MOST Trial: Argatroban or Eptifibatide Added to Thrombolysis in Acute Ischemic Stroke

Study at a glance:

• Journal: New England Journal of Medicine, 2024

• Population: Adults with acute ischemic stroke receiving thrombolysis within 3 hours

• Method: Randomized, controlled trial comparing argatroban, eptifibatide, or placebo added to standard thrombolysis

• Key Finding: Neither argatroban nor eptifibatide improved functional recovery; higher mortality observed with argatroban

Summary:
The MOST Trial evaluated whether adding argatroban, a blood thinner, or eptifibatide, a platelet aggregation inhibitor, to standard intravenous thrombolysis improves recovery after acute ischemic stroke. Adults treated within 3 hours of symptom onset were randomly assigned to receive argatroban, eptifibatide, or placebo shortly after starting clot-busting therapy. Functional recovery at 90 days was measured using a disability scale, where higher scores indicate better outcomes. The average scores were 5.2 for argatroban, 6.3 for eptifibatide, and 6.8 for placebo, indicating no meaningful improvement from either drug. Safety outcomes showed similar rates of intracranial bleeding across groups (2–4%), but mortality was higher in the argatroban (24%) and eptifibatide (12%) groups compared to placebo (8%).

Takeaway:
Adding argatroban or eptifibatide to standard thrombolysis did not improve recovery and was associated with higher mortality, suggesting these agents are not beneficial in this setting.

Source: Adeoye O, Broderick JP, Derdeyn CP, et al. Adjunctive intravenous argatroban or eptifibatide for ischemic stroke. N Engl J Med. 2024 Sep 5;391(9):810-820. doi: 10.1056/NEJMoa2314779.

Available at: https://www.nejm.org/doi/10.1056/NEJMoa2314779