"Agatroban in the Treatment of Acute Ischemic Stroke Chinese Expert Consensus 2021" Highlights Quick View of Stroke "Miscellaneous" Issue 11

"Chinese Stroke Journal" is a high-level academic journal of medical specialty that is headed by the Ministry of Science and Technology of the People's Republic of China and sponsored by the China Institute of Science and Technology Information and Science and Technology Press
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In order to strengthen the medical information exchange in the field of cerebrovascular diseases, improve the academic level of medicine, and serve the majority of medical technology and health workers, the Chinese Journal of Stroke and the Yimaitong platform jointly launched a series of columns-"Stroke "Miscellaneous" Talks"
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This column selects the high-quality content related to stroke in each issue of the Chinese Journal of Stroke, adapts it, and publishes it on the "Yimaitong Neurology" public account.
I look forward to learning and discussing stroke-related diseases with you! This article is organized: "Chinese Stroke Journal" Editorial Department Note: This article has been officially authorized by "Chinese Stroke Journal", please do not reprint without authorization
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Original source: Beijing Neuroscience Society Vascular Neurology Professional Committee, Argatroban Treatment of Acute Ischemic Stroke Chinese Expert Consensus Group.
Argatroban Treatment of Acute Ischemic Stroke Chinese Expert Consensus 2021[J].
Chinese Journal of Stroke, 2021, 16(09): 946-953.
http:// The current treatment principle of acute ischemic stroke (AIS) is Intravenous thrombolysis and/or endovascular therapy (EVT) are performed within the treatment time window, and corresponding treatment measures are taken for different causes, including antiplatelet aggregation, anticoagulation, blood pressure lowering, lipid lowering and rehabilitation treatment
.

Although most anticoagulant drugs can reduce the recurrence rate of stroke or the risk of deep vein thrombosis to a certain extent, they also increase the risk of bleeding events
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Among the anticoagulant drugs, argatroban reported fewer bleeding events, and there was no report of heparin-induced thrombocytopenia
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In view of this, argatroban has been approved for AIS treatment in China, Japan, South Korea and other countries
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In order to promote the more reasonable and standardized use of argatroban by clinicians, the Beijing Society of Neuroscience organized domestic experts in the field of cerebrovascular to measure and grade the recommended level and evidence level of the treatment plan according to the standards in Table 1, drafting, voting and The classification recommendations and the non-grading consensus-based statement were revised, and the "Chinese Expert Consensus on Argatroban Treatment of Acute Ischemic Stroke 2021" was reached.
The recommendations are as follows
.

Argatroban administration route and dosage, adverse reactions and prevention 1.
Administration route and dosage When treating AIS whose onset is less than 48 hours, the recommended dosage and method of argatroban are: initial administration of 10 mg every 4 hours, continuous intravenous administration Inner pump, dilute with appropriate liquid (normal saline is recommended), continuous medication for 48 hours; after 48 hours, change to once every 12 hours, 10mg each time, dilute with proper liquid (normal saline is recommended), duration of intravenous drip ≥3 hours, 5 consecutive days, the total treatment time is 7 days
.

2.
Adverse reactions The adverse reactions of argatroban are mainly bleeding in different parts.
The incidence of hemorrhagic cerebral infarction is 1.
2%, the incidence of gastrointestinal hemorrhage is 0.
2%, and the incidence of cerebral hemorrhage is 0.
1%.
In addition, occasionally See allergy and anaphylactic shock (including urticaria, dyspnea, lowered blood pressure, etc.
)
.

3.
Prevention of adverse reactions ① AIS patients with diabetes, hypertension (blood pressure ≤180/110mmHg), coronary heart disease, heparin-induced thrombocytopenia, renal insufficiency can be treated with argatroban, combined with severe liver disease or abnormal liver function Patients are not recommended to use it to prevent increased bleeding risk
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②Argatroban should be used with caution in combination with thrombolytic, anticoagulant, antiplatelet aggregation or defibrinating drugs.
Combination with the above drugs may increase the risk of bleeding.
If it is necessary to use it, attention should be paid to reduce the dose and perform rigorous clinical practice ( Bleeding symptoms) and laboratory monitoring (such as APTT)
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③It is recommended that APTT be monitored within the first 2 hours of medication, and APTT should be determined to be 1.
5 to 3.
0 times the baseline value and less than 100 seconds to reduce the risk of bleeding
.

APTT monitoring should be carried out daily, and the dosage should be adjusted at any time
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Recommendations for argatroban monotherapy ①For patients with atherosclerotic acute ischemic stroke, it is recommended to start argatroban therapy within 48 hours of onset (strong recommendation, moderate quality evidence)
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②For acute ischemic stroke caused by heparin-induced thrombocytopenia, it is recommended to choose argatroban as one of the anticoagulant drugs (non-heparin) (strong recommendation, moderate quality evidence)
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③For patients with mild to moderate cardiogenic acute ischemic stroke, argatroban can be considered for treatment [weak (restricted) recommendation, low-quality evidence]
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④For patients with arteriolar occlusive acute ischemic stroke, argatroban can be used depending on the situation (such as to improve the long-term prognosis) [weak (restricted) recommendation, low-quality evidence]
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⑤For patients with acute ischemic stroke caused by other reasons or unknown reasons, it is not recommended to use argatroban as a routine treatment (no graded consensus-based statement)
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Recommendations for the combination of argatroban 1.
Antiplatelet drugs ① For patients with moderate ischemic stroke (NIHSS 5-15 points) and low bleeding risk, it is recommended to treat argatroban combined with aspirin [weak (limited conditions) recommendation , Moderate-quality evidence]
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②For patients with acute perforating artery infarction or posterior circulation infarction, it is recommended that argatroban combined with dual antiplatelet therapy (aspirin combined with clopidogrel) be used cautiously for treatment, but the risk of bleeding must be paid attention to [weak (restricted conditions) recommendation, low Quality evidence]
.

2.
Intravenous thrombolysis and endovascular treatment ① For patients with acute ischemic stroke who require intravenous thrombolysis, the severity of their condition and the risk of bleeding should be considered.
After fully weighing the benefits and risks of treatment, Argatroban is given within 1 hour of rt-PA injection.
First, intravenous bolus injection (100μg/kg) for 3 to 5 minutes, then intravenous drip (1μg·kg-1·min-1), and adjust APTT to its About 1.
75 times the baseline value (±10%) [weak (restricted) recommendation, moderate quality evidence]
.

②For patients with acute ischemic stroke caused by intracranial large vessel occlusion, when receiving mechanical thrombectomy or bridging therapy (intravenous thrombolysis + mechanical thrombectomy), it is recommended to treat the same situation as ①, and fully weigh the effects of treatment After the benefits and risks, argatroban is given after thrombus removal or intravenous thrombolysis, and the APTT is adjusted to 1.
75-2.
25 times (±10%) of its baseline value [weak (restricted) recommendation, low-quality evidence ]
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Review of previous issues ↓↓↓ Issue 1: Why is it said that playing games can treat cognitive impairment? This review tells you the second issue: How to build a high-quality biobank of cerebrovascular diseases? The Temple of Heaven experience is here! Phase 3: The lower the level of T3 and FT3, the more severe the cognitive impairment in stroke patients? Shijiazhuang People’s Hospital published an important correlation analysis No.
4: Minor head trauma can also cause stroke in children? Lan Yina and Lv Jinhao, First Medical Center of the General Hospital of the People’s Liberation Army, reported rare cases Issue 5: Professor Wang Yilong: Interpretation of the key points of the "Chinese Expert Consensus on Perforator Atherosclerosis" Issue 6: How could severe stroke have such rare complications? Issue 7: Interpretation of "Expert Suggestions for Medical Quality Evaluation and Improvement of Acute Ischemic Stroke Reperfusion Therapy" Issue 8: Solve the "big trouble" of "small stroke", see "Chinese Experts Consensus on Diagnosis and Treatment of Cerebrovascular Diseases 2021" Recommended Issue 9: Going the wrong way, normal bacteria turn into a devil in seconds.
Issue 10: Sleeping more and less is better than sleeping well