Abstract Number: Esoc2026ys56 Clinical and Imaging Outcomes of Argatroban in Early Neurological Deterioration of Subcortical and Brainstem Infarctions

Abstract Background and aims Argatroban has been suggested to improve functional outcomes in patients with acute ischemic stroke who experience early neurological deterioration (END).This study aimed to determine whether argatroban use was associated with neurological or radiological outcomes in patients with END due to stroke progression in subcortical or brainstem infarctions. Methods We retrospectively analyzed patients admitted between January 2011 and December 2024. END was defined as ≥2 worsening in total National Institutes of Health Stroke Scale (NIHSS) or ≥1 worsening in motor or consciousness subscores. The primary outcomes were neurological improvement (NI, NIHSS improvement ≥1) and a 3-month modified Rankin Scale (mRS) score of 0–3. Radiological outcomes were assessed using changes in diffusion-weighted imaging (DWI) lesion volume, and clinical outcomes were compared according to the timing of argatroban administration. Baseline imbalances were adjusted using inverse probability of treatment weighting (IPTW). Results A total of 461 patients (age 68.9 ± 12.3 years; 50.1% male) were included, of whom 190 (41.2%) received argatroban. Argatroban after END was associated with higher odds of any NI (IPTW OR 1.511.01–2.05) but not with 3-month mRS 0–3 (IPTW OR 0.950.63–1.43). Baseline DWI volume was identical between the groups, and there was no significant difference in daily lesion growth after adjustment. Early argatroban use was associated with 3-month mRS 0–2 (p for time effect = 0.002). Argatroban after END was associated with NI but not with functional or radiological outcomes. Nevertheless, earlier administration showed a time-dependent association with better functional outcomes. Conflict of interest H Kim: nothing to disclosure Figure 1 - belongs to Results