Comparison of pharmacological induced hypertension and anticoagulation for rescue therapy of early neurologicaldeterioration in lacunar stroke

초록

Background and aims: Although pharmacologically induced hypertension (PIH) and the anticoagulant, argatroban, have been studied in several clinical trials for the treatment of the early neurological deterioration (END), the efficacy and safety of these treatments remained still unclear. Here, we investigated which would be better as a rescue therapy for the lacunar stroke patients with END. Methods: Among the prospective stroke registry of Inha University hospital between April 2014 and August 2021, we reviewed the subjects with lacunar stroke who received the PIH or intravenous infusion of argatroban for rescue therapy of END within 3 days of symptom onset. We compared the END recovery defined as the improvement of NIHSS down to the ones on admission, the excellent outcomes (0 or 1 on mRS at 3 months). Results: Among the 4818 patients with the lacunar stroke, END occurred in the 147 patients. Seventy-nine of END patients received the PIH and 68 patients took the anticoagulation therapy, respectively. Two groups had no difference in age and gender. Compared to the anticoagulation group, PIH group had the higher incidence of the END recovery (77.2% vs. 51.5%, P < 0.01) and excellent stroke outcome (34.2% vs.16.2%, P = 0.04). Safety outcomes, like hemorrhagic conversion and mortality, did not significantly differed between the two groups. Conclusions: As rescue therapy for the stroke progression-related END in the lacunar stroke patients,PIH was more effective with similar safety, compared to the anticoagulation therapy using argatroban.