ABSTRACT NUMBER: ESOC2026A341 ARGATROBAN PLUS ANTIPLATELET THERAPY VERSUS ANTIPLATELET ALONE IN ACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH GRADE ASSESSMENT

Abstract Background and aims Although antiplatelet therapy is commonly used, its effectiveness is limited. Argatroban, a direct thrombin inhibitor, offers potential benefits for AIS patients. This meta-analysis compares the efficacy and safety of combining argatroban with antiplatelet therapy versus antiplatelet therapy alone. Methods PubMed, Scopus, Cochrane, and Web of Science were searched up to May 5, 2025. Primary outcomes included the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Secondary outcomes included early neurological deterioration (END) and safety outcomes. Results 18 studies with a total of 11,781 patients were included in our study. Combined therapy significantly improved functional outcomes: mRS 0-2 (RR = 1.07, 95% CI [1.03–1.11], p = 0.001) and mRS 0-1 (RR = 1.21, 95% CI [1.06–1.38], p = 0.004). Argatroban also reduced the risk of END (RR = 0.49, 95% CI [0.32–0.76], p = 0.001) and overall NIHSS scores (MD = -0.55, 95% CI [-0.99 to -0.10], p = 0.02). No significant differences were found in safety outcomes or mortality. Conclusions Argatroban combined with antiplatelet therapy enhances neurological and functional recovery in AIS without elevating bleeding or mortality risks. This dual approach shows promise as a treatment strategy, though larger randomized trials are needed to validate its benefits. Conflict of interest All Authors have nothing to disclose