Argatroban plus alteplase in posterior versus anterior circulation stroke

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY

Annals of Clinical and Translational Neurology Pub Date : 2024-12-15 DOI:10.1002/acn3.52280

Yu Cui, Hui-Sheng Chen

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引用次数: 0

Abstract

Objective

ARAIS trial failed to demonstrate benefit of argatroban as an adjunct to alteplase for stroke. Given differences between anterior circulation stroke (ACS) and posterior circulation stroke (PCS), we performed prespecified secondary analysis to investigate whether benefit of argatroban was different between ACS and PCS.

Methods

In secondary analysis of ARAIS, patients with definite stroke territories based on responsible vessel examination were classified into ACS and PCS. The primary outcome was a 90-day excellent functional outcome (modified Rankin Scale score of 0 to 1). The efficacy was compared between argatroban plus alteplase and alteplase alone.

Results

This study included 356 patients from the full analysis set of ARAIS trial: 283 in the ACS group and 73 in the PCS group. Compared with alteplase alone, a higher likelihood of 90-day excellent functional outcome was associated with argatroban plus alteplase in PCS group (78.1% versus 61.0%; adjusted RD, 14.4%; 95% CI, 1.6% to 27.2%; p = 0.03), but similar in ACS group (61.7% versus 62.7%; adjusted RD, −2.4%; 95% CI, −10.1% to 5.2%; p = 0.54). After controlling unbalanced sample size bias by propensity score matching, significant interaction between efficacy and stroke territories was found (p = 0.01). The risk of symptomatic intracranial hemorrhage was higher following argatroban plus alteplase than alteplase alone in ACS group (p = 0.02).

Interpretation

Argatroban plus alteplase, compared with alteplase alone, was associated with improved functional outcomes in PCS. This study first demonstrated better benefits of argatroban plus alteplase in PCS, which deserves to be confirmed.

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阿加曲班加阿替普酶在卒中后循环与前循环中的作用。

目的：ARAIS试验未能证明阿加曲班作为阿替普酶辅助治疗脑卒中的益处。鉴于前循环卒中（ACS）和后循环卒中（PCS）之间的差异，我们进行了预先指定的二次分析，以调查阿加曲班在ACS和PCS之间的获益是否不同。方法：在ARAIS的二次分析中，根据责任血管检查确定卒中区域的患者分为ACS和PCS。主要转归是90天的良好功能转归（改进的Rankin量表评分为0到1）。比较阿加曲班加阿替普酶和单独阿替普酶的疗效。结果：本研究纳入了来自ARAIS试验全分析集的356例患者：ACS组283例，PCS组73例。与单独使用阿替普酶相比，PCS组中阿加曲班加阿替普酶获得90天良好功能结局的可能性更高(78.1%比61.0%；调整后的RD为14.4%；95% CI, 1.6% ~ 27.2%；p = 0.03)，但ACS组相似(61.7% vs 62.7%；调整后的RD， -2.4%；95% CI, -10.1% ~ 5.2%；p = 0.54)。通过倾向评分匹配控制不平衡样本量偏差后，发现疗效与卒中区域之间存在显著的交互作用（p = 0.01）。ACS组阿加曲班加阿替普酶治疗后出现症状性颅内出血的风险高于单纯阿替普酶治疗组（p = 0.02）。解释：阿加曲班加阿替普酶与单独使用阿替普酶相比，可改善PCS患者的功能结局。本研究首次证明阿加曲班联合阿替普酶治疗PCS疗效更好，值得进一步证实。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.