Argatroban Plus Antiplatelet Therapy Versus Antiplatelet Alone in Acute Ischemic Stroke: A GRADE Assessment Systematic Review and Meta-analysis.
Ahmed Abbas1, Rashad G. Mohamed2, Yousef Hawas3, Mohamed Ellebedy4, Mohamed Abo-elsoad1, Magdy Shehab5, Amir Hegazi5, Hussien Hussien5, Sarah Amro6, Kareem Khalefa7, Moaz Abouelmagd8, Ahmed Negida9, Muataz Kashbour10
1Faculty of Medicine, Mansoura University, Mansoura, Egypt, 2Mansoura Manchester Program for Medical Education, Faculty of Medicine, Mansoura University, 3Faculty of Medicine, Tanta University, Tanta, Egypt, 4Faculty of Medicine, Sohag University, Sohag, Egypt, 5Mansoura Manchester Program for Medical Education, Faculty of Medicine, Mansoura, 6Department of Nuclear medicine, University hospitals Sussex NHS foundation trust, 7kareemkhalefa188@gmail.com, 8Kasr-alainy Faculty of medicine, Cairo University, Cairo, Egypt, 9Virginia Commonwealth University, 10Dignostic Radiology Department, National Cancer Institute, Misrata, Libya
Objective:
This meta-analysis compares the efficacy and safety of combining argatroban with antiplatelet therapy versus antiplatelet therapy alone.
Background:
Acute ischemic stroke (AIS) is a major global cause of disability and mortality. Although antiplatelet therapy is commonly used, its effectiveness is limited. Argatroban, a direct thrombin inhibitor, offers potential benefits for AIS patients.
Design/Methods:
This study was conducted according to PRISMA guidelines. PubMed, Scopus, Cochrane, and Web of Science were searched up to May 5, 2025. Primary outcomes included the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Secondary outcomes included early neurological deterioration (END) and safety outcomes.
Results:
18 studies with a total of 11,781 patients were included in our study. Combined therapy significantly improved functional outcomes: mRS 0-2 (RR = 1.07, 95% CI [1.03–1.11], p = 0.001) and mRS 0-1 (RR = 1.21, 95% CI [1.06–1.38], p = 0.004). Argatroban also reduced the risk of END (RR = 0.49, 95% CI [0.32–0.76], p = 0.001) and overall NIHSS scores (MD = -0.55, 95% CI [-0.99 to -0.10], p = 0.02). No significant differences were found in safety outcomes or mortality.
Conclusions:
Argatroban combined with antiplatelet therapy enhances neurological and functional recovery in AIS without elevating bleeding or mortality risks. This dual approach shows promise as a treatment strategy, though larger randomized trials are needed to validate its benefits.
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