The Spot Sign for Predicting and Treating ICH Growth Study (STOP-IT)

This is an interventional treatment trial for Intracerebral Hemorrhage focused on measuring intracerebral hemorrhage, ICH, computed tomography angiography, CTA, recombinant activated factor seven, rFVIIa, NovoSeven, recombinant activated factor VII Read More

Inclusion Criteria:

• Acute, spontaneous ICH (including bleeding in cerebellum) diagnosed by non-enhanced CT scan within five hours of symptom onset. (Time of onset is defined as the last time the patient was witnessed to be at baseline (i.e., subjects who have stroke symptoms upon awakening will be considered to have their onset at beginning of sleep)
• Age >/= 18 years through 80 years (candidates must have had their 18th birthday, but not had their 81st birthday)
• For spot positive patients, dosing of study drug within 90 minutes of enrolling CT scan

Exclusion Criteria:

• Time of symptom onset of ICH is unknown or more than five hours prior to baseline CT scan,
• ICH secondary to known or suspected trauma, aneurysm, vascular malformation, hemorrhagic conversion of ischemic stroke, venous sinus thrombosis, thrombolytic treatment of any condition (e.g., myocardial infarction, cerebral infarction, etc.), central nervous system (CNS) tumor or CNS infection
• Brainstem location of hemorrhage (patients with cerebellar hemorrhage may be enrolled)
• Serum creatinine > 1.4 mg/dl (123 μmol/L). Sites that currently perform CTA as standard of care for ICH will follow their standard procedures regarding renal insufficiency.
• Known allergy to iodinated contrast media
• Intravenous or intra-arterial administration of iodinated contrast media within the previous 24 hours of baseline CT scan
• Known hereditary (e.g., hemophilia) or acquired hemorrhagic diathesis, coagulation factor deficiency, or anticoagulant therapy with international normalized ration (INR) > 1.2
• Known or suspected thrombocytopenia (unless current platelet count documented above 50,000 / μl)
• Unfractionated heparin use with abnormal partial thromboplastin time (PTT)
• Low-molecular weight heparin use within the previous 24 hours
• GPIIb/IIIa antagonist use in the previous two weeks
• Direct thrombin inhibitor or factor Xa inhibitor within the previous 48 hours
• Glasgow Coma Scale score < 8 at time of proposed enrollment
• Pre-admission modified Rankin Scale score > 2
• Baseline ICH volume of < 0.5 cc (Hematoma volume will be estimated by local investigators from the baseline CT using the "ABC / 2 method".)
• Baseline ICH volume of > 90 cc
• Planned surgical evacuation of ICH within 24 hours of symptom onset (placement of intraventricular catheter is not a contraindication to study enrollment.)
• Evidence of acute or subacute ischemic stroke on baseline qualifying CT scan
• Clinical history of thromboembolism or ischemic vascular disease, including myocardial infarction, coronary artery bypass surgery, cardiac angina, transient ischemic attack, ischemic stroke, peripheral artery disease (vascular claudication), cerebral bypass surgery, carotid endarterectomy, deep venous thrombosis, pulmonary embolism, or coronary or cerebrovascular angioplasty or stenting. (Clinically silent evidence of old ischemia on EKG (Q waves) or CT scan (silent old infarct) will not be considered reasons for exclusion.)
• Baseline electrocardiogram shows evidence of acute cardiac ischemia (ST elevation in two contiguous leads, new left bundle branch block (LBBB), or ST depression)
• Clinical history suggestive of acute cardiac ischemia (e.g., chest pain)
• Abnormal baseline troponin
• Females of childbearing potential who are known to be pregnant and/or lactating or who have positive pregnancy tests on admission
• Advanced or terminal illness or any other condition the investigator feels would pose a significant hazard to the patient if rFVIIa were administered
• Recent (within 30 days) participation in any investigational drug or device trial or earlier participation in any investigational drug or device trial for which the duration of effect is expected to persist until the time of STOP-IT enrollment
• Planned withdrawal of care or comfort care measures
• Patient known or suspected of not being able to comply with trial protocol (e.g., due to alcoholism, drug dependency or psychological disorder)
• Informed consent cannot be obtained from the patient or legally authorized representative