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Updated: Jun 14, 2025

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke
Opeolu Adeoye1, Joseph Broderick1, Colin P Derdeyn1
1From the Department of Emergency Medicine, Washington University, St. Louis (O.A., P.P., S.P.); the Departments of Neurology and Rehabilitation Medicine (J.B., I.D., S.D., M.H., P.K.), Emergency Medicine (A.P.), and Radiology (A.V.), University of Cincinnati, and the Department of Pharmacy, University of Cincinnati Medical Center (N.S.) - both in Cincinnati; the Department of Radiology, University of Virginia, Charlottesville (C.P.D.); the Clinical Institute for Research and Innovation, Memorial Hermann Hospital (J.C.G.), the Department of Neuroradiology, University of Texas M.D. Anderson Cancer Center (M.W.), and the Department of Neurology, University of Texas Health Science Center (A.D.B.), Houston, Berry Consultants, Austin (S.B., T.G.), and the Texas Stroke Institute, Medical City Healthcare, Dallas (A.J.Y.) - all in Texas; the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.), and the Department of Neurology, McLaren Flint, Flint (A.M.) - both in Michigan; the Department of Neurology, University of Minnesota, Minneapolis (O.B., C.S.); the Department of Neurology, Sarasota Memorial Hospital, Intercoastal Medical Group, Sarasota (M.C.), and the Department of Neurology, Mayo Clinic, Jacksonville (J.H.) - both in Florida; the Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.E., J.I.), and the Department of Medicine (Neurology), Prisma Health-Upstate, University of South Carolina Greenville School of Medicine, Greenville (S.S.); the Department of Emergency Medicine, Temple University, Philadelphia (N.G.); the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (S.J.); the Department of Neurology, Yale University, New Haven, CT (A.S.J.); the Departments of Neurology and Emergency Medicine, State University of New York, New York (S.R.L.); the Department of Neurology, Wake Forest University, Winston-Salem, NC (T.R.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.W.).
Adding argatroban or eptifibatide to intravenous thrombolysis for acute ischemic stroke did not improve outcomes and increased mortality. These adjunctive treatments are not recommended for patients receiving standard stroke care.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Intravenous thrombolysis is a standard treatment for acute ischemic stroke.
- The combined efficacy and safety of thrombolysis with argatroban or eptifibatide remain unclear.
Purpose of the Study:
- To evaluate the efficacy and safety of adjunctive intravenous argatroban or eptifibatide in acute ischemic stroke patients treated with thrombolysis.
- To compare outcomes using the utility-weighted 90-day modified Rankin scale score.
Main Methods:
- Phase 3, randomized, controlled trial involving 514 patients across 57 US sites.
- Patients received intravenous thrombolysis within 3 hours of symptom onset, followed by argatroban, eptifibatide, or placebo.
- Primary outcomes included functional disability (modified Rankin scale) and symptomatic intracranial hemorrhage.
Main Results:
- Adjunctive argatroban or eptifibatide did not improve 90-day functional outcomes compared to placebo.
- Mortality at 90 days was higher with argatroban (24%) and eptifibatide (12%) versus placebo (8%).
- Symptomatic intracranial hemorrhage rates were similar across all groups.
Conclusions:
- Intravenous argatroban or eptifibatide as adjunctive therapy to thrombolysis for acute ischemic stroke did not reduce disability.
- These treatments were associated with increased mortality, suggesting they are not beneficial additions to standard care.
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