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Normobaric Hyperoxia Combined With Intravenous Thrombolysis for Acute Ischemic Stroke:Longterm Outcome (OPENS-3L)

Primary Purpose

Acute Ischemic Stroke

Status
Recruiting
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
Normobaric Hyperoxia
Nasal oxygen
Intravenous thrombolysis(rt-PA)
Sponsored by
Ji Xunming,MD,PhD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Ischemic Stroke

Eligibility Criteria

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

Inclusion Criteria: Age≥18 years; The time from onset to randomization is within 4.5 hours of onset; The clinical diagnosis is acute ischemic stroke (the criteria followed the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018); Baseline NIHSS (at the time of randomization) should be ≥5 and ≤25 points; Pre-stroke mRS score≤1 points; Informed consent from the patient or surrogate. Exclusion Criteria: Intracranial hemorrhage (including parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural/extradural hematoma, etc.); Past history of intracranial hemorrhage; Rapid neurological function improvement, NIHSS score less than 5 points; Presence of proximal arterial occlusion on computed tomography angiography(CTA)/magnetic resonance angiography(MRA) (e.g., intracranial internal carotid artery(ICA), middle cerebral arterial(MCA)-M1, and vertebrobasilar arteries); Massive anterior cerebral infarction identified by CT or MRI (ASPECT < 6 or lesions larger than one third of the territory of the middle cerebral artery); Intended to proceed endovascular treatment; Pregnant women, or planning to become pregnant during the trial; A history of severe head trauma or stroke within 3 months; A history of intracranial or spinal surgery within 3 months; A history of gastrointestinal or urinary bleeding within 3 weeks; two weeks of major surgery; Arterial puncture was performed at the hemostasis site that was not easily compressed within 1 week; Active visceral bleeding; Intracranial tumors, large intracranial aneurysms; Aortic arch dissection was found; Severe, sustained hypertension (Systolic Blood Pressure >185 mmHg or Diastolic Blood Pressure >110 mmHg); Baseline blood glucose of <50mg/dL (2.78 mmol) or >400mg/dL (22.20 mmol); Oral warfarin anticoagulant with international normalized ratio(INR)>1.7 or PT>15 s; Heparin treatment was received within 24 h; Thrombin inhibitors or factor Xa inhibitors were used within 48 h; Propensity for acute bleeding, including platelet counts of less than 100×109/ L or otherwise; Hereditary or acquired bleeding constitution; Onset with seizures; Severe liver and kidney dysfunction; Active and chronic obstructive pulmonary disease or acute respiratory distress syndrome; Patients with anemia or polycythemia vera or other situations that require urgent oxygen inhalation; Patients with upper gastrointestinal bleeding or nausea or vomiting so that they cannot cooperate with the mask to inhale oxygen; Life expectancy < 1 year; Patients who could not complete the 90-day follow-up; Participation in other clinical trials within 3 months prior to screening; Unsuitability or participation in this study as judged by the Investigator may result in subjects being exposed to greater risk.

Sites / Locations

  • Xuan Wu Hospital,Capital Medical UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

NBO group

Control group

Arm Description

Normobaric Hyperoxia combined with intravenous thrombolysis

Nasal oxygen combined with intravenous thrombolysis

Outcomes

Primary Outcome Measures

Excellent functional outcome
Proportion of subjects with modified Rankin Scale (mRS) 0-1 at 12 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome

Secondary Outcome Measures

Cerebral infarct volume
The infarct volume of cerebral infarct is evaluated by MRI
modified Rankin Scale (mRS) score
Ordinal distribution of mRS at 12 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Good functional outcome
Proportion of subjects with modified rankin scale (mRS) 0-2 at 12 months±14 days after randomization
Excellent functional outcome
Proportion of subjects with modified Rankin Scale (mRS) 0-1 at 6 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Good functional outcome
Proportion of subjects with modified rankin scale (mRS) 0-2 at 6 months±14 days after randomization
modified Rankin Scale (mRS) score
Ordinal distribution of mRS at 6 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Scores assessed by National Institutes of Health Stroke Scale(NIHSS)
Scores on the National Institutes of Health Stroke Scale (NIHSS) range from 0 to 42, with higher scores indicating more severe neurologic deficits
Barthel Index (BI)
The BI is an ordinal disability score of 10 categories (range from 0 to 100, higher values indicate better prognosis)
EuroQol five dimensions questionnaire(EQ-5D)
The score ranges from 0 to 100, with higher scores indicating optimal health
Stroke-related mortality
Safety endpoint; the proportion of stroke related deaths in each group
All-cause mortality
Safety endpoint; the proportion of all patients who died in each group
Symptomatic intracranial hemorrhage
Proportion of subjects with symptomatic intracranial hemorrhage at 24 ± 6 hours after randomization (defined by ECASSII and ECASS III)
Asymptomatic intracranial hemorrhage
The incidence of asymptomatic intracranial hemorrhage at 24 ± 6 hours after randomization
PH2 intracranial hemorrhage
The incidence of PH2 intracranial hemorrhage at 24 ± 6 hours after randomization (according to SITS standards)
Adverse events/serious adverse events
Safety endpoint; the proportion of adverse events/serious adverse events in each group

Full Information

First Posted
June 14, 2023
Last Updated
August 17, 2023
Sponsor
Ji Xunming,MD,PhD
Collaborators
Beijing Friendship Hospital, Beijing Shijitan Hospital, Capital Medical University, Beijing Tongren Hospital, People's Hospital of Beijing Daxing District, Tianjin Huanhu Hospital, Guizhou Provincial People's Hospital, Shandong Provincial Hospital, The First Affiliated Hospital of Soochow University, The First Affiliated Hospital of Zhengzhou University, The Affiliated Hospital of Xuzhou Medical University, Shandong Jining No.1 People's Hospital, Linyi People's Hospital, Nanyang Central Hospital, Rizhao People's Hospital, Zhumadian Central Hospital, Second Affiliated Hospital of Nanchang University, Affiliated Hospital of Nantong University, The Second Hospital of Anhui Medical University, Changsha Central Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05965193
Brief Title
Normobaric Hyperoxia Combined With Intravenous Thrombolysis for Acute Ischemic Stroke:Longterm Outcome (OPENS-3L)
Official Title
Normobaric Hyperoxia Combined With Intravenous Thrombolysis for Acute Ischemic Stroke:Longterm Outcome (OPENS-3L)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 17, 2023 (Actual)
Primary Completion Date
August 30, 2025 (Anticipated)
Study Completion Date
October 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Ji Xunming,MD,PhD
Collaborators
Beijing Friendship Hospital, Beijing Shijitan Hospital, Capital Medical University, Beijing Tongren Hospital, People's Hospital of Beijing Daxing District, Tianjin Huanhu Hospital, Guizhou Provincial People's Hospital, Shandong Provincial Hospital, The First Affiliated Hospital of Soochow University, The First Affiliated Hospital of Zhengzhou University, The Affiliated Hospital of Xuzhou Medical University, Shandong Jining No.1 People's Hospital, Linyi People's Hospital, Nanyang Central Hospital, Rizhao People's Hospital, Zhumadian Central Hospital, Second Affiliated Hospital of Nanchang University, Affiliated Hospital of Nantong University, The Second Hospital of Anhui Medical University, Changsha Central Hospital

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
The purpose of this study is to determine the long-term efficacy and safety of Normobaric Hyperoxia combined with intravenous thrombolysis for acute ischemic stroke.
Detailed Description
In this study, cases of acute ischemic stroke who undergo intravenous thrombolysis within 4.5 hours from onset are included. The Normobaric Hyperoxia(NBO) group receive basic intravenous thrombolysis and given 100% oxygen inhalation at a ventilation rate of 10L/ min using a sealed non-ventilating oxygen storage mask and keep giving oxygen for 4 hours. The control group receive basic intravenous thrombolysis and given oxygen inhalation at a ventilation rate of 1L/min using nasal cannula and keep giving oxygen for 4 hours. The investigators aimed to determine the long-term effect of Normobaric Hyperoxia combined with intravenous thrombolysis for acute ischemic stroke.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Ischemic Stroke

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
1102 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
NBO group
Arm Type
Experimental
Arm Description
Normobaric Hyperoxia combined with intravenous thrombolysis
Arm Title
Control group
Arm Type
Placebo Comparator
Arm Description
Nasal oxygen combined with intravenous thrombolysis
Intervention Type
Device
Intervention Name(s)
Normobaric Hyperoxia
Intervention Description
Within 4.5 hours after stroke onset, patients were randomized into the NBO group and immediately given 100% oxygen inhalation (no more than 30 minutes after randomization) at a ventilation rate of 10L/ min using a sealed non-ventilating oxygen storage mask and keep giving oxygen for 4 hours. If the patient needs to be intubated with a ventilator to maintain ventilation, the FiO2 should be set to 1.0.
Intervention Type
Device
Intervention Name(s)
Nasal oxygen
Intervention Description
For nasal oxygen group, Patients were immediately given oxygen inhalation (no more than 30 minutes after randomization) at a ventilation rate of 1L/min using nasal cannula and keep giving oxygen for 4 hours. If the patient needs to be intubated with a ventilator to maintain, the FiO2 should be set to 0.3 and gradualy incerased if spO2≤94%.
Intervention Type
Drug
Intervention Name(s)
Intravenous thrombolysis(rt-PA)
Intervention Description
10% dose of rt-PA (0.9 mg/kg) is given as bolus and the rest given as an infusion over the remaining 1 hour. Maximum dose 90mg.
Primary Outcome Measure Information:
Title
Excellent functional outcome
Description
Proportion of subjects with modified Rankin Scale (mRS) 0-1 at 12 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Time Frame
12 months±14 days after randomization
Secondary Outcome Measure Information:
Title
Cerebral infarct volume
Description
The infarct volume of cerebral infarct is evaluated by MRI
Time Frame
24-48hours after randomization
Title
modified Rankin Scale (mRS) score
Description
Ordinal distribution of mRS at 12 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Time Frame
12 months±14 days after randomization
Title
Good functional outcome
Description
Proportion of subjects with modified rankin scale (mRS) 0-2 at 12 months±14 days after randomization
Time Frame
12 months±14 days after randomization
Title
Excellent functional outcome
Description
Proportion of subjects with modified Rankin Scale (mRS) 0-1 at 6 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Time Frame
6 months±14 days after randomization
Title
Good functional outcome
Description
Proportion of subjects with modified rankin scale (mRS) 0-2 at 6 months±14 days after randomization
Time Frame
6 months±14 days after randomization
Title
modified Rankin Scale (mRS) score
Description
Ordinal distribution of mRS at 6 months±14 days after randomization; mRS score ranges from 0 to 5, and the higher score means a worse outcome
Time Frame
6 months±14 days after randomization
Title
Scores assessed by National Institutes of Health Stroke Scale(NIHSS)
Description
Scores on the National Institutes of Health Stroke Scale (NIHSS) range from 0 to 42, with higher scores indicating more severe neurologic deficits
Time Frame
4 ± 2 hours, 24 ± 6 hours, 72 ± 24 hours, 7 ± 2 days after randomization
Title
Barthel Index (BI)
Description
The BI is an ordinal disability score of 10 categories (range from 0 to 100, higher values indicate better prognosis)
Time Frame
6 months±14 days,12 months±14 days after randomization
Title
EuroQol five dimensions questionnaire(EQ-5D)
Description
The score ranges from 0 to 100, with higher scores indicating optimal health
Time Frame
6 months±14 days,12 months±14 days after randomization
Title
Stroke-related mortality
Description
Safety endpoint; the proportion of stroke related deaths in each group
Time Frame
12 months±14 days after randomization
Title
All-cause mortality
Description
Safety endpoint; the proportion of all patients who died in each group
Time Frame
12 months±14 days after randomization
Title
Symptomatic intracranial hemorrhage
Description
Proportion of subjects with symptomatic intracranial hemorrhage at 24 ± 6 hours after randomization (defined by ECASSII and ECASS III)
Time Frame
24 ± 6 hours after randomization
Title
Asymptomatic intracranial hemorrhage
Description
The incidence of asymptomatic intracranial hemorrhage at 24 ± 6 hours after randomization
Time Frame
24 ± 6 hours after randomization
Title
PH2 intracranial hemorrhage
Description
The incidence of PH2 intracranial hemorrhage at 24 ± 6 hours after randomization (according to SITS standards)
Time Frame
24 ± 6 hours after randomization
Title
Adverse events/serious adverse events
Description
Safety endpoint; the proportion of adverse events/serious adverse events in each group
Time Frame
24 ± 12 hours, 7 ± 2 days, 90± 7 days, 6 months±14 days,12 months±14 days after randomization

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age≥18 years; The time from onset to randomization is within 4.5 hours of onset; The clinical diagnosis is acute ischemic stroke (the criteria followed the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018); Baseline NIHSS (at the time of randomization) should be ≥5 and ≤25 points; Pre-stroke mRS score≤1 points; Informed consent from the patient or surrogate. Exclusion Criteria: Intracranial hemorrhage (including parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural/extradural hematoma, etc.); Past history of intracranial hemorrhage; Rapid neurological function improvement, NIHSS score less than 5 points; Presence of proximal arterial occlusion on computed tomography angiography(CTA)/magnetic resonance angiography(MRA) (e.g., intracranial internal carotid artery(ICA), middle cerebral arterial(MCA)-M1, and vertebrobasilar arteries); Massive anterior cerebral infarction identified by CT or MRI (ASPECT < 6 or lesions larger than one third of the territory of the middle cerebral artery); Intended to proceed endovascular treatment; Pregnant women, or planning to become pregnant during the trial; A history of severe head trauma or stroke within 3 months; A history of intracranial or spinal surgery within 3 months; A history of gastrointestinal or urinary bleeding within 3 weeks; two weeks of major surgery; Arterial puncture was performed at the hemostasis site that was not easily compressed within 1 week; Active visceral bleeding; Intracranial tumors, large intracranial aneurysms; Aortic arch dissection was found; Severe, sustained hypertension (Systolic Blood Pressure >185 mmHg or Diastolic Blood Pressure >110 mmHg); Baseline blood glucose of <50mg/dL (2.78 mmol) or >400mg/dL (22.20 mmol); Oral warfarin anticoagulant with international normalized ratio(INR)>1.7 or PT>15 s; Heparin treatment was received within 24 h; Thrombin inhibitors or factor Xa inhibitors were used within 48 h; Propensity for acute bleeding, including platelet counts of less than 100×109/ L or otherwise; Hereditary or acquired bleeding constitution; Onset with seizures; Severe liver and kidney dysfunction; Active and chronic obstructive pulmonary disease or acute respiratory distress syndrome; Patients with anemia or polycythemia vera or other situations that require urgent oxygen inhalation; Patients with upper gastrointestinal bleeding or nausea or vomiting so that they cannot cooperate with the mask to inhale oxygen; Life expectancy < 1 year; Patients who could not complete the 90-day follow-up; Participation in other clinical trials within 3 months prior to screening; Unsuitability or participation in this study as judged by the Investigator may result in subjects being exposed to greater risk.
Facility Information:
Facility Name
Xuan Wu Hospital,Capital Medical University
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100069
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xunming Ji, MD. PhD
Phone
861013120136877
Email
jixunming@vip.163.com
First Name & Middle Initial & Last Name & Degree
Hetao Bian, MD. PhD
Phone
18266806812
Email
hetaobian@163.com

12. IPD Sharing Statement

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Normobaric Hyperoxia Combined With Intravenous Thrombolysis for Acute Ischemic Stroke:Longterm Outcome (OPENS-3L)

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