Impact of non-amyloid cerebral small vessel disease on the efficacy and safety of argatroban in acute ischemic stroke: a retrospective cohort study.

OBJECTIVE: To investigate whether imaging features of non-cerebral amyloid angiopathy cerebral small vessel disease (non-amyloid CSVD) influence the efficacy of argatroban in acute ischaemic stroke (AIS) and to test for effect modification. METHODS: Patients with AIS admitted to Songxi County Hospital from January 2022 to December 2023 were enrolled and divided into an argatroban group and a control group. CSVD imaging markers (multiple lacunar infarcts, multiple subcortical white matter lesions, white matter hyperintensities, and brain atrophy) were assessed. Multivariable logistic regression was used to analyse favourable outcome at 90 days (modified Rankin Scale score 0-2), and interaction terms were introduced to test for effect modification. RESULTS: A total of 139 patients were included (66 in the argatroban group, 73 in the control group). Argatroban reduced early neurological deterioration (adjusted OR 0.045, p = 0.004), but no significant difference was observed in the rate of favourable outcome at 90 days between the two groups (80.3% vs. 79.5%, p = 0.208). Severe white matter hyperintensities modified the efficacy of argatroban (p for interaction < 0.10), with greater benefit seen in patients without severe white matter hyperintensities. Only one intracranial haemorrhage occurred, and it was in the control group. CONCLUSION: In patients with AIS after exclusion of cerebral amyloid angiopathy, argatroban improves early neurological function but does not improve functional outcome at 90 days. Severe white matter hyperintensities may be potential effect modifiers, generating hypotheses for imaging-based treatment stratification that warrant prospective validation.