Comparison of clinical efficacy between argatroban and tirofiban in patients with atherosclerotic cerebral infarction complicated by early neurological deterioration.

BACKGROUND: Early neurological deterioration (END) is common after acute ischemic stroke and is associated with poor functional outcomes. Argatroban and tirofiban are increasingly used as rescue antithrombotic therapies for END, but their comparative effectiveness remains unclear. METHODS: This two-center retrospective cohort study included patients with atherosclerosis-related acute ischemic stroke complicated by END who were treated with either argatroban or tirofiban. Propensity scores with stabilized inverse probability of treatment weighting (IPTW) and overlap weighting were applied to reduce confounding. The primary outcome was a favorable functional outcome at 90 days (modified Rankin Scale [mRS] score of 0-2). Secondary outcomes included excellent functional outcomes (mRS score of 0-1), mRS shift, neurological improvement, and safety outcomes. Subgroup and sensitivity analyses were also performed. RESULTS: A total of 139 patients were included (argatroban, n = 68; tirofiban, n = 71). After weighting, no statistically significant differences were observed in favorable functional outcomes at 90 days between argatroban and tirofiban in the stabilized IPTW analysis (RR, 0.80, 95% CI: 0.60-1.06) and overlap weighting analysis (RR 0.88, 95% CI: 0.65-1.21). Secondary efficacy and safety outcomes also showed no statistically significant between-group differences. Subgroup analyses suggested potential treatment interactions with stroke severity and etiology. Argatroban tended to be associated with better outcomes in patients with mild stroke severity after END, whereas tirofiban appeared to be associated with more favorable outcomes in patients with large-artery atherosclerosis and those with moderate-to-severe stroke severity after END. CONCLUSION: No statistically significant differences were detected in overall efficacy or safety outcomes between argatroban and tirofiban in patients with END after atherosclerosis-related ischemic stroke. Subgroup findings suggest that treatment effects may vary according to stroke subtype, highlighting the need for further prospective studies to explore mechanism-based, individualized antithrombotic strategies.