Can the combination of antiplatelet or alteplase thrombolytic therapy with argatroban benefit patients suffering from acute stroke? a systematic review, meta-analysis, and meta-regression

<b>Background</b>The effectiveness of administering argatroban as a treatment approach following antiplatelet therapy or alteplase thrombolytic therapy in patients with acute stroke is presently uncertain. However, it is important to highlight the potential benefits of combining this medication with known thrombolytics or antiplatelet therapy. One notable advantage of argatroban is its short half-life, which helps minimize excessive anticoagulation and risk of bleeding complications in inadvertent cases of hemorrhagic stroke.By conducting a meticulous review and meta-analysis, we aim to further explore the common use of argatroban and examine the plausible advantages of combining this medication with established thrombolytic and antiplatelet therapies.<b>M</b><b>ethod</b>In this study, we performed a rigorous and methodical search for both randomized controlled trials and retrospective analyses. Our main objective was to analyze the impact of argatroban on the occurrence of hemorrhagic events and the mRS scores of 0-2. We utilized a meta-analysis to assess the relative risk (RR) associated with using argatroban versus not using it.

**背景**
目前，急性脑卒中患者在接受抗血小板治疗或阿替普酶（alteplase）溶栓治疗后，采用阿加曲班（argatroban）作为后续治疗手段的有效性尚未明确。但需着重强调，将该药物与已获批的溶栓剂或抗血小板治疗联合应用存在潜在获益。阿加曲班的一项显著优势在于其半衰期较短，可在意外发生出血性脑卒中时，最大限度降低过度抗凝及出血并发症的风险。本研究通过开展严谨的系统评价与荟萃分析，旨在进一步探究阿加曲班的临床应用现状，并评估其与标准溶栓及抗血小板治疗联合使用的潜在优势。

**方法**
本研究对随机对照试验与回顾性分析两类研究进行了严格且系统的检索。本研究的核心目标为分析阿加曲班对出血事件发生情况及改良Rankin量表（mRS）评分0~2分患者占比的影响。本研究采用荟萃分析方法，评估使用阿加曲班与未使用阿加曲班两组间的相对危险度（RR）。