Anticoagulant therapy with a selective thrombin inhibitor for acute cerebral infarction: usefulness of coagulation markers for evaluation of efficacy.
BACKGROUND
Argatroban is a selective thrombin inhibitor used for the treatment of atherothrombotic infarction. We evaluated its therapeutic effect using coagulation markers in 30 patients with cardioembolic infarction and 30 patients with atherothrombotic infarction during the immediate period after ischemic stroke.


METHODS
Argatroban therapy was initiated within 24 hours of the onset of stroke and the course was followed until 7 days after the start of treatment. Neurological evaluation was performed using the Hemispheric Stroke Scale (HSS). We also monitored the serial changes in activated partial thromboplastin time, prothrombin time, thrombin-antithrombin complex (TAT), and prothrombin fragments 1 + 2 (F1 + 2).


RESULTS
Both groups of patients showed significant improvement of HSS after 7 days of argatroban therapy (p < 0.05). Hemorrhagic infarction developed in 8 of patients with cardioembolic infarction, but no worsening of symptoms was noted in any of these patients. There was no significant prolongation of activated partial thromboplastin time or prothrombin time after 7 days, while levels of both TAT and F1 + 2 were significantly decreased from day 2.


CONCLUSIONS
The decrease in TAT and F1 + 2 during argatroban therapy suggested improvement of hypercoagulability, which might explain how this drug prevents the recurrence of both ATI and CEI in the acute stage. Our findings also suggested that TAT and F1 + 2 might be useful indices for evaluation of argatroban efficacy.
D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D001798:Blood Proteins / Q000032:analysis; D002544:Cerebral Infarction / Q000188:drug therapy*; D004617:Embolism; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010875:Pipecolic Acids / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy; D013449:Sulfonamides; D013927:Thrombosis; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D015415:Biomarkers; D001798:Blood Proteins; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; C031942:argatroban