Safety and effects of continuous argatroban administration in acute cerebral infarction: a retrospective analysis

Argatroban is an antithrombotic agent commonly used in the acute phase of cerebral infarction. Although the standard administration method is continuous infusion within the first 2 days only, many patients receive continuous intravenous infusion beyond day 3 owing to concerns of symptoms worsening during intermittent dosing, which may be insufficient given the short half-life of argatroban. However, evidence supporting the continuous intravenous infusion beyond day 3 remains limited. This study aimed to compare the safety and efficacy between continuous and intermittent argatroban administration.

Patients who received argatroban for acute cerebral infarction at Kyoto University Hospital between January 2019 and August 2021 were retrospectively evaluated. The patients were categorized based on actual treatment regimens into either the intermittent or continuous infusion group. Clinical characteristics, safety outcomes, and neurological status were then compared between the groups. The primary outcome was the incidence of bleeding events, and the secondary outcome was neurological status, as assessed using the manual muscle test.

No clear difference in safety was observed between the two groups. The proportion of patients with a manual muscle test score of 10 significantly increased over time in the intermittent infusion group, whereas no such trend was observed in the continuous infusion group. Subgroup analysis by stroke type showed a similar increasing trend in all groups except the continuous infusion group with branch atheromatous disease, which is known to be associated with a high risk of early neurological deterioration.

Continuous argatroban administration was not associated with an increased risk of bleeding events within the limitations of the current study, despite more intensive concomitant antithrombotic therapy. Although no clear neurological improvement was observed, continuous administration may represent a feasible treatment option in carefully selected patients; however, these findings should be interpreted with caution due to baseline imbalances and potential selection bias, warranting further prospective investigation.