Argatroban Plus R-tPA for Acute Ischemic Stroke: a Prospective, Random, Open Label, Blinded Assessment of Outcome Multi-center Study
Overview
- Phase
- Phase 4
- Intervention
- rt-PA
- Conditions
- Stroke
- Sponsor
- General Hospital of Shenyang Military Region
- Enrollment
- 808
- Locations
- 1
- Primary Endpoint
- Proportion of mRS (0-1）
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
Acute ischemic stroke (AIS) is the most common type of stroke, which has high rate of morbidity, mortality and disability. A large number of studies have confirmed that the thrombolytic therapy can effectively open blood vessels and improve the functional prognosis of acute ischemic stroke. Therefore, all guidelines recommend intravenous thrombolysis as the first treatment of ischemic stroke patients within 4.5 hours of onset. However, about 1/3 patients receiving thrombolysis will have good prognosis, while a large number of patients will still be disabled and even dead. How to improve the neurological prognosis of thrombolytic patients has been a hot topic in the world.
Recent studies have found that the combined application of argatroban and rt-PA in the treatment of AIS might improve the clinical prognosis and not significantly increase bleeding. Some studies have reported that the combined application of argatroban and rt-PA could improve the blood vessel opening rate, and prevent re-occlusion after opening.
Based on the discussion, the present study is designed to explore the efficacy and safety of argatroban plus rt-PA in the treatment of AIS.
Investigators
Hui-Sheng Chen
Department Chairman
General Hospital of Shenyang Military Region
Eligibility Criteria
Inclusion Criteria
- •18-80 years old;
- •Time from onset to treatment ≤4.5 hours;
- •Diagnosis of ischemic stroke
- •Signed informed consent by patient self or legally authorized representatives.
Exclusion Criteria
- •History of stroke within 3 months;
- •History of intracranial hemorrhage;
- •Suspected subarachnoid hemorrhage;
- •Intracranial tumour, vascular malformation or arterial aneurysm;
- •Major surgery within 1 month;
- •Systolic pressure ≥180 mmHg or diastolic pressure ≥110 mmHg;
- •Platelet count \< 105/mm3;
- •Heparin therapy or oral anticoagulation therapy within 48 hours;
- •Abnormal APTT;
- •Thrombin or Xa factor inhibitor;
Arms & Interventions
Argatroban combined with rt-PA
Drug: Argatroban combined with rt-PA Argatroban as a 100 ug/kg bolus over 3 to 5 minutes was administered intravenously within 1 hour of the tPA bolus followed by a continuous Argatroban infusion of 1.0 ug/kg per minute for 48 hours adjusted to a target activated partial thromboplastin time of 1.75 X baseline (about 10%)
Intervention: rt-PA
Argatroban combined with rt-PA
Drug: Argatroban combined with rt-PA Argatroban as a 100 ug/kg bolus over 3 to 5 minutes was administered intravenously within 1 hour of the tPA bolus followed by a continuous Argatroban infusion of 1.0 ug/kg per minute for 48 hours adjusted to a target activated partial thromboplastin time of 1.75 X baseline (about 10%)
Intervention: Argatroban
rt-PA
Drug: rt-PA Intravenous throbolysis with 0.9mg/kg rtPA.
Intervention: rt-PA
Outcomes
Primary Outcomes
Proportion of mRS (0-1）
Time Frame: 90±7 days
Secondary Outcomes
- Proportion of mRS (0-2）(90±7 days)
- proportion of more than 2 decrease in NIHSS score(48 hours)
- proportion of early neurological deterioration(48 hours)
- Vascular Events(90±7 days)
- symptomatic intracranial hemorrhage(48 hours)