Efficacy and Prognosis of Adjuvant Argatroban Treatment in Acute Ischemic Stroke Patients with Early Neurological Deterioration.

IF 2 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Discovery medicine Pub Date : 2023-04-01 DOI:10.24976/Discov.Med.202335175.19

Shu Xu, Wenjun Zhang, Yan Zhang, Zhou Xu, Ting Wu

{"title":"Efficacy and Prognosis of Adjuvant Argatroban Treatment in Acute Ischemic Stroke Patients with Early Neurological Deterioration.","authors":"Shu Xu, Wenjun Zhang, Yan Zhang, Zhou Xu, Ting Wu","doi":"10.24976/Discov.Med.202335175.19","DOIUrl":null,"url":null,"abstract":"Background: The therapeutic outcomes for acute ischemic stroke (AIS) with early neurological deterioration (END) are adverse. Argatroban is a novel direct thrombin inhibitor, which is safe in the treatment of AIS, but its efficacy is controversial. This study sought to assess the therapeutic effect of argatroban as an adjunct to aspirin in the treatment of AIS patients with END. Patients' prognosis for the presence of END was also evaluated.Methods: Overall, 166 AIS patients with END were included in the study from June 2018 to June 2021 in The Affiliated Zhangjiagang Hospital of Soochow University. Patients were divided in the control group (aspirin alone) and the study group (aspirin combined with argatroban). General data of the patients were collected. Clinical indexes such as the modified Edinburgh-Scandinavian stroke scale (MESSS), and the serum fibrinogen (FIB) and neuropeptide Y (NPY) levels before and after treatment were also collected. Correlations between prognosis and general data, and FIB and NPY levels in AIS patients with END were analyzed by multivariate logistic regression. The performance of FIB and NPY levels in predicting patients' prognosis was further analyzed using receiver operating characteristic (ROC) curves.Results: There was no significant difference in the general data, such as sex, age, course of disease and basic diseases between the 2 groups. After treatment, the MESSS score (13.08 ± 3.24 vs. 16.48 ± 3.32, p < 0.001), serum FIB level (2.72 ± 0.81 vs. 3.52 ± 0.71, p < 0.001), and NPY level (121.28 ± 17.34 vs. 152.09 ± 18.25, p < 0.001) of the study group was significantly lower than that of the control group. A further analysis revealed that the serum FIB (OR, odds ratio = 2.296, 95% confidence interval, CI: 1.437-3.669, p = 0.001) and NPY (OR = 1.020, 95% CI: 1.002-1.039, p = 0.031) levels were independent risk factors of patients' prognosis for the presence of END.Conclusions: Aspirin combined with argatroban significantly improved neurological impairment of AIS patients with END, which is worthy of clinical application.","PeriodicalId":11379,"journal":{"name":"Discovery medicine","volume":"35 175","pages":"185-192"},"PeriodicalIF":2.0000,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Discovery medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.24976/Discov.Med.202335175.19","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The therapeutic outcomes for acute ischemic stroke (AIS) with early neurological deterioration (END) are adverse. Argatroban is a novel direct thrombin inhibitor, which is safe in the treatment of AIS, but its efficacy is controversial. This study sought to assess the therapeutic effect of argatroban as an adjunct to aspirin in the treatment of AIS patients with END. Patients' prognosis for the presence of END was also evaluated.

Methods: Overall, 166 AIS patients with END were included in the study from June 2018 to June 2021 in The Affiliated Zhangjiagang Hospital of Soochow University. Patients were divided in the control group (aspirin alone) and the study group (aspirin combined with argatroban). General data of the patients were collected. Clinical indexes such as the modified Edinburgh-Scandinavian stroke scale (MESSS), and the serum fibrinogen (FIB) and neuropeptide Y (NPY) levels before and after treatment were also collected. Correlations between prognosis and general data, and FIB and NPY levels in AIS patients with END were analyzed by multivariate logistic regression. The performance of FIB and NPY levels in predicting patients' prognosis was further analyzed using receiver operating characteristic (ROC) curves.

Results: There was no significant difference in the general data, such as sex, age, course of disease and basic diseases between the 2 groups. After treatment, the MESSS score (13.08 ± 3.24 vs. 16.48 ± 3.32, p < 0.001), serum FIB level (2.72 ± 0.81 vs. 3.52 ± 0.71, p < 0.001), and NPY level (121.28 ± 17.34 vs. 152.09 ± 18.25, p < 0.001) of the study group was significantly lower than that of the control group. A further analysis revealed that the serum FIB (OR, odds ratio = 2.296, 95% confidence interval, CI: 1.437-3.669, p = 0.001) and NPY (OR = 1.020, 95% CI: 1.002-1.039, p = 0.031) levels were independent risk factors of patients' prognosis for the presence of END.

Conclusions: Aspirin combined with argatroban significantly improved neurological impairment of AIS patients with END, which is worthy of clinical application.

查看原文本刊更多论文

阿加曲班辅助治疗急性缺血性脑卒中伴早期神经功能恶化的疗效及预后。

背景:急性缺血性卒中(AIS)伴早期神经功能恶化(END)的治疗结果是不利的。阿加曲班是一种新型的直接凝血酶抑制剂，治疗AIS是安全的，但其疗效存在争议。本研究旨在评估阿加曲班作为阿司匹林辅助治疗AIS合并终末期患者的疗效。还评估了患者存在END的预后。方法:2018年6月至2021年6月，苏州大学附属张家港医院共纳入166例AIS合并END患者。患者分为对照组(阿司匹林单独)和研究组(阿司匹林联合阿加曲班)。收集患者的一般资料。收集治疗前后的临床指标，如改进的爱丁堡-斯堪的纳维亚卒中量表(MESSS)，血清纤维蛋白原(FIB)和神经肽Y (NPY)水平。采用多因素logistic回归分析AIS合并END患者预后与一般数据、FIB和NPY水平的相关性。采用受试者工作特征(ROC)曲线进一步分析FIB和NPY水平对患者预后的预测作用。结果:两组患者性别、年龄、病程、基础疾病等一般资料比较，差异均无统计学意义。治疗后，研究组的mess评分(13.08±3.24比16.48±3.32,p < 0.001)、血清FIB水平(2.72±0.81比3.52±0.71,p < 0.001)、NPY水平(121.28±17.34比152.09±18.25,p < 0.001)均显著低于对照组。进一步分析发现，血清FIB (OR，比值比= 2.296,95%可信区间，CI: 1.437 ~ 3.669, p = 0.001)和NPY (OR = 1.020, 95% CI: 1.002 ~ 1.039, p = 0.031)水平是影响患者预后的独立危险因素。结论:阿司匹林联合阿加曲班可显著改善AIS合并END患者的神经功能损害，值得临床推广。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Discovery medicine MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

5.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Discovery Medicine publishes novel, provocative ideas and research findings that challenge conventional notions about disease mechanisms, diagnosis, treatment, or any of the life sciences subjects. It publishes cutting-edge, reliable, and authoritative information in all branches of life sciences but primarily in the following areas: Novel therapies and diagnostics (approved or experimental); innovative ideas, research technologies, and translational research that will give rise to the next generation of new drugs and therapies; breakthrough understanding of mechanism of disease, biology, and physiology; and commercialization of biomedical discoveries pertaining to the development of new drugs, therapies, medical devices, and research technology.