Yun Liu Li-Na Zhu Jing Li Hai-Cheng Yuan Guo-chen Zhao Zhen-Guang Li
author_sort	Peng-Fei Wang
title	Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
title_short	Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
title_full	Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
title_fullStr	Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
title_full_unstemmed	Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
title_sort	early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/883d3f3f9ba5480891671d91c74fb2e2
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Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis

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