Thrombolysis Treated With TNK-tPA in Acute Ischemic Stroke Patients （3T Stroke-Ⅲ）
- Registration Number
- NCT05745259
- Lead Sponsor
- Beijing Tiantan Hospital
- Brief Summary
The trial is prospective, randomized, open-label, blinded endpoint (PROBE) design. Patients with acute ischemic stroke, who are eligible for standard intravenous thrombolysis within 4.5 hours of stroke onset will be randomized 1:1 to 0.25mg/kg or 0.9 mg/kg alteplase before all participants undergo endovascular thrombectomy.
- Detailed Description
The study will be a multi-center, prospective, randomized, open- label, blinded endpoint (PROBE), controlled phase 3 trial (2 arm with 1:1 randomization) in ischemic stroke patients. Imagine is performed with CT or MRI acutely with imaging follow-up at 24-36 hours. The sample size is 1630.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 1630
- 18≤Age≤80 years old;
- The clinical diagnosis was Acute ischemic stroke The time from onset to treatment was < 4.5h; The time at which symptoms begin is defined as "the time at which they finally appear normal";
- MRS before onset was ≤1 points;
- Baseline NIHSS (at the time of randomization) should be ≥5 and ≤25 points;
- Informed consent from the patient or surrogate.
- Intracranial hemorrhage identified by CT or MRI (CMBs detected by SWI is not counted);
- Massive anterior cerebral infarction identified by CT or MRI (ASPECT < 6 or lesions larger than one third of the territory of the middle cerebral artery or with a volume larger than 70mL)
- Patients planning to receive endovascular therapy
- A history of severe CNS damage (such as aneurysm or arteriovenous malformation, craniocerebral trauma, intracranial or spinal cord surgery)
- Onset with seizures, and the paralysis was suspected to be related to Todd paralysis.
- Administration of heparin within 48 hours preceding the onset of stroke with a baseline APTT exceeding the upper limit of the normal range.
- Oral anticoagulant (such as warfarin) treatment with baseline INR>1.7 or PT>15 s;
- Administration of thrombin inhibitors or factor Xa inhibitors within 48 hours preceding the onset of stroke with abnormal coagulation parameters or platelet count;
- BP couldn't be controlled with aggressive treatment. Uncontrolled hypertension was defined as systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, measured for three times every 10 minutes.
- Platelet count of less than 100×109/ L;
- Blood glucose <50 mg/dl (<2.8 mmol/L) or >400 mg/dl (22.22 mmol/L);
- History of intracranial hemorrhage or active hemorrhagic disease. (Such as gastrointestinal, urinary tract or retinal bleeding)
- Tumors with an increased risk of bleeding.
- Prolonged or traumatic cardiopulmonary resuscitation (>2 min), delivery within the last 10 days or recent puncture of non-compression vessels such as subclavian vein or jugular vein
- Acute pancreatitis or severe liver disease, including liver failure, cirrhosis, portal hypertension, esophageal varicose veins, and active hepatitis;
- Aortic arch dissection;
- Major surgery or severe trauma in the past 2 weeks;
- Subjects had serious, fatal, or disabling disease with an expected survival of less than 3 months;
- Unable to complete neurological assessment and follow-up visits because of dementia or mental illness;
- Pregnant women, lactating women, or have positive pregnancy test;
- Allergy to tenecteplase or alteplase or their components;
- Participation in other clinical trials within 3 months prior to screening;
- Unsuitable to involve in this study or would result in increased risk, as judged by the investigators.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Alteplase Alteplase Patients will receive intravenous Alteplase at the standard licensed dose of 0.9 mg/kg up to a maximum of 90mg, 10% as bolus and the remainder over 1 hour. Tenecteplase Tenecteplase Patients will receive intravenous Tenecteplase, 0.25mg/kg, maximum 25mg, administered as a bolus over 5\~10 seconds
- Primary Outcome Measures
Name Time Method Modified Rankin Scale(mRS) 90±7 days Proportion of subjects with mRS scores of (0-1) at 90±7 days.
- Secondary Outcome Measures
Name Time Method National Institutes of Health Stroke Scale (NIHSS) 7±2days or discharge Proportion of subjects with ≥ 4 point reduction in NIHSS or reaching 0-1 at 7 ± 2 days or before discharge (whichever occurs first)
Modified Rankin Scale(mRS) 90±7 days mRS scores at 90±7 days.
The new vascular events 90±7 days Incidence of the new vascular events, ischemic stroke, hemorrhagic stroke, myocardial infarction and cardio-cerebral revascularization at 90±7 days. (including: carotid endarterectomy, intracranial and extracranial artery interventional therapy, intracranial and extracranial artery bypass surgery, coronary interventional or bypass therapy)
EQ-5D 90±7 days EQ-5D scores at 90±7 days.
Trial Locations
- Locations (63)
Xuanwu Hospital Capital Medical University
🇨🇳Beijing, Beijing, China
Xuancheng People's Hospital
🇨🇳Xuancheng, Anhui, China
Beijing Tiantan Hospital, Capital Medical University Beijing
🇨🇳Beijing, Beijing, China
Three Gorges Hospital Affiliated to Chongqing University
🇨🇳Chongqing, Chongqing, China
Quanzhou First Hospital
🇨🇳Quanzhou, Fujian, China
Lanzhou University First Hospital
🇨🇳Lanzhou, Gansu, China
Zhoukou Downtown Hospital
🇨🇳Zhoukou, Henan, China
The Third People's Hospital of Huizhou
🇨🇳Huizhou, Guangdong, China
The First People's Hospital of Yulin
🇨🇳Yulin, Guangxi, China
Handan Central Hospital
🇨🇳Handan, Hebei, China
Hengshui people's Hospital (Harrison International Peace Hospital)
🇨🇳Hengshui, Hebei, China
Daqing Oilfield General Hospital
🇨🇳Daqing, Heilongjiang, China
Daqing People's Hospital
🇨🇳Daqing, Heilongjiang, China
Anyang People's Hospital
🇨🇳Anyang, Henan, China
Jiaozuo People's Hospital
🇨🇳Jiaozuo, Henan, China
Nanyang South Stone Hospital
🇨🇳Nanyang, Henan, China
Taizhou People's Hospital
🇨🇳Taizhou, Jiangsu, China
Xinxiang Central Hospital
🇨🇳Xinxiang, Henan, China
The First People's Hospital of Jingzhou
🇨🇳Jingzhou,, Hubei, China
Xuzhou Mining Group General Hospital
🇨🇳Xuzhou, Jiangsu, China
Jilin Guowen Hospital
🇨🇳Siping, Jilin, China
Baogang Hospital of Inner Monglia
🇨🇳Baotou, Inner Monglia, China
Keshenketengqi Mongolian Medicine Hospital
🇨🇳Chifeng, Inner Mongolia, China
The First Hospital of Jilin University
🇨🇳Changchun, Jilin, China
Siping Central People's Hospital
🇨🇳Siping, Jilin, China
Beipiao Central Hospital
🇨🇳Beipiao, Liaoning, China
Dalian Central Hospital
🇨🇳Dalian, Liaoning, China
Fushun Mining Bureau General Hospital
🇨🇳Fushun, Liaoning, China
Liaoning Health Industry Group Fuxin Mine General Hospital
🇨🇳Fuxin, Liaoning, China
The First Affiliated Hospital of Jinzhou Medical University
🇨🇳Jinzhou, Liaoning, China
Affiliated Central Hospital of Shenyang Medical College
🇨🇳ShenYang, Liaoning, China
Air Force Hospital of Northern War Zone,PLA
🇨🇳Shenyang, Liaoning, China
The First Affiliated Hospital of China Medical University
🇨🇳ShenYang, Liaoning, China
The First People's Hospital of Shenyang
🇨🇳Shenyang, Liaoning, China
Dezhou Hospital of Shandong University Qilu Hospital (Dezhou People's Hospital)
🇨🇳Dezhou, Shandong, China
Jinan People's Hospital
🇨🇳Jinan, Shandong, China
Liaocheng People's Hospital
🇨🇳Liaocheng, Shandong, China
Linyi Hospital of Traditional Chinese Medicine
🇨🇳Linyi, Shandong, China
Linyi People's Hospital
🇨🇳Linyi, Shandong, China
The First People's Hospital of Tancheng County
🇨🇳Linyi, Shandong, China
Taian Central Hospital (Tai 'an Central Hospital of Qingdao University, Tai 'an Medical and Nursing Center)
🇨🇳Taian, Shandong, China
Tengzhou Central Hospital
🇨🇳Tengzhou, Shandong, China
Weifang Hospital of Traditional Chinese Medicine
🇨🇳Weifang, Shandong, China
Yantai Yuhangding Hospital
🇨🇳Yantai, Shandong, China
Sinopharm Coal Mine General Hospital
🇨🇳Datong, Shanxi, China
Linfen Central Hospital
🇨🇳Linfen, Shanxi, China
Linfen People's Hospital
🇨🇳Linfen, Shanxi, China
Shanxi Cardiovascular Disease Hospital
🇨🇳Taiyuan, Shanxi, China
Dazhu County People's Hospital
🇨🇳Dazhu, Sichuan, China
Mianyang Central Hospital
🇨🇳Mianyang, Sichuan, China
General Hospital of Northern War Zone,PLA
🇨🇳Shenyang, Liaoning, China
General Hospital of Ningxia Medical University Cardio-cerebral Vascular Disease Hospital
🇨🇳Yinchuan, Ningxia, China
The First People's Hospital of Yinchuan
🇨🇳Yinchuan, Ningxia, China
Yuebei People's Hospital
🇨🇳Shaoguan, Guangdong, China
Tangshan Workers' Hospital
🇨🇳Tangshan, Hebei, China
Pingmei Shenma medical group general hospital
🇨🇳Pingdingshan, Henan, China
The Second Affiliated Hospital of Suzhou Medical University
🇨🇳Suzhou, Jiangsu, China
Xuzhou Central Hospital
🇨🇳Xuzhou, Jiangsu, China
Baotou Central Hospital
🇨🇳Baotou, Inner Mongolia, China
The Affiliated Hospital of Xuhzou Meidcal University
🇨🇳Xuzhou, Jiangsu, China
Tonghua Central Hospital
🇨🇳Tonghua, Jilin, China
Meihekou Central Hospital
🇨🇳Tonghua, Jilin, China
Qilu Hospital of Shandong University
🇨🇳Jinan, Shandong, China