Outcomes of Argatroban Treatment in Patients With Atherothrombotic Stroke - Japan

The failure could easily been because they were using invalid endpoints like the Rankin scale.
 The Rankin Scale has no useful discrimination at all. You should be using scans that show dead and damaged areas.
http://stroke.ahajournals.org/content/47/2/471.abstract?sid=d6bd5731-7770-4a3a-94b0-bd54612be400

Observational Nationwide Study in Japan

1. Tomoki Wada, MD;
2. Hideo Yasunaga, MD, PhD;
3. Hiromasa Horiguchi, PhD;
4. Takehiro Matsubara, MD, PhD;
5. Kiyohide Fushimi, MD, PhD;
6. Susumu Nakajima, MD, PhD;
7. Naoki Yahagi, MD, PhD

+ Author Affiliations

1. From the Departments of Emergency and Critical Care Medicine (T.W., T.M., S.N., N.Y.) and Clinical Epidemiology and Health Economics, School of Public Health (H.Y.), The University of Tokyo, Tokyo, Japan; Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan (H.H.); and Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan (K.F.).

1. Correspondence to Tomoki Wada, MD, Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail wadat-eme@h.u-tokyo.ac.jp

Abstract

Background and Purpose—Argatroban, a selective thrombin inhibitor, is recommended for the use in patients with atherothrombotic stroke by the Japanese Guidelines for the Management of Patients with Acute Ischemic Stroke. We performed a nationwide Japanese study to investigate whether argatroban improved early stroke outcomes in patients with acute atherothrombotic stroke.

Methods—This retrospective observational study, using the Diagnosis Procedure Combination database in Japan, included patients who were hospitalized from July 1, 2010, to March 31, 2012, with a diagnosis of atherothrombotic stroke within 1 day of stroke onset. Patients were divided into 2 groups: those receiving argatroban on admission (argatroban group), and those who did not receive argatroban during hospitalization (control group). To balance the baseline characteristics and concomitant treatments during hospitalization between the 2 groups, one-to-one propensity-score matching analyses were performed. The main outcomes were the modified Rankin Scale score at discharge and the occurrence of hemorrhagic complications during hospitalization. An ordinal logistic regression analysis evaluated the association between argatroban use and modified Rankin Scale at discharge.

Results—After propensity-score matching, 2289 pairs of patients were analyzed. There were no significant differences in modified Rankin Scale at discharge between the argatroban and the control groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.88–1.16). The occurrence of hemorrhagic complications did not differ significantly between the argatroban and the control groups (3.5% versus 3.8%; P=0.58).

Conclusions—The present study suggested that argatroban was safe, but had no added benefit in early outcomes after acute atherothrombotic stroke.