ABSTRACT NUMBER: ESOC2026A879 SAFETY AND EFFICACY OF ARGATROBAN PLUS ANTIPLATELET THERAPY FOR NON-CARDIOEMBOLIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 3,017 PATIENTS

Abstract Background and aims Argatroban plus antiplatelet therapy in patients with acute non-cardioembolic stroke who did not receive reperfusion therapy is unclear. We conducted this meta-analysis to assess whether argatroban combined with antiplatelet therapy (APT) improved efficacy and safety neurological outcomes. Methods A database search up to December 2025 identified eligible studies, including one randomized controlled trial and five observational cohorts (2 Propensity-Score Matched) comparing argatroban plus APT with APT alone in 3,035 patients. The primary outcomes were good functional outcomes, defined as modified ranking scale (mRs) scores 0-2, early neurological deterioration (END), intracraneal hemorrhage (ICH) and mortality. Results Pooled analysis revealed that argatroban administration was associated with higher rates of mRS 0-2 at 90 days (RR=1.10, 95% CI: 1.06-1.14, p=<0.00001), significant reductions in END (RR=0.57, 95% CI: 0.37-0.88, p=0.01. No significant differences emerged in NIHSS score changes (RR=0.10, 95% CI:-1.14-1.34, p=0.81), ICH (RR=0.94, 95% CI: 0.56-1.59, p=0.83) or 90-day mortality (RR=0.43, 95% CI: 0.15-1.23, p=0.11). Conclusions This meta-analysis suggests that argatroban plus APT in patients with non-cardioembolic stroke may improve good functional outcomes and reduce END, without altering NIHSS scores, ICH, nor mortality events. As the first meta-analysis addressing this question, our findings are concordant with the sole available randomized controlled trial, reinforcing the biological plausibility and clinical relevance of argatroban in this setting. These results strengthen the current evidence base and underscore the need for adequately powered randomized clinical trial. Conflict of interest Amiel Armando Aragon Cortes. Nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results Table 1 - belongs to Conclusions Table 2 - belongs to Conclusions Table 3 - belongs to Conclusions Table 4 - belongs to Conclusions