Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke: An Updated Systematic Review and Meta-analysis.
7 affiliations
- 1Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
- 2Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
- 3Department of Medicine, Foundation University Medical College, Islamabad, Pakistan.
- 4Department of Medicine, Rashid Latif Medical College, Lahore, Pakistan.
- 5Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
- 6Department of Medicine, Continental Medical College, Lahore, Pakistan.
- 7Carle Foundation Hospital, Illinois, USA. [email protected].
Abstract
Introduction
Acute ischemic stroke (AIS) is a life-threatening condition. Argatroban can limit thrombus progression and improve AIS's functional outcomes. This study assessed the efficacy and safety of argatroban in combination with antiplatelet therapy compared to control.Methods
PubMed and Scopus were searched. Primary outcomes were Modified Rankin Scale (mRS) 0-2 and composite hemorrhage; secondary outcomes included mRS (0-1), early neurological deterioration (END), change in National Institutes of Health Stroke Scale (NIHSS) score, mortality, intracranial and organ hemorrhage. A random-effects model was used, with risk ratios (RRs) reported for binary outcomes, while mean differences (MDs) for continuous outcomes at 95% confidence intervals (CI) and a p-value of 0.05.Results
17 studies were included with a total of 51,703 and 18,759 patients in the argatroban and control group, respectively. The primary outcomes, mRS (0-2), and composite hemorrhage showed no significant difference between argatroban and control (RR: 1.03, CI: 0.97-1.10, p = 0.26 and RR: 1.10, CI: 0.98-1.23, p = 0.11, respectively). However, argatroban significantly reduced END (RR: 0.48, CI: 0.30-0.75, p < 0.05) and favored mRS (0-1) with RR:1.22 (CI: 1.01-1.48, p = 0.03). The change in NIHSS score and incidence of mortality, stroke recurrence, intracranial and organ hemorrhage was comparable between the two groups. Subgroup analyses by antiplatelet drug in the intervention and comparison groups confirmed that argatroban showed the most pronounced results when combined with DAPT. While the overall pooled analysis did not demonstrate increased hemorrhagic risk, subgroup analysis restricted to randomized controlled trials revealed a significant increase in composite and intracranial hemorrhage with argatroban. GRADE assessment of RCT-derived evidence indicated very low to high certainty across all outcomes.Conclusion
Argatroban as an adjunct to antiplatelet therapy did not significantly improve overall functional outcome (mRS 0-2) or reduce composite hemorrhage compared with antiplatelet therapy alone. However it appears safe and may reduce END significantly.
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BibTeX
@article{fatima2026efficacy,
title = {{Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke: An Updated Systematic Review and Meta-analysis.}},
author = {Syeda Takreem Fatima and Ahmed Raza and Abdullah Javed and Shabnam Ijaz and Mishaal Noor and Syeda Duaa Uzair and Abdul Raheem Malik and Rana Ali Mustafa and Safi Ur Rehman Daim},
journal = {European journal of clinical pharmacology},
year = {2026},
month = oct,
doi = {10.1007/s00228-026-04203-7},
url = {https://europepmc.org/article/MED/42911256},
note = {CC BY},
}
RIS
TY - JOUR
TI - Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke: An Updated Systematic Review and Meta-analysis.
AU - Syeda Takreem Fatima
AU - Ahmed Raza
AU - Abdullah Javed
AU - Shabnam Ijaz
AU - Mishaal Noor
AU - Syeda Duaa Uzair
AU - Abdul Raheem Malik
AU - Rana Ali Mustafa
AU - Safi Ur Rehman Daim
PY - 2026
DA - 2026/10/22
JO - European journal of clinical pharmacology
DO - 10.1007/s00228-026-04203-7
UR - https://europepmc.org/article/MED/42911256
AB - Introduction Acute ischemic stroke (AIS) is a life-threatening condition. Argatroban can limit thrombus progression and improve AIS's functional outcomes. This study assessed the efficacy and safety of argatroban in combination with antiplatelet therapy compared to control.Methods PubMed and Scopus were searched. Primary outcomes were Modified Rankin Scale (mRS) 0-2 and composite hemorrhage; secondary outcomes included mRS (0-1), early neurological deterioration (END), change in National Institutes of Health Stroke Scale (NIHSS) score, mortality, intracranial and organ hemorrhage. A random-effects model was used, with risk ratios (RRs) reported for binary outcomes, while mean differences (MDs) for continuous outcomes at 95% confidence intervals (CI) and a p-value of 0.05.Results 17 studies were included with a total of 51,703 and 18,759 patients in the argatroban and control group, respectively. The primary outcomes, mRS (0-2), and composite hemorrhage showed no significant difference between argatroban and control (RR: 1.03, CI: 0.97-1.10, p = 0.26 and RR: 1.10, CI: 0.98-1.23, p = 0.11, respectively). However, argatroban significantly reduced END (RR: 0.48, CI: 0.30-0.75, p < 0.05) and favored mRS (0-1) with RR:1.22 (CI: 1.01-1.48, p = 0.03). The change in NIHSS score and incidence of mortality, stroke recurrence, intracranial and organ hemorrhage was comparable between the two groups. Subgroup analyses by antiplatelet drug in the intervention and comparison groups confirmed that argatroban showed the most pronounced results when combined with DAPT. While the overall pooled analysis did not demonstrate increased hemorrhagic risk, subgroup analysis restricted to randomized controlled trials revealed a significant increase in composite and intracranial hemorrhage with argatroban. GRADE assessment of RCT-derived evidence indicated very low to high certainty across all outcomes.Conclusion Argatroban as an adjunct to antiplatelet therapy did not significantly improve overall functional outcome (mRS 0-2) or reduce composite hemorrhage compared with antiplatelet therapy alone. However it appears safe and may reduce END significantly.
SN - 0031-6970
SN - 1432-1041
ER -