We enrolled 180 patients who were treated for deteriorating acute subcortical ischemic stroke. Table 1 presents the baseline characteristics of the patients. The average age of the patients was 63.13 ± 8.44 years. Moreover, 43.89% of the patients were ≥ 65 years old while 56.67% of the patients were male. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 10 ± 4. The median time from onset to IV argatroban was 16 ± 8 hours with 44% of the patients receiving IV argatroban within 12 hours. Further, 20% and 12% had moderate to severe middle cerebral artery stenosis and basal artery stenosis, respectively, based on computed tomography (CT) or magnetic resonance imaging (MRI). Furthermore, 25%, 12.5%, 62.5% had 0, 1 or 2, and 3 risk factors, respectively.
Table 1
Baseline characteristics of the patients.
Characteristics | Total |
Case no | 180 |
Mean age (yr) | 63.13 ± 8.44 |
< 65 (%) | 56.11% |
≥ 65 (%) | 43.89% |
Gender, male (%) | 56.67% |
Risk factor (%) | |
0 | 25% |
1 or 2 | 12.5% |
≥ 3 | 62.5% |
Stroke severity | |
Mild (NIHSS < 7) | 25.6% |
Moderate (7 ≤ NIHSS ≤ 15) | 62.2% |
Severe (NIHSS༞15) | 12.2% |
Median baseline NIHSS score | 10 ± 4 |
Stenosis of middle cerebral artery | 20% |
Stenosis of basilar artery | 12% |
Onset to needle time (h) | 16 ± 8 h |
< 12 | 44% |
≥ 12 | 56% |
Table 2 shows the values of different coagulate makers before and after argatroban therapy. There was a slightly increased aPTT prolongation after 24 h of argatroban treatment, which was 44% greater than the pretreatment value. Moreover, there was PT prolongation at 24 hours after initial treatment; however, there was no significant difference with the baseline value. Plasma TT were significantly prolonged after therapy. The mean values before and after 24 hours of treatment with argatroban were 17.25 ± 2.64 and 56.73 ± 24.18, respectively.
Table 2
Values of different coagulation makers before and after agatroban therapy.
| Before therapy | 24 h after agatroban therapy |
TT | 17.25 ± 2.64 | 56.73 ± 24.18∗ |
aPTT | 25.71 ± 2.45 | 37.03 ± 6.29∗ |
PT | 10.80 ± 0.60 | 11.46 ± 0.35 |
|
∗ p < 0.05, compared with initial value before therapy.
The mean NIHSS scores after or before 7 days of treatment with argatroban were 10 ± 4 (range: 4–22) and 6.98 ± 3.88 (range: 0–16), respectively. Among the included patients, 44 (24.44%) patients showed complete recovery, 61 (33.89%) patients showed remarkable progress, 32 (17.78%) patients made progress, 28 (15.56%) patients showed no change, and 15 (8.33%) patients worsened after treatment with argatroban. Taken together, the total effective rate was 76.11%. Further, 72, 96, 12, patients with plasma TT were tested within 40 s (Table 3, group a), 40–80 s (Table 3, group b), and > 80 s (Table 3, group c). In group a, the mean NIHSS score decreased from 10.01 ± 3.86 to 7.92 ± 4.45 at 7 days after argatroban treatment. Moreover, 16 (22.22%), 22 (30.56%), 10 (13.89%), 17 (23.61%), and 7 (9.72%) patients showed complete recovery, remarkable progress, progress, no change, and worsening after treatment with argatroban, respectively. Taken together, the total effective rate was 66.67%. In group b, the mean NIHSS score decreased from 9.79 ± 3.49 to 6.14 ± 3.88. Further, 24 (25%), 35 (36.46%), 20 (20.83%), 10 (10.42%), and 7 (7.29%) patients showed complete recovery, remarkable progress, progress, no change, and worsening after treatment with argatroban, respectively. Taken together, the total effective rate was 82.29%. In group c, the mean NIHSS score decreased from 11.62 ± 2.28 to 8.11 ± 2.03. Moreover, 4 (33.33%), 4 (33.33%), 2 (16.67%), 1 (8.33%), and 1 (8.33%) patient showed complete recovery, remarkable progress, progress, no change, and worsening treatment with argatroban. Taken together, the total effective rate was 83.33%.
Table 3
Therapeutic effect in the different groups.
| n | NIHSS score | NIHSS score | Hemorrhage | Complete recovery | Remarkable progress | Progress | No change | Deterioration | Total effective |
| (before therapy) | (7d after therapy) | n | n (%) | n (%) | n (%) | n (%) | n (%) | rate (%) |
Group a | 72 | 10.01 ± 3.86 | 7.92 ± 4.45∗ | 0 | 16 (22.22) | 22 (30.56.) | 10 (13.89) | 17 (23.61) | 7 (9.72) | 66.67 |
Group b | 96 | 9.79 ± 3.49 | 6.14 ± 3.88∗ | 0 | 24 (25.00) | 35 (36.46) | 20 (20.83) | 10 (10.42) | 7 (7.29) | 82.29 |
Group c | 12 | 11.62 ± 2.28 | 8.11 ± 2.03∗ | 1 | 4 (33.33) | 4 (33.33) | 2 (16.67) | 1 (8.33) | 1 (8.33) | 83.33 |
Total | 180 | 10 ± 4 | 6.98 ± 3.88∗ | 1 | 44 (24.44) | 61 (33.89) | 32 (17.78) | 28 (15.56) | 15 (8.33) | 76.11 |
|
Group a: TT<40; group b: 80≥TT≥40; group c: TT>80. ∗ p < 0.05, compared with NIHSS score before therapy. n: number
None of the patients showed severe systemic or symptomatic intracerebral bleeding. Hemorrhagic infarction developed in 1 patient in group c; however, the patient’s symptoms did not worsen.