Argabotran tPA Stroke study

study design and results in the first treated cohort. Arch Neurol 2006; 63:1057-1062. Argatroban is a direct thrombin inhibitor, commonly used for HIT that augments t PA in animal models. 15 patients with MCA occlusions with mean NIHSS score of 14 were given t-PA then argotroban. They received a 100 ug/kg bolus followed by a 1 ug/kg for 48 hours adjusted to a target PTT of 1.75 times control. 2 patients had SICH, 1 had asymptomatic bleeding, one died. 6 had complete recanalization, 4 had partial recanalization, and three ultimately reoccluded within 2 hours of t PA administration. Comment-- ARGIS 1 showed argatroban was safe but ineffective. Intravenous tPAdoes not benefit 57-58 % of patients who receive it. Only 20-30 % completely recanalize on TCD. Argatroban began before t PA finished. Argatroban was chosen because of its short half life and the ease of monitoring by APTT. The small group showed greater recanalization in combined treated group than in historical controls with just t PA.