Argatroban, which is a
thrombin inhibitor, has an indication as a treatment in the acute phase on atherosclerotic
ischemic stroke in Japan. Howeve, in
cardioembolic stroke,
argatroban is considered to be contraindicated with the side effect of
hemorrhage, though there is no clear clinical evidence to show that
argatroban increases hemorrhagic compared with
heparin. The efficacy of
anticoagulant treatment with
argatroban on
cardioembolic stroke was evaluated retrospectively in this study. We identified 3,113 patients from the Japan Standard
Stroke Registry Study who had had a cardioembolic
ischemic stroke. We excluded patients with the anti-platelet treatment or the combination
therapy of anticoagulation. Our analyses are therefore based on a cohort of 2,529 patients who were treated either with
heparin, and
argatroban, or with no anti-coagulation treatment. With multivariable regression, hemorrhagic it was shown that
hemorrhage was significantly reduced in
heparin and
argatroban treatments in the patients with mild severity. There was no significant difference in the recurrence of
ischemic stroke between the treatments. Both
argatroban and
heparin showed dramatic improvement compared with the no treatment standard, but only
heparin achieved statistical significance for mortality and change in NIHSS score (admission to discharge) in the moderate
stroke subgroup [NIHSS 11-22]. Both
heparin and
argatroban [more so than
heparin alone] have a significantly reduced mortality risk. From the present study, it is suggested that
argatroban may be useful on
cardioembolic stroke, increasing the improvement of recovery of
stroke severity without increasing the risk of
hemorrhage. Further prospective studies are awaited for evaluating better the efficacy of
argatroban on
cardioembolic stroke.