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Tenecteplase Pulmonary Embolism Italian Study

Information source: University Of Perugia
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Pulmonary Embolism

Intervention: tenecteplase (Drug)

Phase: Phase 2

Status: Terminated

Sponsored by: University Of Perugia

Official(s) and/or principal investigator(s):
Giancarlo Agnelli, MD, Study Chair, Affiliation: Department of Internal Medicine - University of Perugia
Cecilia Becattini, MD, Study Director, Affiliation: Department of Internal Medicine - University of Perugia

Summary

To assess the efficacy and safety of Tenecteplase versus Placebo in normotensive patients with sub-massive Pulmonary Embolism and Right Ventricular Dysfunction (RVD) all receiving unfractionated heparin (UFH)

Clinical Details

Official title: A Phase II Multicenter, Randomized, Double Blind Study Comparing the Efficacy and Safety of Single Bolus i.v. Tenecteplase Versus Placebo in Normotensive Patients With Pulmonary Embolism and Right Ventricular Dysfunction

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome: Clinically relevant reduction of RVD

Secondary outcome:

Clinically relevant reduction of RVD; Clinical deterioration requiring escalation of treatment

PE recurrence

Death

Detailed description: In patients with major acute PE thrombolysis has been shown to be life saving (22). Recent registries showed the beneficial effect of thrombolysis also in patients with PE not associated with shock or hypotension (4-23). In these patients thrombolytic treatment has been shown to obtain an improvement of 37% in lung perfusion, detected by lung scan, with respect to an improvement of 18. 8% obtained by heparin treatment (24). In a different trial, rt-PA resulted in a faster and greater improvement of pulmonary artery hypertension than heparin treatment (25). Indeed, PE has a wide spectrum of severity at presentation and it is conceivable that the use of more aggressive treatments should be reserved to patients at high risk for adverse outcome. Hence, the search started of prognostic factors of adverse outcome in patients with pulmonary embolism. RVD has been associated with early adverse outcome (PE recurrence and mortality) in patients with acute PE (26-28; 3). In-hospital mortality in PE patients with and without echocardiographic RVD has been found to be 18. 4% and 5. 7%, respectively (3). Ribeiro et al. found a higher mortality in patients with PE and severe RVD: in-hospital mortality was 7. 9% in the overall population with respect to 14. 3% in patients with severe RVD (5). The ICOPER registry reported a 2-week mortality of 15. 9% in patients presenting with RVD in comparison with 8% in patients without RVD (23). In MAPPET 10% of patients with RVD died within 30 days as compared to 4. 1% of patients without (4). RVD is a common finding in patients with acute PE and normal blood pressure (BP) (29-33). Recent data suggest that patients with objectively confirmed PE, normal BP and echocardiographic evidence of RVD have a high incidence of adverse outcome (7) and may potentially benefit from more aggressive treatment (34-35). In a recent study patients with acute PE were classified according to the presence of RVD and hypotension; the short-term mortality and the incidence of PE-related shock in patients with normal BP and echo RVD was respectively 5% and 10%. None of the patients with normal BP and no RVD died or experienced PE-related shock (6). It has been recently demonstrated in patients with PE and pulmonary hypertension or RVD but without arterial hypotension or shock, that rt-PA significantly reduces the incidence of adverse in-hospital outcome events (death and clinical deterioration) with respect to heparin (8). Consecutive patients with symptomatic PE, since no more than four days, confirmed by objective testing (high probability lung scan or intermediate probability lung scan and objectively confirmed deep vein thrombosis or spiral CT or pulmonary angiography or TE echocardiography) will undergo echocardiographic examination within 24 hour from diagnosis. Patients with RVD and normal BP (Systolic BP> 100 mmHg) will be included in the study. 180 patients will be randomized in the study. The patients included in the study will be randomized, in a double blind fashion, to receive Tenecteplase + UFH (90 patients) or Placebo + UFH (90 patients). Study treatment should be administered within 6 hours from echocardiography. Echocardiography will be repeated at 24 hours and 7 days or discharge (whichever comes first) from Tenecteplase or Placebo injection. A Follow-up visit at 30 days from randomization will include: clinical history, physical examination and ECG and an echocardiographic examination.

Eligibility

Minimum age: 18 Years. Maximum age: 85 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- age between 18 and 85;

- symptomatic PE confirmed by: high probability lung scan, or intermediate probability

lung scan and objectively confirmed deep vein thrombosis, or spiral CT-scan or pulmonary angiography or TE echocardiography;

- normal blood pressure (SBP >100mmHg);

- RVD at echocardiography (see criteria);

- written informed consent.

Exclusion Criteria:

- absence of RVD at echocardiography;

- shock or hypotension (SBP < 100 mmHg);

- therapeutic heparin (UFH or LMWH) treatment for more than 48 hours prior to

randomization;

- administration of thrombolytic agents within the previous 4 days;

- vena cava filter insertion or pulmonary thrombectomy within the previous 4 days

- chronic pulmonary hypertension or severe COPD;

- hypertension defined as blood pressure >180/110 mm Hg (systolic BP >180 mm Hg and/or

diastolic BP >110 mm Hg) on a single, reliable measurement during current admission at enrolling site prior to randomisation;

- use of GP IIb/IIIa antagonists within the preceding 7 days;

- significant bleeding disorders either at present or within the past 6 months;

- active peptic ulceration;

- known diabetic haemorrhagic retinopathy or other haemorrhagic ophthalmic conditions;

- known haemorrhagic diathesis;

- known arterial aneurysm and known arterial/venous malformation;

- known neoplasm with increased bleeding risk;

- prolonged cardiopulmonary resuscitation (>10 minutes) in the previous two weeks;

- current oral anticoagulation;

- major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2

months;

- any known history of stroke or transient ischaemic attack (TIA) or dementia;

- any recent head trauma and any other trauma occurring after onset of the current

pulmonary embolism;

- any known history of central nervous system damage (i. e. neoplasm, aneurysm,

intracranial or spinal surgery);

- known subacute bacterial endocarditis;

- known acute pancreatitis;

- known severe hepatic dysfunction, including hepatic failure, cirrhosis, portal

hypertension

- (oesophageal varices) and active hepatitis;

- pregnancy or lactation or parturition within the previous 30 days;

- women of childbearing potential must have a negative pregnancy test, or use a

medically accepted method of birth control;

- treatment with an investigational drug under another study protocol in the past 7

days;

- previous enrolment in this study;

- known hypersensitivity to Tenecteplase, Alteplase, unfractionated heparin, or to any

of the excipients;

- anticipated or obvious problem with vascular access;

- any other condition that the investigator feels would place the patient at increased

risk if the investigational therapy is initiated;

- inability to follow protocol requirements

Locations and Contacts

Medicina D'Urgenza e Pronto Soccorso - Opsedale Regionale, Ancona 60020, Italy

Divisione di Cardiologia - Azienda Ospedaliera di Venere -Giovanni XXIII, Bari 70012, Italy

Medicina d'Urgenza - Policlinico S. Orsola, Bologna, Italy

U.O. di Cardiologia - Ospedale di Bentivoglio, Bologna 40010, Italy

Reparto di Cardiologia - Casa di Cura Poliambulanza - Congregazione Suore Ancelle della Carità, Brescia 25124, Italy

UTIC - Ospedale Civile di Brescia, Brescia 25100, Italy

Medicina D'Urgenza, Cardiologia - Ospedale Civile "San Sebastiano", Caserta 81100, Italy

Dipartimento di Emergenza Accettazione - Azienda Ospedaliera Universitaria Careggi, Firenze 50100, Italy

Dipartimento di Emegernza e Accetazione (DEA) - Az. Ospedale-Università San Martino di Genova, Genova 16132, Italy

Divisione Medica II - Ospedale Galliera, Genova 16128, Italy

Reparto di Cardiologia - Presidio Ospedaliero Piana di Lucca, Lucca 55100, Italy

Dipartimento Cuore Polmone - Ospedale Carlo Poma, Mantova 46100, Italy

Medicina D'Urgenza - Az. Osped. Ospedale Niguarda "Cà Granda", Milano 20162, Italy

Medicina D'Urgenza - Ospedale Maggiore Policlinico, Milano 20122, Italy

Reparto di Cardiologia - Azienda Ospedaliera Fatebenfratelli Oftalmico, Milano 20121, Italy

Reparto di Pneumologia - Ospedale San Giuseppe, Milano 20123, Italy

Unità Operativa di Cardiologia - Ospedale S Carlo Borromeo, Milano 20153, Italy

Medicina Interna II - Azienda Ospedaliera "Maggiore della Carità" di Novara, Novara 28100, Italy

Department of Internal Medicine - University of Perugia, Perugia 06129, Italy

Malattie Apparato Respiratorio - Ospedale Cisanello, Pisa 56124, Italy

Reparto di Angiologia - Arcispedale Santa Maria Nuova, Reggio Emilia 42100, Italy

Divisione di Cardiologia - Ospedale Civile, Rovigo 45100, Italy

Divisione di Pneumologia - Ospedale S Maria, Terni 05100, Italy

Medicina D'Urgenza - Azienda Ospedaliera S. Giovanni Battista "Le Molinette", Torino 10100, Italy

Medicina D'Urgenza - Ospedale Cattinara, Trieste 34100, Italy

Dipartimento di Cardiologia - Ospedale del Delta, Lagosanto, Ferrara 44023, Italy

Unità Operativa di Cardiologia - Azienda Ospedaliera - Ospedale Civile di Vimercate, Desio, Milano 20033, Italy

Divisione di Cardiologia - Azienda Ospedaliera - Ospedale Civile di Legnano, Legnano, Milano 2025, Italy

Unità Operativa di Cardiologia - Ospedale di Circolo e Fondazione Macchi, Varese, Milano 21100, Italy

Divisione Medica II - Ospedale di Vimercate, Vimercate, Milano 22059, Italy

Additional Information

Starting date: July 2004
Last updated: April 29, 2008

Page last updated: August 23, 2015

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