Argatroban plus Dual Antiplatelet Therapy versus Dual Antiplatelet Alone for Acute Atherothrombotic Cerebral Infarction

Background: Dual antiplatelet therapy (DAPT) is more effective than aspirin alone in preventing early recurrences of non-cardioembolic strokes. In Japan, DAPT is often combined with argatroban, a direct thrombin inhibitor, for treating acute atherosclerotic stroke. However, the safety and effectiveness of this combination compared with those of DAPT alone remains unclear. Methods: We identified patients with acute atherothrombotic stroke treated with DAPT between April 2016 and March 2022, using the Diagnostic Procedure Combination database, a large national inpatient database in Japan. Patients were divided into two groups: those receiving DAPT plus argatroban and those receiving DAPT alone. We compared 7-day mortality, hemorrhagic complications, and readmission for stroke recurrence within 90 days between the groups using propensity-score overlap weighting analyses. Results: Of 59,983 eligible patients, 47,213 received DAPT plus argatroban, while 12,770 received DAPT alone. In the propensity-score overlap weighting analyses, no significant differences in 7-day mortality (0.2% vs. 0.2%; adjusted risk ratio [aRR], 0.77; 95% confidence interval [CI], 0.49–1.21), the proportions of hemorrhagic complications (2.3% vs. 2.1%; aRR, 1.12; 95% CI, 0.99–1.27), or 90-day readmission for stroke recurrence (1.2% vs. 1.2%; aRR, 0.99; 95%CI, 0.84–1.17) were observed between the DAPT plus argatroban and DAPT alone groups. Conclusions: The outcomes did not differ significantly between DAPT alone and argatroban combined with DAPT for acute atherothrombotic stroke.