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Reduced-Dose Versus Full-Dose Alteplase for High-Risk Pulmonary Embolism (REDSTEM)

14 settembre 2026 aggiornato da: Kristina Svennerholm, Sahlgrenska University Hospital

Reduced-Dose Versus Full-Dose Systemic Thrombolysis for High-Risk Pulmonary Embolism: A Multicentre, Randomised, Open-Label, Blinded-Endpoint Trial

High-risk pulmonary embolism is a life-threatening condition requiring immediate reperfusion therapy. Full-dose systemic thrombolysis is recommended as first-line treatment, but its use is limited by the risk of major bleeding, including intracranial hemorrhage. Reduced-dose systemic thrombolysis may reduce bleeding while maintaining clinical efficacy, but this strategy has not been adequately evaluated in patients with high-risk pulmonary embolism.

REDSTEM is an international, multicenter, randomized, adaptive, open-label, blinded-endpoint phase 4 trial comparing reduced-dose alteplase with standard full-dose alteplase in adults with acute high-risk pulmonary embolism. The trial will assess whether reduced-dose alteplase preserves early clinical efficacy while reducing severe clinically significant bleeding. Participants will be followed for up to 12 months.

Panoramica dello studio

Stato

Non ancora reclutamento

Descrizione dettagliata

Systemic thrombolysis is recommended as first-line reperfusion therapy for high-risk pulmonary embolism. However, bleeding complications limit its use in clinical practice and contribute to undertreatment of eligible patients. Existing evidence from small randomized trials, observational studies, and meta-analyses suggests that lower-dose thrombolysis may improve safety while maintaining efficacy, but previous studies have included mixed-risk pulmonary embolism populations and only a limited number of patients with high-risk pulmonary embolism.

REDSTEM was designed to evaluate whether a reduced-dose alteplase strategy can provide a more favorable balance between efficacy and safety compared with standard full-dose alteplase in patients with high-risk pulmonary embolism. The study uses randomized treatment allocation, blinded endpoint adjudication, independent safety monitoring, and an adaptive design allowing sample-size re-estimation if required.

The trial includes early clinical assessments during the acute phase and follow-up through 12 months to evaluate clinical outcomes, safety, functional recovery, quality of life, and health care resource utilization.

Tipo di studio

Interventistico

Iscrizione (Stimato)

400

Fase

  • Fase 4

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Backup dei contatti dello studio

Luoghi di studio

      • Copenhagen, Danimarca
        • Rigshospitalet
        • Contatto:
          • Jesper Kjaergaard, MD, PhD
      • Bergen, Norvegia, 5021
        • Haukeland University Hospital
        • Contatto:
          • Lasse Melvear Gii, MD, PhD
      • Drammen, Norvegia, 3004
        • Drammen Hospital
        • Contatto:
          • Jonas Pivoriunas, MD, PhD
      • Grålum, Norvegia, 1714
        • Ostfold Hisptal
        • Contatto:
          • Hans Joakim Myklebust-Hansen, MD
      • Lörenskog, Norvegia, 1478
        • Akershus University Hospital
        • Contatto:
          • Hamza Nahoui, MD
      • Oslo, Norvegia, 0450
        • Oslo University Hospital, Ullevål
        • Contatto:
          • Mari Asphjell Björnaas, MD, PhD
      • Stavanger, Norvegia, 4021
        • Stavanger University Hospital
        • Contatto:
          • Trond Johan Cooper, MD
      • Falun, Svezia
        • Falun Hospital
        • Contatto:
          • Jessica Silfverberg, MD
      • Gothenburg, Svezia
        • Sahlgrenska University Hospital/Östra
        • Contatto:
          • Katarina Glise Sandblad, MD, PhD
      • Jönköping, Svezia
        • Ryhov County Hospital
        • Contatto:
          • Antheia Kissopoulou, MD, PhD
      • Lund, Svezia
        • Skåne University Hospital, Lund
        • Contatto:
          • Marcus Ohlsson, MD
      • Malmö, Svezia
        • Skåne University Hospital, Malmö
        • Contatto:
          • Marcus Ohlsson, MD, PhD
      • Mölndal, Svezia
        • Sahlgrenska University Hospital/Mölndal
        • Contatto:
          • Louise Martinell, MD, PhD
      • Norrtälje, Svezia
        • Norrtälje Hospital
        • Contatto:
          • Sune Forsberg, MD, PhD
      • Skövde, Svezia
        • Skaraborgs Hospital Skövde
        • Contatto:
          • Freyr Einarsson, MD
        • Contatto:
          • Erik Ullemark, MD
      • Stockholm, Svezia
        • Danderyd Hospital
        • Contatto:
          • Nina Olausson, MD, PhD
      • Stockholm, Svezia
        • Karolinska University Hospital, Solna
        • Contatto:
          • Therese Djärv, MD, PhD
      • Stockholm, Svezia
        • Karolinska University Hospital, Huddinge
        • Contatto:
          • Therese Djärv, MD, PhD
      • Stockholm, Svezia
        • Capio S:t Göran's Hospital
        • Contatto:
          • Rickard Markgren, MD, PhD
      • Stockholm, Svezia
        • Södersjukhuset, Stockholm South General Hospital
        • Contatto:
          • Jacob Hollenberg, MD, PhD
      • Umeå, Svezia
        • University Hospital of Umeå
        • Contatto:
          • Johanna Pennlert, MD, PhD
      • Uppsala, Svezia
        • Uppsala University Hospital
        • Contatto:
          • Sofia Vikman, MD, PhD
    • Västra Götaland County

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Descrizione

Inclusion Criteria:

  1. Participant aged 18 years or older.
  2. Acute pulmonary embolism verified by computed tomography pulmonary angiography or pulmonary angiography. In hemodynamically unstable participants unable to undergo immediate imaging, presumed pulmonary embolism may be diagnosed based on bedside echocardiographic findings consistent with acute right ventricular pressure overload and high clinical suspicion of pulmonary embolism, provided that alternative causes of hemodynamic instability have been reasonably excluded. In such cases, the treating clinician must have independently decided to initiate thrombolytic therapy irrespective of study participation, and confirmatory imaging demonstrating pulmonary embolism must be performed as soon as clinically feasible.
  3. High risk for early death, defined by at least one of the following:

    1. High-risk pulmonary embolism according to European Society of Cardiology criteria:

      • Cardiac arrest with return of spontaneous circulation;
      • Obstructive shock, defined as systolic blood pressure <90 mmHg or use of vasopressors to maintain systolic blood pressure ≥90 mmHg despite adequate filling status, together with end-organ hypoperfusion such as elevated serum lactate >2 mmol/L, altered mental status, or cold clammy skin;
      • Persistent hypotension, defined as systolic blood pressure <90 mmHg or a drop in systolic blood pressure ≥40 mmHg for longer than 15 minutes, not caused by new-onset arrhythmia, hypovolemia, or sepsis.
    2. Abnormal right ventricular function on echocardiography or computed tomography pulmonary angiography, defined as right ventricular/left ventricular ratio ≥1.0, and elevated cardiac troponin above the local upper reference limit, and acute respiratory failure not primarily caused by underlying lung disease, defined as requiring facemask oxygen supplementation ≥12 L/min, high-flow nasal oxygen, or non-invasive ventilation with FiO2 ≥60% to reach oxygen saturation ≥94%.
  4. Female participants of childbearing potential must have a negative urine or serum pregnancy test.

Exclusion Criteria:

  1. Catastrophic pulmonary embolism, defined as ongoing cardiac arrest and/or need for extracorporeal cardiopulmonary resuscitation and/or immediate VA-ECMO as judged by the treating physicians.
  2. Known hypersensitivity to alteplase or any of its excipients.
  3. Contraindication to systemic thrombolysis with one or more of the following:

    • History of hemorrhagic stroke;
    • Ischemic stroke within the previous 6 months;
    • Central nervous system neoplasm;
    • Major trauma, major surgery, or major head injury within the previous 3 weeks;
    • Active life-threatening bleeding, bleeding into a critical organ or area, or known severe bleeding diathesis;
    • Chronic use of full-dose oral or parenteral anticoagulation before presentation.
  4. The participant has already received reperfusion treatment for the index pulmonary embolism before randomization, including systemic thrombolysis, surgical embolectomy, or catheter-directed intervention.
  5. Pregnancy.
  6. Current participation in another study that would interfere with participation in this trial.
  7. Any other condition that would put the participant at unacceptable risk from the trial interventions as judged by the treating clinician.
  8. In countries where required by national regulations: lack of affiliation to a social security system or equivalent health insurance coverage.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Separare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Reduced-Dose Alteplase
Participants randomized to reduced-dose systemic thrombolysis will receive alteplase 0.6 mg/kg body weight, up to a maximum dose of 50 mg, administered intravenously over 15 minutes.
Alteplase 0.6 mg/kg body weight, maximum 50 mg, administered as an intravenous infusion over 15 minutes
Altri nomi:
  • Reduced-dose systemic thrombolysis, Low-dose alteplase, tPA
Comparatore attivo: Full-Dose Alteplase
Participants randomized to standard full-dose systemic thrombolysis will receive alteplase 1.5 mg/kg body weight, up to a maximum dose of 100 mg, administered as a 10 mg intravenous bolus over 1 to 2 minutes followed by a 90 mg intravenous infusion over 2 hours.
Alteplase 1.5 mg/kg body weight, maximum 100 mg, administered as a 10 mg intravenous bolus over 1 to 2 minutes followed by 90 mg as an intravenous infusion over 2 hours.
Altri nomi:
  • Full-dose systemic thrombolysis, Standard-dose alteplase, tPA

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Incidence of composite efficacy endpoint
Lasso di tempo: Within 7 days after randomization
Incidence of a composite endpoint comprising all-cause mortality within 7 days, cardiopulmonary resuscitation and/or veno-arterial extracorporeal membrane oxygenation within 7 days, recurrent pulmonary embolism within 7 days, clinical deterioration within 24 hours, and lack of clinical improvement at 6 hours.
Within 7 days after randomization
Key secondary endpoint - Incidence of severe clinically significant bleeding
Lasso di tempo: Within 7 days after randomization
Incidence of severe clinically significant bleeding, defined as major bleeding according to International Society on Thrombosis and Haemostasis criteria or bleeding requiring urgent medical intervention.
Within 7 days after randomization

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
All-cause mortality
Lasso di tempo: At 7 days and 30 days after randomization
Incidence of death from any cause.
At 7 days and 30 days after randomization
Pulmonary embolism-related mortality
Lasso di tempo: At 7 days and 30 days after randomization
Incidence of pulmonary embolism-related death.
At 7 days and 30 days after randomization
Cardiopulmonary resuscitation and/or VA-ECMO
Lasso di tempo: Within 7 days after randomization
Incidence of cardiopulmonary resuscitation and/or veno-arterial extracorporeal membrane oxygenation.
Within 7 days after randomization
Incidence of clinical deterioration
Lasso di tempo: Within 24 hours after randomization
Incidence of life-threatening hemodynamic or respiratory decline requiring cardiopulmonary resuscitation, endotracheal intubation, or VA-ECMO, or an increase in SCAI SHOCK stage after investigational medicinal product administration.
Within 24 hours after randomization
Lack of clinical improvement assessed by SCAI SHOCK stage and oxygen requirement
Lasso di tempo: At 6 hours after randomization
Incidence of unchanged SCAI SHOCK stage or unchanged or rising fraction of inspired oxygen required to maintain oxygen saturation of at least 94%.
At 6 hours after randomization
Time to clinical stabilization based on predefined hemodynamic and respiratory criteria
Lasso di tempo: From randomization until clinical stabilization, assessed up to 7 days after randomization
Time from randomization to the time point at which predefined hemodynamic or respiratory stabilization criteria have been continuously fulfilled for at least 30 minutes
From randomization until clinical stabilization, assessed up to 7 days after randomization
Incidence of recurrent pulmonary embolism
Lasso di tempo: At 7 days and 30 days after randomization
Incidence of objectively confirmed recurrent pulmonary embolism.
At 7 days and 30 days after randomization
Initiation of invasive or non-invasive mechanical ventilation
Lasso di tempo: Within 7 days after randomization
Incidence of initiation of invasive or non-invasive mechanical ventilation.
Within 7 days after randomization
Win ratio for efficacy
Lasso di tempo: Within 7 days after randomization
Win ratio based on all-cause mortality, cardiopulmonary resuscitation and/or VA-ECMO, clinical deterioration, lack of clinical improvement, recurrent pulmonary embolism, and time to clinical stabilization.
Within 7 days after randomization
Net clinical benefit
Lasso di tempo: Within 7 days after randomization
Composite net clinical benefit including severe clinically significant bleeding, all-cause mortality, cardiopulmonary resuscitation and/or VA-ECMO, recurrent pulmonary embolism, clinical deterioration, and lack of clinical improvement.
Within 7 days after randomization
Rescue treatment
Lasso di tempo: Before clinical stabilization, up to 7 days after randomization
Need for rescue treatment, defined as additional alteplase, catheter-directed intervention, surgical embolectomy, or VA-ECMO before stabilization.
Before clinical stabilization, up to 7 days after randomization
ICU or high-dependency unit length of stay in days
Lasso di tempo: Within 30 days after randomization
Length of stay in intensive care unit and/or high-dependency unit.
Within 30 days after randomization
Hospital length of stay
Lasso di tempo: Within 30 days after randomization
Length of hospital stay.
Within 30 days after randomization
Major bleeding
Lasso di tempo: At 48 hours, 7 days, and 30 days after randomization
Incidence of major bleeding according to International Society on Thrombosis and Haemostasis criteria.
At 48 hours, 7 days, and 30 days after randomization
Bleeding requiring urgent medical intervention
Lasso di tempo: At 48 hours, 7 days, and 30 days after randomization
Incidence of severe bleeding requiring urgent medical intervention.
At 48 hours, 7 days, and 30 days after randomization
Intracerebral bleeding
Lasso di tempo: Within 7 days after randomization
Incidence of intracerebral bleeding.
Within 7 days after randomization

Altre misure di risultato

Misura del risultato
Misura Descrizione
Lasso di tempo
All-cause mortality at 12 months
Lasso di tempo: At 12 months after randomization
Incidence of death from any cause.
At 12 months after randomization
At 12 months after randomization
Lasso di tempo: At 12 months after randomization
Incidence of objectively confirmed recurrent pulmonary embolism.
At 12 months after randomization
Persistent dyspnea assessed using the modified Medical Research Council scale
Lasso di tempo: At 3 months and 12 months after randomization
Persistent dyspnea assessed using the modified Medical Research Council scale.
At 3 months and 12 months after randomization
Functional status assessed using the Post-VTE Functional Status Scale
Lasso di tempo: At 3 months and 12 months after randomization
Functional status assessed using the post-VTE functional status (PVFS) scale. Scores range from 0 to 4, where 0 indicates no functional limitations and 4 indicates severe functional limitations. Higher scores indicate worse functional status. Death before the scheduled assessment is recorded as grade D.
At 3 months and 12 months after randomization
Exercise tolerance assessed using the 6-minute walk test
Lasso di tempo: At 3 months and 12 months after randomization
Exercise tolerance assessed using the 6-minute walk test, reported as distance walked in meters. A greater distance indicates better exercise tolerance.
At 3 months and 12 months after randomization
Persistent right ventricular dysfunction assessed by echocardiography
Lasso di tempo: At 3 months and/or 12 months after randomization
Persistent right ventricular dysfunction according to echocardiography report, when performed as clinically indicated.
At 3 months and/or 12 months after randomization
Pulmonary embolism-specific quality of life assessed using the PEmb-QoL questionnaire
Lasso di tempo: At 3 months and 12 months after randomization
Pulmonary embolism-specific health-related quality of life assessed using the Pulmonary Embolism Quality of Life (PEmb-QoL) questionnaire. The PEmb-QoL summary score ranges from 0 to 100, with higher scores indicating worse health-related quality of life.
At 3 months and 12 months after randomization
Health-related quality of life assessed using EQ-5D-5L
Lasso di tempo: At 3 months and 12 months after randomization
Health-related quality of life assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument.
At 3 months and 12 months after randomization
Chronic thromboembolic pulmonary hypertension
Lasso di tempo: At 12 months after randomization
Incidence of chronic thromboembolic pulmonary hypertension.
At 12 months after randomization
Health care resource utilization
Lasso di tempo: During 12 months after randomization
Cost of health care resource utilization during the 12-month follow-up period.
During 12 months after randomization

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Investigatori

  • Investigatore principale: Kristina Svennerholm, Sahlgrenska University Hospital / University of Gothenburg

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Stimato)

1 dicembre 2026

Completamento primario (Stimato)

31 gennaio 2030

Completamento dello studio (Stimato)

31 gennaio 2031

Date di iscrizione allo studio

Primo inviato

2 settembre 2026

Primo inviato che soddisfa i criteri di controllo qualità

10 settembre 2026

Primo Inserito (Effettivo)

14 settembre 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

17 settembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

14 settembre 2026

Ultimo verificato

1 settembre 2026

Maggiori informazioni

Termini relativi a questo studio

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

SÌ

Descrizione del piano IPD

De-identified individual participant data underlying the published results may be shared upon reasonable request after publication. Access will require approval by the sponsor and principal investigator, a scientifically sound proposal, scientific collaboration with the trial investigators, compliance with applicable ethical, regulatory, data protection, and consent requirements, and a signed data sharing agreement.

Periodo di condivisione IPD

After publication of the trial results.

Criteri di accesso alla condivisione IPD

Reasonable request, subject to approval by the sponsor and principal investigator and applicable legal, ethical, and data protection requirements.

Tipo di informazioni di supporto alla condivisione IPD

  • STUDIO_PROTOCOLLO
  • LINFA

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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