Adjunctive Argatroban or Eptifibatide Shows No Benefit with Thrombolysis in Thrombectomy Patients: JAMA

These results show no significant improvement in clinical outcomes with the addition of either drug compared to placebo. Reperfusion success was defined by a Thrombolysis in Cerebral Infarction (TICI) score of 2b/2c/3 on completion angiography. The rates of good reperfusion were 83% (83 of 92 patients) for placebo, 84% (82 of 98 patients) for eptifibatide and 63% (17 of 27 patients) for argatroban. Rates of symptomatic intracranial hemorrhage were similar across all groups, indicating no excess bleeding risk with the experimental agents.

The results highlight that adding blood-thinning agents like argatroban or eptifibatide to intravenous thrombolysis does not improve outcomes in patients undergoing thrombectomy. However, this study suggest that future studies might explore whether these agents could benefit patients who are not candidates for intravenous thrombolysis. Overall, the findings of the MOST trial provide crucial clarity in refining acute stroke care strategies, showing that for now, standard intravenous thrombolysis followed by thrombectomy remains the optimal pathway.

Source:

Rines, I., Adeoye, O., Barreto, A. D., Broderick, J., Carrozzella, J., Chen, H., Concha, M., Elm, J., Grotta, J. C., Jasne, A. S., Khatri, P., Roy, A., Vagal, A., Wintermark, M., Yoo, A. J., Derdeyn, C. P., & MOST Investigators. (2025). Intravenous argatroban or eptifibatide in patients undergoing mechanical thrombectomy: A subgroup analysis of the MOST randomized clinical trial: A subgroup analysis of the MOST randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2025.2794