Timely Initiation of Argatroban Improves Prognosis in Patients With Acute Ischemic Stroke Attributed to Large Artery Atherosclerosis: A Cohort Study.

Introduction: Previous studies have demonstrated the benefits of anticoagulant therapy in acute ischemic stroke (AIS) of large artery atherosclerosis (LAA) etiology, although no prior research has examined the impact of the timing of anticoagulation initiation in this population.

Methods: A retrospective cohort study was conducted to assess the effect of early argatroban administration on clinical outcomes in AIS with LAA. Patients were stratified into an early administration group and a late administration group based on the time from stroke onset to argatroban initiation: ≤24 h and >24 h. The primary outcome was the proportion of favorable outcome, defined as modified Rankin Scale (mRS) score 0-2 at 90 days. Secondary outcomes included the proportion of patients achieving mRS 0-1 at 90 days, the mRS score at 90 days, and changes in National Institutes of Health Stroke Scale (NIHSS) score from baseline to 7 days or discharge. Safety outcomes comprised symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END) during hospitalization, and organ hemorrhage within 90 days. Adjustments for potential confounders were performed using logistic regression.

Results: From February 2022 to February 2024, 401 AIS patients treated with argatroban were enrolled. After excluding patients with non-LAA etiologies, thrombolysis, and follow-up loss, 55 patients received argatroban ≤24 h after stroke onset, and 98 received it >24 h. At 90 days, 43.6% of the early administration group achieved favorable outcomes versus 27.6% of the later administration group (p = 0.024). One sICH occurred in the later administration group. END was observed in one (1.8%) patient in the early administration group and five (5.1%) in the later administration group.

Conclusion: This is the first study to demonstrate that timely argatroban initiation may improve clinical outcomes in thrombolysis-naive patients with LAA AIS. However, the results should be interpreted with caution due to the study's retrospective design and limited sample size.