Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke (CLEAR Stroke) Trial

Inclusion Criteria: Patients must have a serious measurable neurological deficit on the NIH Stroke Scale due to focal brain ischemia. An NIH Stroke Scale score >5 at the time that intravenous study drug is begun. Age: 18 through 80 years (i.e. candidates must have had their 18th birthday, but not had their 81st birthday). Intravenous therapy must be initiated within 3 hours of onset of stroke symptoms. Exclusion Criteria: History of stroke in the past 3 months. Previous intra-cranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation Clinical presentation suggests a subarachnoid hemorrhage, even if initial CT scan is normal Hypertension at time of treatment; systolic BP > 185 or diastolic > 110 mmHg or aggressive measures to lower blood pressure to below these limits are needed. Presumed septic embolus Presumed pericarditis including pericarditis after acute myocardial infarction Recent (within 30 days) surgery or biopsy of parenchymal organ Recent (within 30 days) trauma, with internal injuries or ulcerative wounds Recent (within 90 days) severe head trauma or head trauma with loss of consciousness Any active or recent (within 30 days) serious systemic hemorrhage Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency; or oral anticoagulant therapy with prothrombin time greater than 15 or INR > 1.4 Baseline lab values: positive urine pregnancy test, glucose < 50 or > 400 mg/dl, platelets <100,000 /mm3, Hct <25 %, or creatinine > 4 mg/dl Ongoing renal dialysis, regardless of creatinine If heparin has been administered within 48 hours, the patient must have a normal partial thromboplastin time (PTT) Arterial puncture at a non-compressible site or a lumbar puncture in the previous 7 days Seizure at onset of stroke Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations Other serious, advanced, or terminal illness or any other condition that the investigator feels would pose a significant hazard to the patient if rt-PA or eptifibatide therapy were initiated Patients whose peripheral venous access is so poor that they are unable to have two standard peripheral Intravenous lines started. Current participation in another research drug treatment protocol. Patient cannot start another experimental agent until after 90 days Informed consent is not or cannot be obtained Any known history of amyloid angiopathy. Exclusion Criteria/CT Scan: High density lesion consistent with hemorrhage of any degree. Significant mass effect with midline shift. Large (more than 1/3 of the middle cerebral artery) regions of clear hypodensity on the baseline CT scan. Sulcal effacement and/or loss of grey-white differentiation alone are not contraindications for treatment.