title: Outcomes of Argatroban Treatment in Patients With Atherothrombotic Stroke: Observational Nationwide Study in Japan.
abstract: OBJECTIVE
  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.
authors.affiliation: 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.). wadat-eme@h.u-tokyo.ac.jp.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Wada
authors.affiliation: 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.).
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: 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.).
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.affiliation: 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.).
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: 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.).
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: 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.).
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: 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.).
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000188:drug therapy*; D020767:Intracranial Thrombosis / Q000150:complications / Q000188:drug therapy*; D007564:Japan; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010875:Pipecolic Acids / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D013449:Sulfonamides; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; C031942:argatroban
keywords: anticoagulants; argatroban; propensity score; stroke; thrombin