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

14 września 2026 zaktualizowane przez: 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.

Przegląd badań

Status

Jeszcze nie rekrutacja

Szczegółowy opis

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.

Typ studiów

Interwencyjne

Zapisy (Szacowany)

400

Faza

  • Faza 4

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Kontakt w sprawie studiów

Kopia zapasowa kontaktu do badania

Lokalizacje studiów

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

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

  • Dorosły
  • Starszy dorosły

Akceptuje zdrowych ochotników

Nie

Opis

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.

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Randomizowane
  • Model interwencyjny: Przydział równoległy
  • Maskowanie: Pojedynczy

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Eksperymentalny: 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
Inne nazwy:
  • Reduced-dose systemic thrombolysis, Low-dose alteplase, tPA
Aktywny komparator: 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.
Inne nazwy:
  • Full-dose systemic thrombolysis, Standard-dose alteplase, tPA

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Incidence of composite efficacy endpoint
Ramy czasowe: 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
Ramy czasowe: 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

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
All-cause mortality
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: Within 7 days after randomization
Incidence of initiation of invasive or non-invasive mechanical ventilation.
Within 7 days after randomization
Win ratio for efficacy
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: Within 30 days after randomization
Length of hospital stay.
Within 30 days after randomization
Major bleeding
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: Within 7 days after randomization
Incidence of intracerebral bleeding.
Within 7 days after randomization

Inne miary wyników

Miara wyniku
Opis środka
Ramy czasowe
All-cause mortality at 12 months
Ramy czasowe: At 12 months after randomization
Incidence of death from any cause.
At 12 months after randomization
At 12 months after randomization
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: 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
Ramy czasowe: At 12 months after randomization
Incidence of chronic thromboembolic pulmonary hypertension.
At 12 months after randomization
Health care resource utilization
Ramy czasowe: During 12 months after randomization
Cost of health care resource utilization during the 12-month follow-up period.
During 12 months after randomization

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Śledczy

  • Główny śledczy: Kristina Svennerholm, Sahlgrenska University Hospital / University of Gothenburg

Publikacje i pomocne linki

Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.

Publikacje ogólne

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Szacowany)

1 grudnia 2026

Zakończenie podstawowe (Szacowany)

31 stycznia 2030

Ukończenie studiów (Szacowany)

31 stycznia 2031

Daty rejestracji na studia

Pierwszy przesłany

2 września 2026

Pierwszy przesłany, który spełnia kryteria kontroli jakości

10 września 2026

Pierwszy wysłany (Rzeczywisty)

14 września 2026

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

17 września 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

14 września 2026

Ostatnia weryfikacja

1 września 2026

Więcej informacji

Terminy związane z tym badaniem

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

TAK

Opis planu 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.

Ramy czasowe udostępniania IPD

After publication of the trial results.

Kryteria dostępu do udostępniania IPD

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

Typ informacji pomocniczych dotyczących udostępniania IPD

  • PROTOKÓŁ BADANIA
  • SOK ROŚLINNY

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Nie

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

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