Study of the Combination Therapy of Rt-PA and Eptifibatide to Treat Acute Ischemic Stroke "CLEAR-ER"

Completed

Phase 2 Results

Update History

18 Mar '14
The description was updated.
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The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA (recombinant tissue plasminogen activator) in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER 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 (NCT00250991) 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 is designed to provide data concerning the risks and benefits of combining eptifibatide with medium dose intravenous rt-PA in 126 acute ischemic stroke patients within 3 hours of symptom onset. Patients will be randomized to a combined intravenous medium-dose rt-PA and eptifibatide regimen, or standard dose rt-PA in a 5 to 1 ratio. This will result in a total of 105 patients treated with a combined regimen, and 21 patients treated with standard dose IV rt-PA alone.
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The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER 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 is designed to provide data concerning the risks and benefits of combining eptifibatide with medium dose intravenous rt-PA in 126 acute ischemic stroke patients within 3 hours of symptom onset. Patients will be randomized to a combined intravenous medium-dose rt-PA and eptifibatide regimen, or standard dose rt-PA in a 5 to 1 ratio. This will result in a total of 105 patients treated with a combined regimen, and 21 patients treated with standard dose IV rt-PA alone.
The eligibility criteria were updated.
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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 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. 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 Iinternational Normalized Ratio (INR) > 1.7. - Baseline lab values: positive urine pregnancy test, glucose < 50 or > 400 mg/dl, platelets <100,000 /mm3, Hct (hematocrit) <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. - 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.
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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 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. 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 INR > 1.7. - 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. - 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.
11 Oct '12
A location was updated in Los Angeles.
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The overall status was removed for UCLA Ronald Reagan Medical Center.
A location was updated in San Diego.
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The overall status was removed for University of California San Diego.
A location was updated in Santa Monica.
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The overall status was removed for UCLA Medical Center Santa Monica.
A location was updated in Washington.
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The overall status was removed for Washington Hospital Center.
A location was updated in Edgewood.
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The overall status was removed for St. Elizabeth Healthcare Edgewood.
A location was updated in Florence.
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The overall status was removed for St. Elizabeth Healthcare Florence.
A location was updated in Ft. Thomas.
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The overall status was removed for St. Elizabeth Healthcare Ft. Thomas.
A location was updated in Bethesda.
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The overall status was removed for Suburban Hospital.
A location was updated in Ann Arbor.
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The overall status was removed for University of Michigan Medical Center.
A location was updated in New Brunswick.
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The overall status was removed for Robert Wood Johnson University Hospital.
A location was updated in Asheville.
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The overall status was removed for Mission Hospital, Inc..
A location was updated in Cincinnati.
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The overall status was removed for University Hospital.
A location was updated in Cincinnati.
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The overall status was removed for Good Samaritan Hospital.
A location was updated in Cincinnati.
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The overall status was removed for Mercy Hospital Mt Airy.
A location was updated in Cincinnati.
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The overall status was removed for Mercy Hospital, Western Hills.
A location was updated in Cincinnati.
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The overall status was removed for The Christ Hospital.
A location was updated in Cincinnati.
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The overall status was removed for The Jewish Hospital.
A location was updated in Cincinnati.
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The overall status was removed for Bethesda North Hospital.
A location was updated in Philadelphia.
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The overall status was removed for Hospital of the University of Pennsylvania.
A location was updated in Morgantown.
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The overall status was removed for West Virginia University Hospital.