Evidence map›Paper›PMID 40392513›Full record

SynthesisTranslational stroke research2025

Exploring the Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke Patients: A Systematic Review and Meta-analysis.

Yousr Ahmed, Mostafa Hossam El Din Moawad, Gulnaz Bahtiyarova, Younes Nabgouri, Mohammed Elkholy, Reham M Wagih, Ibrahim Serag, Ibraheem M Alkhawaldeh, Mohamed Abouzid, Mahmoud Elsayed

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Translational stroke research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Yousr Ahmed *Department of Pulmonology and Critical Care, Johns Hopkins University, Baltimore, MD, USA.
Mostafa Hossam El Din Moawad *Alexandria Main University Hospital, Alexandria, Egypt.
Gulnaz Bahtiyarova *Department of Internal Medicine First, Pavlov State Medical University, Saint Petersburg, Russia.
Younes NabgouriDepartment of Internal Medicine First, Pavlov State Medical University, Saint Petersburg, Russia.
Mohammed ElkholyThe Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Reham M WagihDepartment of Total Parenteral Nutrition, Alexandria Main University Hospital, Alexandria, Egypt.
Ibrahim SeragFaculty of Medicine, Mansoura University, Mansoura, Egypt.
Ibraheem M AlkhawaldehFaculty of Medicine, Mutah University, Al-Karak, Jordan.
Mohamed AbouzidDepartment of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St, Poznan, 60-806, Poland. mmahmoud@ump.edu.pl.
Mahmoud ElsayedStroke and Neurovascular Regulation Laboratory, 149 13 Th Street Room 6405, Charlestown, MA, 02129, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Acute ischemic stroke (AIS) is a major cause of disability and mortality worldwide. While antiplatelet therapy is standard for secondary prevention, many patients still experience early neurological deterioration (END). Argatroban, a direct thrombin inhibitor, can potentially limit thrombus progression and improve AIS's functional outcomes. This meta-analysis assessed the efficacy and safety of argatroban in combination with single (SAPT) or dual antiplatelet therapy (DAPT) compared to antiplatelets alone. Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted until January 2025. Randomized controlled trials (RCTs) and cohort studies evaluating argatroban plus antiplatelets versus antiplatelets alone in AIS patients were included. The primary outcome was a 90-day modified Rankin Score (mRS) of 0-2. Secondary outcomes included mRS 0-1 and mRS 3-5 at 90 days, END, and National Institutes of Health Stroke Scale (NIHSS) improvement, stroke recurrence, intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), and mortality. We used the mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous ones at 95% confidence intervals (CI) and a P-value of 0.05. A total of 14 studies (four RCTs and 10 cohort studies) were included. Compared to antiplatelets alone, argatroban significantly improved functional outcomes, increasing the incidence of mRS 0-2 (OR = 1.36 [95%CI: 1.05, 1.76, P = 0.02]) and mRS 0-1 (OR = 1.54 [95%CI: 1.08, 2.2, P = 0.02]) while reducing END (OR = 0.42 [95%CI: 0.21, 0.85, P = 0.02]). Argatroban was also associated with greater NIHSS score improvement (MD =  - 0.52 [95%CI: - 0.89, - 0.15, P = 0.005]). No significant differences were observed in mRS 3-5, stroke recurrence, ICH, sICH, or mortality. Subgroup analysis indicated that argatroban combined with DAPT showed the greatest benefits. Argatroban combined with antiplatelet therapy improves functional recovery and reduces END without increasing bleeding risks. These findings support its use, particularly with DAPT, in mild to moderate AIS management. Further large-scale RCTs are needed to optimize dosing strategies and patient selection.

Indexed as

ArginineIschemic StrokePipecolic AcidsPlatelet Aggregation InhibitorsSulfonamidesDrug Therapy, CombinationHumansRandomized Controlled Trials as TopicTreatment OutcomeargatrobanArgininePipecolic AcidsPlatelet Aggregation InhibitorsSulfonamidesAntiplateletsArgatrobanIschemic strokeModified Rankin Score

Identifiers

PMID40392513
PMCPMC12596288

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.