The efficacy and safety of argatroban in the treatment of acute ischemic stroke: a systematic review and Meta-analysis

Abstract:

Objective The efficacy and safety of argatroban in acute ischemic stroke（AIS） remains controversial. Our study aims to conduct a systematic review and Meta-analysis on the efficacy and safety of argatroban in AIS.Methods Relevant literatures were searched from the databases of PubMed，The Cochrane Library，Embase，ClinicalTrials.gov，CNKI，CBM，VIP and Wanfang until April 2022. Two trained researchers screened the literature，extracted data and assessed the bias risk independently. The Meta-analysis was performed using RevMan 5.4 software.Results A total of 25 studies were enrolled in the Meta-analysis，including 4 696 AIS patients（2 271 cases in the argatroban group and 2 425 cases in the control group）. Overall Meta-analysis showed that argatroban significantly improved early neurological function recovery（OR=2.69，95%CI=1.66-4.34，P<0.001），and reduced early neurological deterioration（OR=0.42，95%CI=0.29-0.60，P<0.001）. However，there was no significant influence on the proportion of patients with modified Rankin Scale（mRS） score of 0-1（P=0.080），the proportion of patients with mRS score of 0-2（P=0.230） and recurrence rate of stroke（P=0.190）. The subgroup analysis showed argatroban combined with oral antiplatelet drugs was associated with higher incidence of 90-day mRS 0-2（OR=1.55，95%CI=1.17-2.05，P=0.003）. There was no significant difference in the incidence of any intracranial hemorrhage（P=0.730），symptomatic intracranial hemorrhage（P=0.990），systemic bleeding（P=0.150） and mortality（P=0.990）.Conclusion Argatroban may improve the early neurological function recovery in AIS patients without increasing the risk of bleeding and mortality.