- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02814409
Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST2)
March 27, 2018 updated by: NHS Greater Glasgow and Clyde
Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST 2)
The principle research question is: in patients with acute ischaemic stroke eligible for intravenous (IV) thrombolysis, is tenecteplase superior in efficacy to alteplase, based on functional outcome as assessed by modified Rankin Scale distribution at day 90?
Study Overview
Status
Unknown
Conditions
Study Type
Interventional
Enrollment (Anticipated)
1870
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Glasgow, United Kingdom
- Recruiting
- Queen Elizabeth University Hospital
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Contact:
- Alicia Murray
- Email: Alicia.Murray@glasgow.ac.uk
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion criteria:
- Eligible for intravenous thrombolysis.
- Male or non-pregnant female ≥18 years of age.
- <4.5h after symptom onset.
- Consent of patient or legal representative.
- Independent prior to the stroke (estimated modified Rankin Scale 0-1).
Exclusion criteria:
- Eligible for intravenous thrombolysis: Evidence of intracranial haemorrhage or significant non-stroke intracranial pathology likely to account for clinical presentation or represent a risk of intracerebral haemorrhage (eg Central Nervous System neoplasm) on pre-treatment computerised tomography (CT) scan; Stroke within the previous 14 days, thrombolytic therapy within the past 14 days, or hypodensity on pre-treatment computerised tomography (CT) scan consistent with recent cerebral ischaemia other than the presenting event; Systolic blood pressure more than 185 or diastolic blood pressure more than 110 mmHg, or aggressive management (intravenous pharmacotherapy) necessary to reduce blood pressure to these limits; Clinical history suggestive of subarachnoid haemorrhage even if no blood is evident on computerised tomography (CT) scan; High risk of haemorrhage, including major surgery, trauma or gastrointestinal or urinary tract haemorrhage within the previous 21 days; Arterial puncture at a non-compressible site within the previous 7 days; Prolonged cardiopulmonary resuscitation (> 2 minutes) within the previous 14 days; Acute pericarditis and/or subacute bacterial endocarditis; acute pancreatitis; Severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis; Active peptic ulceration; Known history of haemorrhagic stroke; Known defect of clotting or platelet function (other than antiplatelet therapy); Hypo- or hyperglycaemia (blood glucose <2 mmol/l or >18 mmol/l) sufficient to account for neurological symptoms; Seizure at onset of symptoms unless brain imaging identifies positive evidence of significant brain ischaemia (eg early ischaemic change or hyperdense vessel on plain computerised tomography (CT) scan, computerised tomography angiography (CTA) scan confirmed arterial occlusion); Pregnancy (for women of child-bearing potential a negative pregnancy test will be required prior to randomisation); Inadequate haemostasis: Taking warfarin and international normalised ratio (INR) >1.3, Taking a Direct Oral Anticoagulant (dabigatran, rivaroxaban, apixaban, edoxaban) unless known to be >12 hours since last dose and with normal coagulation assays, Low molecular weight heparin (at doses other than prophylaxis of venous thromboembolism) administered within the preceding 48 hours, Unfractionated heparin administered within the previous 48 hours and activated partial thromboplastin time (APTT) is prolonged.
- Acute endovascular treatment for stroke planned.
- Any major medical condition likely to limit survival to day 90.
- Unavailable for day 90 follow-up.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Alteplase - standard care
Alteplase 0.9 mg/kg with 10% of the total dose administered as an initial intravenous bolus and remaining 90% of the total dose administered as an intravenous infusion over 1 hour (maximum dose 90mg).
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Experimental: Tenecteplase
Tenecteplase 0.25mg/kg administered as a single rapid intravenous bolus (maximum dose 25mg).
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
modified Rankin Scale
Time Frame: Day 90 (+/- 7)
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modified Rankin Scale (mRS) at day 90, determined by the Rankin Focused Assessment (RFA) method using centralised telephone interview, analysed by ordinal distribution ("shift") analysis of the scores in intervention and control groups.
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Day 90 (+/- 7)
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Full neurological recovery (modified Rankin Scale 0-1 versus 2-6).
Time Frame: Day 90 (+/- 7)
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Day 90 (+/- 7)
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Independent recovery (modified Rankin Scale score 0-2 versus 3-6).
Time Frame: Day 90 (+/- 7)
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Day 90 (+/- 7)
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Early major neurological improvement of 8 or more points, or return to the National Institutes of Health Stroke Scale (NIHSS) total score of 0 or 1 at 24 hour(s).
Time Frame: 24 hours
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24 hours
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Health Related Quality of Life (EuroQol five dimensions questionnaire, EQ-5D)
Time Frame: Day 90 (+/- 7)
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Day 90 (+/- 7)
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Barthel Index score
Time Frame: Day 90 (+/- 7)
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Day 90 (+/- 7)
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Mortality
Time Frame: Day 90 (+/- 7)
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Day 90 (+/- 7)
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Imaging scan up to 36 hours, combined with a neurological deterioration NIHSS≥4 points from baseline (or lowest NIHSS value baseline-24 h), or leading to death (Safe Implementation of Thrombolysis in Stroke-Monitoring study definition).
Time Frame: 36 hours
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36 hours
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Symptomatic Intra-Cerebral Haemorrhage (SICH) by (European Cooperative Acute Stroke Study) ECASS-2 and ECASS-3 definitions.
Time Frame: up to day 90
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up to day 90
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Parenchymal Haematoma type 2 (PH2) haemorrhage on post-treatment computerised tomography (CT) scan up to 36 hours after treatment.
Time Frame: 36 hours
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36 hours
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Intracranial haemorrhage
Time Frame: 22-36 hours
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Any intracranial haemorrhage on 22-36 hours computerised tomography (CT) scan
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22-36 hours
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Significant extracranial haemorrhage (requirement for blood transfusion or drop in haemoglobin of ≥20mg/l in the 36h after treatment).
Time Frame: 36 hours
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36 hours
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Keith Muir, MD, FRCP, University of Glasgow
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
December 15, 2016
Primary Completion (Anticipated)
August 1, 2019
Study Completion (Anticipated)
August 1, 2019
Study Registration Dates
First Submitted
June 23, 2016
First Submitted That Met QC Criteria
June 23, 2016
First Posted (Estimate)
June 27, 2016
Study Record Updates
Last Update Posted (Actual)
March 29, 2018
Last Update Submitted That Met QC Criteria
March 27, 2018
Last Verified
March 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Stroke
- Ischemic Stroke
- Molecular Mechanisms of Pharmacological Action
- Fibrinolytic Agents
- Fibrin Modulating Agents
- Tissue Plasminogen Activator
- Plasminogen
- Tenecteplase
Other Study ID Numbers
- NorthGlasgowU
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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