Argatroban plus dual antiplatelet therapy versus dual antiplatelet alone for acute atherothrombotic cerebral infarction

Saki Nakashima; Satoshi Kodama; Shotaro Aso; Taisuke Jo; Hideo Yasunaga; Toshiaki Isogai; Hiroki Matsui; Yuichiro Shirota; Kiyohide Fushimi; Tatsushi Toda; Masashi Hamada

doi:10.1177/17474930251344458

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Argatroban plus dual antiplatelet therapy versus dual antiplatelet alone for acute atherothrombotic cerebral infarction

Journal article

Peer reviewed

Argatroban plus dual antiplatelet therapy versus dual antiplatelet alone for acute atherothrombotic cerebral infarction

Saki Nakashima, Satoshi Kodama, Shotaro Aso, Taisuke Jo, Hideo Yasunaga, Toshiaki Isogai, Hiroki Matsui, Yuichiro Shirota, Kiyohide Fushimi, Tatsushi Toda, …

International journal of stroke, Vol.20(9), pp.1123-1131

10/01/2025

DOI: 10.1177/17474930251344458

PMID: 40375365

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Abstract

Dual antiplatelet therapy (DAPT) is more effective than aspirin alone in preventing early recurrences of non-cardioembolic strokes. In Japan, DAPT is often combined with argatroban, a direct thrombin inhibitor, for treating acute atherosclerotic stroke. However, the safety and effectiveness of this combination compared with those of DAPT alone remains unclear. We identified patients with acute atherothrombotic stroke treated with DAPT between April 2016 and March 2022, using the Diagnostic Procedure Combination database, a large national inpatient database in Japan. Patients were divided into two groups: those receiving DAPT plus argatroban and those receiving DAPT alone. We compared 7-day mortality, hemorrhagic complications, and readmission for stroke recurrence within 90 days between the groups using propensity-score overlap weighting analyses. Of 59,983 eligible patients, 47,213 received DAPT plus argatroban, while 12,770 received DAPT alone. In the propensity-score overlap weighting analyses, no significant differences in 7-day mortality (0.2% vs 0.2%; adjusted risk ratio [aRR], 0.77; 95% confidence interval [CI], 0.49-1.21), the proportions of hemorrhagic complications (2.3% vs 2.1%; aRR, 1.12; 95% CI, 0.99-1.27), or 90-day readmission for stroke recurrence (1.2% vs 1.2%; aRR, 0.99; 95%CI, 0.84-1.17) were observed between the DAPT plus argatroban and DAPT alone groups. The outcomes did not differ significantly between DAPT alone and argatroban combined with DAPT for acute atherothrombotic stroke.

Aged

Aged, 80 and over

Arginine - analogs & derivatives

Arginine - therapeutic use

Cerebral Infarction - drug therapy

Drug Therapy, Combination

Dual Anti-Platelet Therapy - methods

Female

Humans

Japan

Male

Middle Aged

Pipecolic Acids - therapeutic use

Platelet Aggregation Inhibitors - therapeutic use

Sulfonamides - therapeutic use

Treatment Outcome

Details

Title: Subtitle: Argatroban plus dual antiplatelet therapy versus dual antiplatelet alone for acute atherothrombotic cerebral infarction
Creators: Saki Nakashima - The University of Tokyo
Satoshi Kodama - The University of Tokyo
Shotaro Aso - The University of Tokyo
Taisuke Jo - University of Tokyo Health Sciences
Hideo Yasunaga - University of Tokyo Health Sciences
Toshiaki Isogai - Tokyo Metropolitan Tama Medical Center
Hiroki Matsui - University of Tokyo Health Sciences
Yuichiro Shirota - The University of Tokyo
Kiyohide Fushimi - Department of Health Policy and Informatics, Institute of Science Tokyo Graduate School, Tokyo, Japan
Tatsushi Toda - The University of Tokyo
Masashi Hamada - The University of Tokyo
Resource Type: Journal article
Publication Details: International journal of stroke, Vol.20(9), pp.1123-1131
DOI: 10.1177/17474930251344458
PMID: 40375365
ISSN: 1747-4930
eISSN: 1747-4949
Language: English
Date published: 10/01/2025
Academic Unit: Neurology
Record Identifier: 9985177946102771

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