Clinical trial NCT00250991: Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke (CLEAR Stroke) Trial
Official title: Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke (CLEAR Stroke) Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Stroke
Keywords: stroke
integrilin
eptifibatide
activase
recombinant tissue plasminogen activator
rt-PA
recombinant t-PA
SPOTRIAS
Lead sponsor: University of Cincinnati
Sponsor class: OTHER
Collaborators: name: National Institute of Neurological Disorders and Stroke (NINDS)
First posted: 2005-11-09
Enrollment: 94
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Primary purpose: TREATMENT

Brief summary: The purpose of this study is determine the effects of using of a combination of two drugs--integrilin (eptifibatide) and activase (recombinant tissue plasminogen activator, rt-PA, or recombinant t-PA)--to dissolve blood clots in patients who have a stroke.

Detailed description: The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke (CLEAR Stroke) trial is 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.

The CLEAR Stroke study will enroll 100 participants with acute stroke due to a blood clot. The purpose of this multi-center, randomized, double-blind study is to determine the effects of using a combination of two drugs, integrilin (or eptifibatide) and activase (or recombinant tissue plasminogen activator, rt-PA, recombinant t-PA), to dissolve blood clots. More specifically, the CLEAR study is being done to determine if a lower dose of activase, given in combination with a second drug, integrilin, is a safe treatment for acute stroke.

Activase, 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. Integrilin is also already FDA-approved as a treatment for blood clots causing heart attack. The investigational aspect of this study is the use of integrilin for a stroke victim in combination with activase.

Eligibility criteria: Inclusion Criteria:

* 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 that intravenous study drug is begun.
* Age: 18 through 80 years (i.e. candidates must have had their 18th birthday, but not had their 81st birthday).
* Intravenous therapy must be initiated within 3 hours of onset of stroke symptoms.

Exclusion Criteria:

* 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 prothrombin time greater than 15 or INR \> 1.4
* 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
* If heparin has been administered within 48 hours, the patient must have a normal partial thromboplastin time (PTT)
* 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.

Exclusion Criteria/CT Scan:

* 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.

Primary outcomes:
measure: The primary safety endpoint in this safety study will be the incidence of symptomatic intracranial hemorrhage .
timeFrame: within 36 hours
measure: The primary measure of early beneficial drug activity will be the incidence of early neurological improvement, as measured by the NIHSSS </= 2
timeFrame: at 24 hours from symptom onset
Secondary outcomes:
Other outcomes:
Locations:
city: Phoenix
country: United States
facility: Barrow Neurologic Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Rd
state: Arizona
city: Los Angeles
country: United States
facility: University of California, Los Angeles, UCLA Medical Center, 10833 Le Conte Ave.
state: California
city: Santa Monica
country: United States
facility: Santa Monica-UCLA Medical Center, 1250 16th Street
state: California
city: Santa Monica
country: United States
facility: St. John's Health Center, 1328 22nd St
state: California
city: Edgewood
country: United States
facility: St. Elizabeth Medical Center South, One Medical Village Drive
state: Kentucky
city: Louisville
country: United States
facility: Jewish Hospital Louisville, Jewish Hospital Healthcare Services Inc., 200 Abraham Flexner Way
state: Kentucky
city: Ann Arbor
country: United States
facility: University of Michigan, University of Michigan Health System, 1500 E. Medical Center Drive, TC B1354, Box 0303
state: Michigan
city: New Hyde Park
country: United States
facility: Long Island Jewish, North Shore-Long Island Jewish Health System, 270-05 76 Avenue
state: New York
city: Cincinnati
country: United States
facility: The Christ Hospital, 2139 Auburn Ave.
state: Ohio
city: Cincinnati
country: United States
facility: University of Cincinnati, University Hospital, 234 Goodman Ave.
state: Ohio
city: Cincinnati
country: United States
facility: Good Samaritan Hospital, 375 Dixmyth Ave.,
state: Ohio
city: Cincinnati
country: United States
facility: The Jewish Hospital of Cincinnati, 4777 East Galbraith Rd,
state: Ohio
city: Cincinnati
country: United States
facility: Mercy Hospital, Western Hills, 3131 Queen City Ave.
state: Ohio
city: Cincinnati
country: United States
facility: Mercy Hospital, Mt Airy, 2446 Kipling Ave.
state: Ohio
city: Montgomery
country: United States
facility: Bethesda North Hospital, 10500 Montgomery Rd
state: Ohio
city: Allentown
country: United States
facility: Lehigh Valley Hospital, 1200 South Cedar Crest Blvd
state: Pennsylvania
city: Philadelphia
country: United States
facility: University of Pennsylvania, University of Pennsylvania Medical Center, 3400 Spruce Street
state: Pennsylvania
city: Providence
country: United States
facility: Brown University, Rhode Island Hospital, 593 Eddy St.
state: Rhode Island
city: Nashville
country: United States
facility: Vanderbilt University, University Hospital, 1211 22nd Ave. S.
state: Tennessee
Study officials:
affiliation: University of Cincinnati College of Medicine, Department of Emergency Medicine
name: Arthur Pancioli, MD
role: PRINCIPAL_INVESTIGATOR
References: