Phase 2 The Combined Approach to Lysis Utilizing Eptifibatide and Rt-PA in Acute Ischemic Stroke-Full Dose Regimen(CLEAR-FDR)
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 27
- 试验地点
- 8
- 主要终点
- The Number of Patients Who Experience Symptomatic Intracerebral Hemorrhage (sICH).
研究概览
简要总结
The primary goal of this trial is to determine if individuals with acute ischemic stroke treated with a full dose of IV recombinant tissue plasminogen activator (rt-PA) plus IV eptifibatide started within 3 hours of symptom onset are more likely to have a better outcome than individuals treated with standard IV rt-PA alone.
详细描述
The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke-Full Dose Regimen (CLEAR-FDR Stroke Trial) is a Phase II trial and part of the Specialized Program on Translational Research in Acute Stroke (SPOTRIAS). The overall goals of SPOTRIAS are to enhance delivery of acute stroke patient care and train acute stroke translational researchers.
Stroke most often occurs when blood flow to the brain stops because it is blocked by a blood clot. When a blood clot blocks the blood supply to the brain, parts of the brain may not get enough blood and oxygen to survive. As a result, permanent brain damage can occur, which can affect a person's ability to walk, talk, and function independently. In order to reduce the risk of permanent damage, it is important to restore blood flow to the brain as quickly as possible.
rt-PA, used alone, is already approved by the Food and Drug Administration (FDA) as treatment for patients with a stroke caused by blockage of an artery in the brain and when given within 3 hours of the onset of stroke symptoms. Eptifibatide is also already FDA-approved as a treatment for blood clots causing heart attack. The investigational aspect of this study is the use of eptifibatide for a stroke victim in combination with rt-PA.
The CLEAR Stroke Trial demonstrated that the combination of low dose rt-PA plus eptifibatide can be safely given to acute ischemic stroke patients within 3 hours of symptom onset.
The CLEAR-ER Stroke Trial demonstrated that the combination of medium dose rt-PA plus eptifibatide can be safely given to acute ischemic stroke patients within 3 hours of symptom onset.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients must have a serious measurable neurological deficit on the NIH Stroke Scale due to focal brain ischemia.
- •An NIH Stroke Scale score >5 at the time the rt-PA is begun.
- •Age: 18 through 85 years (i.e. candidates must have had their 18th birthday, but not had their 86th birthday).
- •Intravenous rt-PA therapy must be initiated within 3 hours of onset of stroke symptoms.
排除标准
- •History of stroke in the past 3 months.
- •Previous intra-cranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation.
- •Clinical presentation suggests a subarachnoid hemorrhage, even if initial CT scan is normal.
- •Hypertension at time of treatment; systolic BP > 185 or diastolic > 110 mmHg or aggressive measures to lower blood pressure to below these limits are needed.
- •Presumed septic embolus.
- •Presumed pericarditis including pericarditis after acute myocardial infarction.
- •Recent (within 30 days) surgery or biopsy of parenchymal organ.
- •Recent (within 30 days) trauma, with internal injuries or ulcerative wounds.
- •Recent (within 90 days) severe head trauma or head trauma with loss of consciousness.
- •Any active or recent (within 30 days) serious systemic hemorrhage.
- •Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency; or oral anticoagulant therapy with International Normalized Ratio (INR) > 1.
- •Baseline lab values: positive urine pregnancy test, glucose < 50 or > 400 mg/dl, platelets <100,000 /mm3, Hct <25 %, or creatinine > 4 mg/dl.
- •Ongoing renal dialysis, regardless of creatinine.
- •Subjects who received Low Molecular Weight heparins (such as Dalteparin, Enoxaparin, Tinzaparin) as deep vein thrombosis (DVT) prophylaxis or in full dose within the previous 24 hours.
- •Subjects who received heparin or a direct thrombin inhibitor (such as bivalirudin, argatroban, or lepirudin) within 48 hours from screening must have had a normal partial prothrombin time (PTT).
- •Subjects who received Factor Xa inhibitors (such as fondaparinux) or direct thrombin inhibitors (such as dabigatran) within the last 4 days.
- •Arterial puncture at a non-compressible site or a lumbar puncture in the previous 7 days.
- •Seizure at onset of stroke.
- •Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations.
- •Other serious, advanced, or terminal illness or any other condition that the investigator feels would pose a significant hazard to the patient if rt-PA or eptifibatide therapy were initiated.
- •Patients whose peripheral venous access is so poor that they are unable to have two standard peripheral intravenous lines started.
- •Current participation in another research drug treatment protocol. Patient cannot start another experimental agent until after 90 days.
- •Informed consent is not or cannot be obtained.
- •Any known history of amyloid angiopathy.
- •High density lesion consistent with hemorrhage of any degree.
- •Significant mass effect with midline shift.
- •Large (more than 1/3 of the middle cerebral artery) regions of clear hypodensity on the baseline CT scan. Sulcal effacement and/or loss of grey-white differentiation alone are not contraindications for treatment.
研究组 & 干预措施
Eptifibatide
All subjects will receive the standard dose of IV rt-PA. All subjects will promptly receive an IV bolus of 135mcg/kg eptifibatide followed by an IV infusion of 0.75 mcg/kg/min eptifibatide for 2 hours.
干预措施: Eptifibatide (Drug)
结局指标
主要结局
The Number of Patients Who Experience Symptomatic Intracerebral Hemorrhage (sICH).
时间窗: within 36 hours after stroke onset
Any ICH related to a decline in neurologic status or the development of new neurologic symptoms which in the judgment of the clinical investigator was related to the ICH. Judgment of significant neurological decline was made by the local clinical investigator
次要结局
- The Number of Patients Who Experience Any Intracerebral Hemorrhage (ICH).(within 36 hours after stroke onset)
- The Number of Patients Who Develop Parenchymal Hemorrhage Types 1( PH-1) and 2 (PH-2).(within 36 hours after stroke onset)
研究者
Arthur Pancioli
sub investigator
University of Cincinnati