IN patients with branch atherosclerosis disease (BAD), early neurological deterioration (END) poses a significant threat to recovery, even in mild strokes. Now, a new randomized clinical trial has revealed that a therapeutic strategy combining argatroban and dual antiplatelet therapy (DAPT) may significantly reduce this risk while improving long-term outcomes.
A multicenter, open-label, randomized controlled trial enrolled 100 patients with BAD-related mild stroke (NIH Stroke Scale score ≤5) across four centers in China. All patients were treated within 48 hours of symptom onset and randomly assigned to receive either argatroban plus DAPT or DAPT alone.
The findings were striking: END occurred in only 20.4% of patients in the argatroban + DAPT group compared to 47.1% in the DAPT-alone group. This corresponds to a risk ratio of 2.31 (95% CI, 1.49–3.58; P=0.006), suggesting that the combination therapy more than halved the likelihood of neurological decline in the acute phase.
Moreover, by day 90, 87.8% of patients in the argatroban group had achieved an excellent functional outcome (mRS score 0–1), compared to 68.6% in the DAPT-alone group (risk difference: -19.1%; P=0.025). Importantly, safety outcomes were favorable, with only one minor hemorrhagic event in each group.
These findings offer a potential paradigm shift in the early treatment of BAD-related stroke, a subtype often underrecognized for its high risk of deterioration. While further studies in broader populations are needed, these data suggest that argatroban, when used early in conjunction with DAPT, may be a safe and effective approach to improving neurological outcomes in high-risk patients.
Healthcare professionals managing stroke patients may want to take note—this trial offers actionable insights into optimizing outcomes in a particularly vulnerable subgroup.
Reference: Xu J et al. Effect of Argatroban Plus Dual Antiplatelet in Branch Atherosclerosis Disease: A Randomized Clinical Trial. Stroke. 2025. doi: 10.1161/STROKEAHA.124.048872. [Epub ahead of print].
