MOST (argatroban)
Trial question
What is the role of adjunctive argatroban in patients with AIS?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
48.0% female
52.0% male
N = 287
287 patients (138 female, 149 male).
Inclusion criteria: patients with AIS who had received intravenous thrombolysis within 3 hours after symptom onset.
Key exclusion criteria: known allergy or hypersensitivity to argatroban; previous stroke in the past 90 days; previous ICH, neoplasm, subarachnoid hemorrhage, or arterial venous malformation; serious systemic hemorrhage in the past 30 days.
Interventions
N=59 argatroban (a bolus of 100 mcg/kg, followed by a 12-hour infusion of 3 mcg/kg/min).
N=228 placebo (matching bolus and 12-hour infusion).
Primary outcome
Mean utility-weighted modified Rankin Scale score at 90 days
5.2 points
6.8 points
6.8 points
5.1 points
3.4 points
1.7 points
0.0 points
Argatroban
Placebo
No significant
difference ↔
No significant difference in mean utility-weighted mRS score at 90 days (5.2 points vs. 6.8 points; MD -1.51, 95% CI -3.09 to 0.07).
Secondary outcomes
Borderline significant decrease in mRS score of 0 or 1 or return to prestroke score at 90 days (24% vs. 40%; OR 0.46, 95% CI 0.24 to 0.89).
Borderline significant decrease in mRS score of 0-2 or return to prestroke score at 90 days (44% vs. 61%; OR 0.5, 95% CI 0.28 to 0.9).
No significant difference in post-thrombectomy grade of 2b or 3 on modified Treatment in Cerebral Ischemia scale (81% vs. 94%; OR 0.28, 95% CI 0.08 to 1.02).
Safety outcomes
No significant difference in symptomatic ICH.
Significant difference in death from any cause (24% vs. 8%).
Conclusion
In patients with AIS who had received intravenous thrombolysis within 3 hours after symptom onset, argatroban was not superior to placebo with respect to mean utility-weighted mRS score at 90 days.
Reference
Opeolu Adeoye, Joseph Broderick, Colin P Derdeyn et al. Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke. N Engl J Med. 2024 Sep 5;391(9):810-820.
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