Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 14, 2022; 10(2): 585-593
Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.585
Efficacy and safety of argatroban in treatment of acute ischemic stroke: A meta-analysis
Bin Lv, Fang-Fang Guo, Jia-Cai Lin, Feng Jing
Bin Lv, Feng Jing, Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
Fang-Fang Guo, Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Jia-Cai Lin, Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572022, Hainan Province, China
Author contributions: Lv B and Guo FF contributed equally to this work; Lv B and Guo FF searched the related articles, analyzed the data, and wrote the manuscript; Lin JC analyzed and interpreted the data; Jing F conceived and designed this study, and made critical revision to the manuscript; all the authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Jing, MD, Doctor, Department of Neurology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. jfsuccess@126.com
Received: June 18, 2021
Peer-review started: June 18, 2021
First decision: September 28, 2021
Revised: October 14, 2021
Accepted: December 2, 2021
Article in press: December 2, 2021
Published online: January 14, 2022
Processing time: 207 Days and 18.7 Hours
Abstract
BACKGROUND

Argatroban is a novel direct thrombin inhibitor that has been used for treatment of acute ischemic stroke (AIS). To our knowledge, no systematic analysis has assessed the efficacy and safety of argatroban for treatment of AIS.

AIM

To evaluate the efficacy and safety of argatroban for treatment of AIS.

METHODS

Cochrane Library, Medline, PubMed, and Web of Science were searched to retrieve all studies associated with argatroban and AIS. Effective rate, adverse events rate, and 95% confidence intervals were calculated and pooled using meta-analysis methodology.

RESULTS

We only found four randomized controlled studies, comprising 354 cases with 213 in the argatroban group and 141 in the control group. Great heterogeneity was found in the four studies (c2 = 11.44, I2 = 74%, P = 0.01). Subgroup analysis could not be performed because of the absence of detailed data. The two most recent studies showed acceptable heterogeneity (c2 = 1.56, I2 = 36%, P = 0.21). Our analysis showed that argatroban was not more effective than the control therapy in the acute phase of ischemic stroke (Z = 0.01, P = 0.99). Argatroban did not increase the risk of bleeding compared with the control group (c2 = 0.37, I2 = 0%, P = 0.54, Z = 0.80, P = 0.42).

CONCLUSION

Patients with AIS might not benefit from argatroban and combination therapy with argatroban does not increase bleeding tendency.

Keywords: Argatroban; Anticoagulation agents; Acute ischemic stroke; Thrombin; Thrombolysis; Meta-analysis

Core Tip: This study is the first meta-analysis that systematically assessed the efficacy and safety of argatroban as a cure for acute ischemic stroke (AIS). The results showed that argatroban might not benefit for AIS. Also, this meta-analysis further suggested that argatroban does not increase the risk of bleeding for AIS.