Summary

Eligibility
for people ages 18 years and up (full criteria)
Location
at La Jolla, California and other locations
Dates
study started
estimated completion
Principal Investigator
by Brett Meyer, MD

Description

Summary

The primary efficacy objective of the MOST trial is to determine if argatroban (100µg/kg bolus followed by 3µg/kg per minute for 12 hours) or eptifibatide (135µg/kg bolus followed by 0.75µg/kg/min infusion for two hours) results in improved 90-day modified Rankin scores (mRS) as compared with placebo in acute ischemic stroke (AIS) patients treated with standard of care thrombolysis (0.9mg/kg IV rt-PA or 0.25mg/kg IV tenecteplase or TNK) within three hours of symptom onset. Patients may also receive endovascular thrombectomy (ET) per usual care. Time of onset is defined as the last time the patient was last known to be well.

Official Title

Multi-arm Optimization of Stroke Thrombolysis (MOST): a Single Blinded, Randomized Controlled Adaptive, Multi-arm, Adjunctive-thrombolysis Efficacy Trial in Ischemic Stroke

Keywords

Acute Ischemic Stroke Stroke Ischemic Stroke Argatroban Eptifibatide

Eligibility

You can join if…

Open to people ages 18 years and up

  1. Acute ischemic stroke patients
  2. Treated with 0.9mg/kg IV rt-PA or 0.25mg/kg IV TNK within 3 hours of stroke onset or time last known well
  3. Age ≥ 18
  4. NIHSS score ≥ 6 prior to IV thrombolysis
  5. Able to receive assigned study drug within 60 minutes but no later than 75 minutes of initiation of IV thrombolysis

You CAN'T join if...

  1. Known allergy or hypersensitivity to argatroban or eptifibatide
  2. Previous stroke in the past 90 days
  3. Previous intracranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation
  4. Clinical presentation suggested a subarachnoid hemorrhage, even if initial CT scan was normal
  5. Any surgery, or biopsy of parenchymal organ in the past 30 days
  6. Trauma with internal injuries or ulcerative wounds in the past 30 days
  7. Severe head trauma in the past 90 days
  8. Systolic blood pressure persistently >180mmHg post-IV thrombolysis despite antihypertensive intervention
  9. Diastolic blood pressure persistently >105mmHg post-IV thrombolysis despite antihypertensive intervention
  10. . Serious systemic hemorrhage in the past 30 days
  11. . Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR >1.5
  12. . Positive urine or serum pregnancy test for women of child bearing potential
  13. . Glucose <50 or >400 mg/dl
  14. . Platelets <100,000/mm3
  15. . Hematocrit <25 %
  16. . Elevated pre-thrombolysis PTT above laboratory upper limit of normal
  17. . Creatinine > 4 mg/dl
  18. . Ongoing renal dialysis, regardless of creatinine
  19. . Received Low Molecular Weight heparins (such as Dalteparin, Enoxaparin, Tinzaparin) in full dose within the previous 24 hours
  20. . Abnormal PTT within 48 hours prior to randomization after receiving heparin or a direct thrombin inhibitor (such as bivalirudin, argatroban, dabigatran or lepirudin)
  21. . Received Factor Xa inhibitors (such as Fondaparinaux, apixaban or rivaroxaban) within the past 48 hours
  22. . Received glycoprotein IIb/IIIa inhibitors within the past 14 days
  23. . Pre-existing neurological or psychiatric disease which confounded the neurological or functional evaluations e.g., baseline modified Rankin score >3
  24. . Other serious, advanced, or terminal illness or any other condition that the investigator felt would pose a significant hazard to the patient if rt-PA, TNK, eptifibatide or argatroban therapy was initiated
  25. Example: known cirrhosis or clinically significant hepatic disease
  26. . Current participation in another research drug treatment or interventional device trial - Subjects could not start another experimental agent until after 90 days
  27. . Informed consent from the patient or the legally authorized representative was not or could not be obtained
  28. . High density lesion consistent with hemorrhage of any degree
  29. . 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

Locations

  • UCSD Health La Jolla accepting new patients
    La Jolla California 92037 United States
  • UCSD Medical Center - Hillcrest Hospital accepting new patients
    San Diego California 92103 United States

Lead Scientist at UCSD

  • Brett Meyer, MD
    Professor Of Clinical, Neurosciences. Authored (or co-authored) 72 research publications.

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
Washington University School of Medicine
ID
NCT03735979
Phase
Phase 3
Study Type
Interventional
Last Updated