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Tenecteplase Compared to Alteplase for Patients With Large Vesel Oclusion Suspicion Before Thrombectomy

Primary Purpose

Acute Ischemic Stroke

Status
Recruiting
Phase
Phase 3
Locations
Spain
Study Type
Interventional
Intervention
Tenecteplase
Sponsored by
Hospital Universitari Vall d'Hebron Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Ischemic Stroke focused on measuring acute ischemic stroke, large vessel occlusion

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients eligible to undergo intravenous thrombolysis (tPA or TNK) within 4.5 hours after the onset of ischemic stroke. Suspicion of Cerebral vascular occlusion on brain imaging. Age >18 years old Men and women (women with child-bearing potential are excluded, unless pregnancy test negative/ confirmed menstrual period/ postmenopausal or hysterectomy). A new focal disabling neurologic deficit consistent with acute cerebral ischemia. Informed consent obtained from subject or acceptable subject surrogate (i.e. next of kin, or legal representative), or Differed Inform Consent (DIC) to avoid any delay in the initiation of iv thrombolysis. The DIC will be sign by the patient or next of kin at any time after the tPA or TNK treatment is started. Exclusion criteria: Patients with severe preexisting disability, defined as a modified Rankin scale score >3. Glasgow Coma Scale score ≤ 7. Known hemorrhagic diathesis, coagulation factor deficiency, or antivitamin K oral anticoagulant therapy with INR >3.0. Subjects on factor Xa inhibitors (e.g. apixaban) or direct thrombin inhibitors are eligible for participation. Severe, sustained and uncontrollable hypertension (systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg). Serious, advanced, or terminal illness with anticipated life expectancy of less than 3 months. Patients that are unlikely to be available for a 90-day follow-up (e.g. no fixed home address, visitor from overseas). Patient participating in a randomized study, involving an investigational drug or device that would impact this study. Suspicion of aortic dissection presumed septic embolus, or suspicion of bacterial endocarditis. Imaging exclusion criteria: Clinical symptoms suggestive of bilateral stroke or stroke in multiple territories. Cerebral vasculitis. CT or MRI evidence of hemorrhage Significant mass effect with midline shift. Evidence of intracranial tumor. Subjects with known occlusions in multiple vascular territories (e.g., bilateral anterior circulation, or anterior/posterior circulation).

Sites / Locations

  • Hospital Universitari Vall d'HebronRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Tenecteplase (TNK)

Alteplase (tPA)

Arm Description

Drug: Alteplase (tPA) Dose: 0.9 mg/kg Route: Intravenous (IV) infusion

Drug: Tenecteplase (TNK) Dose: 0.25 mg/kg Route: Intravenous (IV) bolus injection

Outcomes

Primary Outcome Measures

Modified Rankin scale score at 3 months
Shift analysis of the modified Rankin scale score at 3 months
Mortality rate
Mortality at 3 months
Symptomatic intracerebral haemorrhage (ICH) and neurological deterioration
Symptomatic ICH defined as intracerebral haemorrhage (PH2) within 36 hours of treatment, combined with neurological deterioration leading to an increase of ≥ 4 points on the National institute of Health Stroke Scale (NIHSS) from baseline, or the lowest NIHSS value between baseline and 24 hours.

Secondary Outcome Measures

Rates of mRS 0-1 at 3 months
Modified Rankin scale score (0-1) rates
Rates of mRS 0-2 at 3 months
Modified Rankin scale score (0-2) rates
Rates of pre-interventional recanalization
Recanalization rate
Dramatic clinical recovery before endovascular treatment (EVT)
Dramatic clinical recovery before EVT (Improvement in > 8 points in the NIHSS score or NIHSS score < 2 before groin puncture)
First pass TICI 3, final TICI 2b-3
Rates of first pass TICI 3, final TICI 2b-3
Distal embolization during EVT
Rates of distal embolization during EVT
Needle-to-groin times and DIDO times
Differences in needle-to-groin times in Mothership patients and in DIDO times in Drip-and-Ship patients.
Time metrics between TNKCAT and non-TNKCAT centers
Differences in time metrics between TNKCAT and non-TNKCAT centers
Final infarct volume on follow up CT
Differences in final infarct volume on follow up CT

Full Information

First Posted
November 4, 2022
Last Updated
November 22, 2022
Sponsor
Hospital Universitari Vall d'Hebron Research Institute
Collaborators
Instituto de Salud Carlos III
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1. Study Identification

Unique Protocol Identification Number
NCT05626972
Brief Title
Tenecteplase Compared to Alteplase for Patients With Large Vesel Oclusion Suspicion Before Thrombectomy
Official Title
A Multi-center, Randomized, Open-label Blinded Endpoint (PROBE), Phase III Study, for the Comparation of Tenecteplase (TNK) Versus Alteplase, With a 1:1 Allocation, Before Thrombectomy in Patients With Acute Ischemic Stroke and Large Vessel Occlusion Suspicion in Catalonia (TNK-CAT)
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
May 27, 2022 (Actual)
Primary Completion Date
May 2023 (Anticipated)
Study Completion Date
May 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Hospital Universitari Vall d'Hebron Research Institute
Collaborators
Instituto de Salud Carlos III

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: The TNKCAT trial represents an innovative approach to optimize timely reperfusion in the Mothership and Drip-and-Ship scenarios. The logistic advantage of a single bolus infusion of TNK (compared to 1-h infusion of tPA) would markedly reduce the needle-to-groin and Door-in- door-out time. The implementation of a quality improvement package (QIP) in the TNKCAT trial would directly improve the quality and efficiency of the Health Care System. In addition, an improvement of transfer models would reduce the cost of unnecessary transfers, together with the fact that TNK is up to 50% less expensive than tPA, makes the TNKCAT in firm line with the sustainability strategy of the National Health Care system. Outcomes: The aim of the present study is to determine the safety and efficacy of TNK (0.25mh/kg) compared to tPA (0.9 mg/kg) in patients with Large Vessel Occlusion (LVO) suspicion, candidates for thrombectomy, in both Mothership and Drip-and-Ship scenarios. Study Duration: 2 years. Patients will participate in the trial for 3 months. Study design: Multicentre, prospective, randomized open-label blinded endpoint (PROBE) phase III study in acute stroke patients with LVO suspicion within 4.5 hours of stroke onset, candidates for EVT. Patients will be randomized 1:1 to standard dose tPA (0.9 mg/kg) or TNK (0.25mg/kg) before EVT. Clinical, imaging and outcome data will be collected at baseline, 24-36 hours, day 3, day 5 and day 90. Estimated enrollment: 500 patients

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Ischemic Stroke
Keywords
acute ischemic stroke, large vessel occlusion

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Sequential Assignment
Masking
Outcomes Assessor
Masking Description
Clinical outcome at day 90 will be obtained by centralized telephone call of the mRS in a blinded manner by certified personnel of the Catalan Stroke Program.
Allocation
Randomized
Enrollment
500 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Tenecteplase (TNK)
Arm Type
Active Comparator
Arm Description
Drug: Alteplase (tPA) Dose: 0.9 mg/kg Route: Intravenous (IV) infusion
Arm Title
Alteplase (tPA)
Arm Type
Active Comparator
Arm Description
Drug: Tenecteplase (TNK) Dose: 0.25 mg/kg Route: Intravenous (IV) bolus injection
Intervention Type
Drug
Intervention Name(s)
Tenecteplase
Intervention Description
Patients will be randomized 1:1 to standard dose tPA (0.9 mg/kg) or TNK (0.25mg/kg) before endovascular therapy (EVT)
Primary Outcome Measure Information:
Title
Modified Rankin scale score at 3 months
Description
Shift analysis of the modified Rankin scale score at 3 months
Time Frame
3 months
Title
Mortality rate
Description
Mortality at 3 months
Time Frame
3 months
Title
Symptomatic intracerebral haemorrhage (ICH) and neurological deterioration
Description
Symptomatic ICH defined as intracerebral haemorrhage (PH2) within 36 hours of treatment, combined with neurological deterioration leading to an increase of ≥ 4 points on the National institute of Health Stroke Scale (NIHSS) from baseline, or the lowest NIHSS value between baseline and 24 hours.
Time Frame
24 -36hours
Secondary Outcome Measure Information:
Title
Rates of mRS 0-1 at 3 months
Description
Modified Rankin scale score (0-1) rates
Time Frame
3 months
Title
Rates of mRS 0-2 at 3 months
Description
Modified Rankin scale score (0-2) rates
Time Frame
3 months
Title
Rates of pre-interventional recanalization
Description
Recanalization rate
Time Frame
during the procedure
Title
Dramatic clinical recovery before endovascular treatment (EVT)
Description
Dramatic clinical recovery before EVT (Improvement in > 8 points in the NIHSS score or NIHSS score < 2 before groin puncture)
Time Frame
before the procedure
Title
First pass TICI 3, final TICI 2b-3
Description
Rates of first pass TICI 3, final TICI 2b-3
Time Frame
immediately after the procedure
Title
Distal embolization during EVT
Description
Rates of distal embolization during EVT
Time Frame
during the procedure
Title
Needle-to-groin times and DIDO times
Description
Differences in needle-to-groin times in Mothership patients and in DIDO times in Drip-and-Ship patients.
Time Frame
immediately after the procedure
Title
Time metrics between TNKCAT and non-TNKCAT centers
Description
Differences in time metrics between TNKCAT and non-TNKCAT centers
Time Frame
at the end of the study
Title
Final infarct volume on follow up CT
Description
Differences in final infarct volume on follow up CT
Time Frame
24-36 hours follow up

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients eligible to undergo intravenous thrombolysis (tPA or TNK) within 4.5 hours after the onset of ischemic stroke. Suspicion of Cerebral vascular occlusion on brain imaging. Age >18 years old Men and women (women with child-bearing potential are excluded, unless pregnancy test negative/ confirmed menstrual period/ postmenopausal or hysterectomy). A new focal disabling neurologic deficit consistent with acute cerebral ischemia. Informed consent obtained from subject or acceptable subject surrogate (i.e. next of kin, or legal representative), or Differed Inform Consent (DIC) to avoid any delay in the initiation of iv thrombolysis. The DIC will be sign by the patient or next of kin at any time after the tPA or TNK treatment is started. Exclusion criteria: Patients with severe preexisting disability, defined as a modified Rankin scale score >3. Glasgow Coma Scale score ≤ 7. Known hemorrhagic diathesis, coagulation factor deficiency, or antivitamin K oral anticoagulant therapy with INR >3.0. Subjects on factor Xa inhibitors (e.g. apixaban) or direct thrombin inhibitors are eligible for participation. Severe, sustained and uncontrollable hypertension (systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg). Serious, advanced, or terminal illness with anticipated life expectancy of less than 3 months. Patients that are unlikely to be available for a 90-day follow-up (e.g. no fixed home address, visitor from overseas). Patient participating in a randomized study, involving an investigational drug or device that would impact this study. Suspicion of aortic dissection presumed septic embolus, or suspicion of bacterial endocarditis. Imaging exclusion criteria: Clinical symptoms suggestive of bilateral stroke or stroke in multiple territories. Cerebral vasculitis. CT or MRI evidence of hemorrhage Significant mass effect with midline shift. Evidence of intracranial tumor. Subjects with known occlusions in multiple vascular territories (e.g., bilateral anterior circulation, or anterior/posterior circulation).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Carlos Molina, Dr
Phone
(+34) 93 489 30 00
Ext
4996
Email
cmolina@vhebron.net
Facility Information:
Facility Name
Hospital Universitari Vall d'Hebron
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Carlos Molina, Dr.
Phone
(+34) 93 489 30 00
Ext
4996
Email
cmolina@vhebron.net

12. IPD Sharing Statement

Plan to Share IPD
No

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Tenecteplase Compared to Alteplase for Patients With Large Vesel Oclusion Suspicion Before Thrombectomy

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