Clinical study on the efficacy and safety of argatroban in patients with progressive cerebral infarction / 中华神经科杂志

ABSTRACT

Objective To evaluate the efficacy and safety of argatroban in the treatment of progressive cerebral infarction.Methods Three hundred hospitalized patients with progressive cerebral infarction from October 2006 to September 2011 were collected,among which 150 cases who agreed to the use of argatroban as experimental group,and 150 cases who didn' t agree to the use of argatroban for economic reasons as control group.Experimental group was treated with venous argatroban.It was 60 mg/d within the first 2 days and 24 h continuous intravenous drip.From the beginning of the 3rd day,the dosage was changed to 10 mg each time,twice a day for 5 days.Additionally,75 mg clopidogrel was given once a day for 12 days.Control group was only treated with 75 mg clopidogrel once a day for 14 days.The degree of neurological deficit was compared using the National Institutes of Health Stroke Scale (NIHSS) scoring and the rehabilitation condition was evaluated by Barthel index (BI) and modified Rankin Scale (mRS) scoring between 2 groups before treatment and 3 d,14 d,30 d and 90 d after treatment respectively,and further compared to patients with large artery stenosis and anterior or posterior circulation infarction.The indexes of coagulation function of 2 groups were monitored meanwhile.Results The degree of neurological deficit was significantly improved in the short term (before treatmentNIHSS 15.19 ± 2.70,after treatment of 3 d 10.75 ±2.09,t =2.l14,P =0.037 ;14 d 8.77 ± 1.50,t =2.092,P =0.039;30 d 6.89 ± 0.79,t =2.520,P =0.013 ;90 d 4.85 ± 0.38,t =2.723,P =0.008),and the activities of daily living were significant enhanced in the experimental group (after treatment of 30 d BI 70.89 ± 12.69,90 d 88.16 ± 11.96,90 d mRS 1.57 + 0.39) when compared with the control group (after treatment of 30 d BI 60.26 ± 11.85,t =2.292,P=0.023;90 d 69.90 ± 12.63,t =2.790,P =0.006;90 d mRS 2.14 ±0.52,t =2.124,P =0.035).For large artery stenosis or posterior circulation infarction,the efficacy of argatroban was better.The indexes of coagulation function were in the normal range both before and after medication.No serious adverse reaction occurred during treatment.Conclusion Argatroban which has a higher security probably improves the prognosis and reduces the disability of patients with progressive cerebral infarction.