The following is a summary of “Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke,” published in the September 2024 issue of Emergency Medicine by Adeoye et al.

The standard treatment of acute ischemic stroke is Intravenous thrombolysis. Researchers conducted a retrospective study to evaluate the effectiveness and safety of combining intravenous thrombolysis with argatroban or eptifibatide for acute ischemic stroke.

They conducted a clinical trial to compare the effects of argatroban, eptifibatide, and placebo in patients with acute ischemic stroke from 57 sites in the United States. Patients who acquired intravenous thrombolysis within 3 hours of sign onset were randomized to receive 1 of the 3 treatments within 75 minutes after thrombolysis. The primary outcome was the utility-weighted 90-day modified Rankin scale score, assessed by centralized adjudication, and the primary safety effect was symptomatic intracranial hemorrhage within 36 hours.

The results showed 514 patients were randomized to receive argatroban (59 patients), eptifibatide (227 patients), or placebo (228 patients), and every individual received intravenous thrombolysis (70% alteplase, 30% tenecteplase), and 225 patients (44%) underwent endovascular thrombectomy. The mean utility-weighted modified Rankin scale scores were significantly lower with argatroban (5.2±3.7) compared to eptifibatide (6.3±3.2) and placebo AT 90 days (6.8±3.0), posterior probability that argatroban was better 0.002 (posterior mean difference, −1.51±0.51), and that eptifibatide was 0.041 (posterior mean difference, −0.50±0.29) better than placebo. The incidence of symptomatic intracranial hemorrhage was equivalent to 4% with argatroban, 3% with eptifibatide, and 2% with placebo. However, mortality at 90 days was higher in the argatroban (24%), followed by eptifibatide (12%) compared to the placebo (8%).

They concluded adjunctive treatment with argatroban or eptifibatide did not improve outcomes but increased mortality in patients with acute ischemic stroke.

Source: nejm.org/doi/full/10.1056/NEJMoa2314779