| 허혈성 뇌졸중의 급성기에 투여한 아가트로반의 임상 효과:
다기관, 무작위 배정, 아스피린-대조 임상시험 |
| 송영목, 정상욱 배희준 윤병우 조기현 이병철 이용석 김종성 한시령 유경무 노재규 |
| 단국대학교 의과대학 신경과학교실, 인제대학교 의과대학 신경과학교실*, 을지의과대학교 신경과학교실†, 서울대학교 의과대학 신경과학교실‡,
전남대학교 의과대학 신경과학교실§, 한림대학교 의과대학 신경과학교실∥, 서울특별시립 보라매병원 신경과¶,
울산대학교 |
| Argatroban Treatment in Acute Ischemic Stroke:
Multicenter, Randomized, Aspirin-Controlled Study |
| Young-Mok Song |
| Department of Neurology, Dankook University College of Medicine; Department of Neurology, Inje University College of Medicine*;
Department of Neurology, Eulji University College of Medicine†; Department of Neurology, Seoul National University College of Medicine‡;
Department of Neurology, Chonnam National University College of Medicine§; Department of Neurology, Hallym University College of Medicine∥;
Department of Neurology, Seoul Municipal Boramae Hospital¶; Department of Neurology, University of Ulsan College of Medicine#,
Department of Neurology The Catholic University of Korea College of Medicine**;
Department of Neurology, Kosin University College of Medicine††, Korea |
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| Abstract |
Background: Argatroban, a direct thrombin inhibitor, has been suggested to be beneficial in acute ischemic stroke by preventing microthrombi formation. The aim of this multicenter, aspirin-controlled, randomized trial is to determine the safety and the efficacy of argatroban compared with aspirin in acute ischemic stroke.
Methods: The patients within 48 hours of noncardioembolic ischemic stroke were recruited from 8 centers. Argatroban was infused continuously at 2.5 mg/hr for the first 48 h, and then 10mg of argatroban was infused over 3 h twice a day on days 3-7. Control group received aspirin 300 mg/day for 7 days. The primary outcome was the NIHSS at 30 days and the secondary outcome was Barthel index (BI) and modified Rankin scale (mRS) at 90 days. The safety was evaluated by the incidence of bleeding complication.
Results: A total of 236 patients (123 for argatroban and 113 for aspirin) were included. NIHSS at 30 days, BI at 90 days and mRS at 90 days did not show significant difference between the argatroban and the aspirin group (3.1±3.1 vs 3.5±3.0, 88.9±22.5 vs 86.2±23.8, 1.4±1.1 vs 1.6±1.3, p>0.3, respectively). Post hoc analysis revealed that as for the patients who were treated within 24 hours after onset, numbers of patients with NIHSS=1 at 30 days were larger in the argatroban group (23 of 49) than in the aspirin group (10 of 40) (p=0.03). Bleeding complication was not different between the two groups (2 of 123 vs 0 of 113: p>0.4).
Conclusions: Argatroban treatment is relatively safe in acute ischemic stroke. The efficacy of argatroban is not superior to aspirin. However, argatroban may be more beneficial in some subgroup of stroke patients than aspirin. Key Words: Argatroban, Thrombin inhibitor, Aspirin |
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