Adjuncts to IV thrombolysis disappoint in ischemic stroke trial

September 11, 2024

Among patients with acute ischemic stroke treated with IV thrombolysis within 3 hours of symptom onset, adjunctive use of IV argatroban or eptifibatide failed to reduce poststroke disability and was associated with increased mortality.

• The phase 3 MOST trial included 514 patients with acute ischemic stroke who’d received IV thrombolysis within 3 hours after symptom onset. Participants were assigned to receive either IV argatroban (n=59), eptifibatide (n=227), or placebo (n=228) within 75 minutes after initiation of thrombolysis. All patients received IV thrombolysis (70% alteplase, 30% tenecteplase), and 225 patients (44%) underwent endovascular thrombectomy.
• At 90 days, the mean utility-weighted modified Rankin scale scores were 5.2±3.7 with argatroban, 6.3±3.2 with eptifibatide, and 6.8±3.0 with placebo. Posterior probabilities that argatroban and eftifibatide were better than placebo were 0.002 and 0.041, respectively. Incidence of symptomatic intracranial hemorrhage within 36 hours of randomization was similar among the three groups (4% with argatroban, 3% with eptifibatide, and 2% with placebo). Ninety-day mortality rates were higher in the argatroban (24%) and eptifibatide (12%) groups vs. the placebo group (8%).

Source:

Adeoye O, et al. (2024, September 4). N Engl J Med. Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke. https://pubmed.ncbi.nlm.nih.gov/39231343/