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Activated Protein C in Acute Stroke Trial (APCAST)
This study is currently recruiting participants.
Verified by National Heart, Lung, and Blood Institute (NHLBI), July 2008
Sponsored by: National Heart, Lung, and Blood Institute (NHLBI)
Information provided by: National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier: NCT00533546
  Purpose

The purpose of this research study is to determine the safety and learn more about the dose of Activated Protein C (APC) in reducing the damage from stroke.


Condition Intervention Phase
Stroke
Drug: Activated Protein C
Phase II

Drug Information available for: Protein C Drotrecogin alfa
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Dose Comparison, Single Group Assignment, Safety/Efficacy Study
Official Title: Activated Protein C in Acute Stroke Trial

Further study details as provided by National Heart, Lung, and Blood Institute (NHLBI):

Primary Outcome Measures:
  • Occurrence of major intracranial hemorrhage (fatal and non-fatal) [ Time Frame: Measured within 36-48 hours of treatment ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Rates of other adverse events, rates of neurological deterioration, functional outcomes, pharmacokinetic analyses, changes in blood and laboratory findings [ Time Frame: Measured at 90 days ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 72
Study Start Date: September 2007
Estimated Study Completion Date: August 2011
Estimated Primary Completion Date: August 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental
Participants will receive APC by intravenous injection.
Drug: Activated Protein C
Intravenous APC (10, 15, 22, 33, 50, and 75 g/kg) administered to patients with acute ischemic stroke within 0 - 6 hours of symptom onset

Detailed Description:

An ischemic stroke occurs when there is damage to the brain caused by blockage in the blood vessels supplying the brain. Approximately 500,000 people in the United States experience this type of stroke each year. The only approved treatment for acute stroke is to attempt to dissolve the blood clot using t-PA (tissue plasminogen activator). This treatment must be given within 3 hours of symptom onset and is associated with a risk of brain hemorrhage (bleeding in the brain) of about 6% (6 in 100 patients).

Activated Protein C (APC) is a protein in the blood that is important in dissolving blood clots and reducing inflammation. Studies in animals suggest that APC may also protect brain cells from injury caused by a stroke. We are doing this study to determine if giving APC to individuals who have had a stroke will be safe and will reduce the damage to brain cells caused by the stroke. APC is currently approved by the Food and Drug Administration (FDA) for use in patients with severe, life-threatening infections.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Symptoms of acute ischemic stroke; acute ischemic stroke is defined as the sudden onset of a measurable neurological deficit presumably attributable to focal cerebral ischemia, and otherwise not attributable to ICH or other disease process
  • Symptom onset within 0-6 hours of administration of study medication Stroke onset is defined as the time of first symptoms or signs of neurologic deficit. If the onset of symptoms/signs is unwitnessed, time of onset is presumed to be the last time the patient was observed to be intact
  • Neurologic deficit on examination with NIHSS of greater than 4 and less than 23
  • In women of childbearing potential, a negative urine pregnancy test prior to enrollment (to be confirmed later by serum test)
  • Signed informed consent by subject or authorized representative

Exclusion Criteria:

  • Computed tomography scan of the brain with evidence of intracranial hemorrhage or any finding not consistent with acute ischemic stroke as cause of presenting symptoms
  • CT imaging demonstrating hypodensity more than 1/3 of MCA territory or mass effect
  • Neurological (other than presenting stroke) or psychiatric condition that may affect the patient's functional status or that may interfere with the patient's assessment
  • Clinically relevant pre-existing neurological deficit (historical modified Rankin score greater than 2 regardless of cause)
  • Treatment with tissue plasminogen activator or other thrombolytic agent within 3 months, including treatment with tissue plasminogen activator for current stroke
  • Need for treatment with anti-platelet agent or anticoagulant within 36 hours
  • Previous stroke or serious head trauma within 3 months
  • Major surgery within previous 14 days
  • History of intracranial hemorrhage
  • Rapidly improving or minor symptoms
  • Symptoms suggestive of subarachnoid hemorrhage
  • Gastrointestinal hemorrhage or urinary tract hemorrhage within previous 21 days
  • Arterial puncture at noncompressible site within the previous 7 days
  • Seizure at onset of stroke
  • Use of oral anticoagulant medications at time of symptom onset or treatment with subcutaneous or intravenous heparin within previous 48 hours with elevated partial thromboplastin time
  • INR values greater than 1.5
  • Platelet count less than 100,000/μL
  • Glucose concentration less than 40 mg/dL or greater than 400mg/dL
  • Participation in another clinical trial within the last 30 days, or planned participation in another clinical trial
  • Women who are currently breast-feeding
  • Known resistance to activated Protein C (Factor V Leiden mutation)
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00533546

Contacts
Contact: Curtis Benesch, MD, MPH 585-275 2810 Curtis_Benesch@urmc.rochester.edu
Contact: Justine Zentner, MS, RN, ANP 585-275-1204 Justine_Zentner@urmc.rochester.edu

Locations
United States, California
University of California Irvine Medical Center Recruiting
Orange, California, United States, 92868
Contact: Camille Fitzpatrick, RN, NP     714-456-2260     fitzpatc@uci.edu    
Principal Investigator: Vivek Jain, MD            
United States, Missouri
Washington University--Barnes-Jewish Hospital Recruiting
St. Louis, Missouri, United States, 63110
Contact: Jill Newgent, RN     314-747-3795     newgentj@neuro.wustl.edu    
Contact: Julie Rickmann     314-747-8794     rickmannj@neuro.wustl.edu    
Principal Investigator: Jin-Moo Lee, MD, PhD            
United States, New York
University of Rochester Recruiting
Rochester, New York, United States, 14642
Contact: Ann Leonhardt, MS, ANP     585-275-2530     Ann_Leonhardt@urmc.rochester.edu    
Principal Investigator: W. Scott Burgin, MD            
Maimonides Medical Center Recruiting
Brooklyn, New York, United States, 11219
Contact: Jill Slater, MS, NP     718-283-7670     jferkel@maimonidesmed.org    
Principal Investigator: Steven H. Rudolph, MD            
Mt. Sinai School of Medicine Not yet recruiting
New York, New York, United States, 10029
Principal Investigator: Steven R Levine, MD            
Rochester General Hospital Recruiting
Rochester, New York, United States, 14621
Contact: Cheryl Weber, RN, MS, CCRC         cheryl.weber@viahealth.org    
Contact: Patricia Wallace, RN, BSN     585-922-5386     pat.wallace@viahealth.org    
Principal Investigator: W. Scott Burgin, MD            
Sponsors and Collaborators
Investigators
Study Chair: Curtis Benesch, MD, MPH University of Rochester
  More Information

Responsible Party: University of Rochester ( Curtis Benesch, MD, MPH )
Study ID Numbers: 537, 5R01HL080107-05
Study First Received: September 19, 2007
Last Updated: July 28, 2008
ClinicalTrials.gov Identifier: NCT00533546  
Health Authority: United States: Food and Drug Administration

Keywords provided by National Heart, Lung, and Blood Institute (NHLBI):
Acute Ischemic Stroke

Study placed in the following topic categories:
Drotrecogin alfa activated
Protein C
Cerebral Infarction
Stroke
Vascular Diseases
Brain Ischemia
Central Nervous System Diseases
Brain Infarction
Ischemia
Brain Diseases
Infarction
Cerebrovascular Disorders

Additional relevant MeSH terms:
Fibrin Modulating Agents
Anticoagulants
Molecular Mechanisms of Pharmacological Action
Therapeutic Uses
Hematologic Agents
Nervous System Diseases
Fibrinolytic Agents
Cardiovascular Diseases
Cardiovascular Agents
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 16, 2009