Low Dose Rt-PA for Acute Normotensive Pulmonary Embolism With RVD

NCT ID: NCT01531829

Last Updated: 2012-02-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

460 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-07-31

Study Completion Date

2012-12-31

Brief Summary

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In selected patients with acute pulmonary embolism(PE), low dose (50mg/2h) recombinant tissue plasminogen activator (rt-PA) regimen had been reported to have less bleeding tendency than the FDA-approved rt-PA 100mg/2h regimen 100mg/2h regimen (3% vs.10%), it is worthwhile to reveal whether low dose rt-PA plus low molecular weight heparin (LMWH) can rapidly reverses RV pressure overload in PE, but not increase bleeding and other adverse events. The aim of the study is to compare thrombolytic treatment with LMWH in patients with acute normotensive PE with right ventricular dysfunction(RVD).

Detailed Description

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In acute pulmonary embolism (PE), normotensive patients with acute RV dysfunction on echocardiography or computed tomography and with myocardial troponin elevation may have an adverse outcome. Thrombolysis rapidly reverses RV pressure overload in PE, but it increases the possibility of bleeding and it remains unclear whether it may improve the early or long-term clinical outcome of these selected normotensive patients.

In our previous study, we found that low dose (50mg/2h) recombinant tissue plasminogen activator (rt-PA) regimen had less bleeding tendency than the 100mg/2h regimen (3% vs.10%), it is worthwhile to reveal whether low dose rt-PA plus Low Molecular Weight Heparin (LMWH) can rapidly reverses RV pressure overload in PE, but not increase bleeding and other adverse events.

In this prospective, multicenter, randomized, control study, we compare low dose rt-PA plus LMWH vs. LMWH alone in acute normotensive pulmonary embolism patients with RV dysfunction. The primary efficacy outcome is the composite of death from any cause or treatment failure, improvements of right ventricular functions on echocardiogram and pulmonary artery obstruction on CT angiographs within 7 days of randomization. Second efficacy outcome is the recurrence of pulmonary embolism and deep venous thrombosis. Safety outcomes include serious life threatening bleeding such as cerebral hemorrhage and other major bleeding episodes, also include mild bleeding. In addition, 90-day clinical and echocardiographic follow-up will be performed, the recurrence of pulmonary embolism and deep venous thrombosis will be recorded. The study is expected to enroll approximately 460 patients.

By determining the benefits vs risks of Low dose rt-PA plus LMWH compared with LMWH alone for the treatment in submassive or intermediate-risk PE, this trial is expected to reveal the worth of Low dose rt-PA plus LMWH treatment and what kind of PE patients are suitable for thrombolysis.

Conditions

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Pulmonary Thromboembolisms Pulmonary Embolism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Low dose (50mg/2h) rt-PA plus LMWH

Low dose (50mg/2h) recombinant tissue plasminogen activator (rt-PA) plus low molecular weight heparin(LMWH)regimen

Group Type EXPERIMENTAL

Recombinant tissue plasminogen activator (rt-PA)

Intervention Type DRUG

Low dose (50mg/2h) rt-PA plus LMWH

LMWH

Low molecular weight heparin

Group Type ACTIVE_COMPARATOR

Low Molecular Weight Heparin

Intervention Type DRUG

0.1ml/10kg,q12h,5-7 days

Interventions

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Recombinant tissue plasminogen activator (rt-PA)

Low dose (50mg/2h) rt-PA plus LMWH

Intervention Type DRUG

Low Molecular Weight Heparin

0.1ml/10kg,q12h,5-7 days

Intervention Type DRUG

Other Intervention Names

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rt-PA Nadroparin

Eligibility Criteria

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Inclusion Criteria

1. 18 y≤Age≤75y
2. Acute PE (first symptoms occurred 14 d or less before randomization) confirmed by lung scan, or a positive computed tomographic pulmonary angiogram, or a positive selective pulmonary angiogram
3. Hemodynamic stability, diastolic pressure\>90mmHg.
4. RV dysfunction confirmed by echocardiography (≥1 criterion), except left-side heart disease, congenital heart disease and mitral valve disease.

* Increase of the right ventricle showed presented with RV end-diastolic anteroposterior diameter \>25 mm, Right/left ventricular end-diastolic diameter \>1 (apical or subcostal 4-chamber view) or Right/left ventricular end-diastolic anteroposterior diameter \>0.5
* Hypokinesis of RV-free wall (range of motion less than 5 mm)
* Tricuspid regurgitation pressure \>30mmHg

Exclusion Criteria

1. RV anterior wall thickness \> 5mm confirmed by echocardiography
2. Active internal bleeding and spontaneous intracranial hemorrhage in preceding 6 months
3. Major surgery, organ biopsy or non-compressible punctures within 2 weeks
4. Ischemic stroke occurred within 2 months
5. Gastrointestinal bleeding within 10 days
6. Severe trauma occurred within15 days
7. Neurosurgery or eye surgery within 1 months
8. Severe hypertension difficult to control (systolic blood pressure\>180mmHg or diastolic blood pressure\>110mmHg)
9. Cardiopulmonary resuscitation
10. Platelet count less than 100×109 / L
11. Pregnancy, or within 2 week post partum
12. Infective endocarditis; left atrial thrombus; aneurysm
13. Serious liver and kidney dysfunction
14. Diabetic hemorrhagic retinopathy
15. Suffering with bleeding disorders
16. Chronic thromboembolic pulmonary hypertension
17. Moderate to severe chronic obstructive pulmonary disease (COPD).
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ministry of Science and Technology of the People´s Republic of China

OTHER_GOV

Sponsor Role collaborator

Beijing Chao Yang Hospital

OTHER

Sponsor Role lead

Responsible Party

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Chen WANG

Professor of respiratory and critical care medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Chen Wang, PhD,MD

Role: PRINCIPAL_INVESTIGATOR

Beijing Chao Yang Hospital

Locations

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Beijing Chao Yang Hospial

Beijing, Beijing Municipality, China

Site Status RECRUITING

Beijing Daxing People's Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

Beijing Fuwai Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

Beijing Hospital, Ministry of Health

Beijing, Beijing Municipality, China

Site Status NOT_YET_RECRUITING

The First Affiliated Hospital of Zhongshan University in Guangzhou

Guangzhou, Guangdong, China

Site Status RECRUITING

The Third Affiliated Hospital of Zhongshan University in Guangzhou

Guangzhou, Guangdong, China

Site Status RECRUITING

The Guangxi Zhuang Autonomous Region people's Hospital

Nanning, Guangxi, China

Site Status RECRUITING

Guangzhou Shenzhen People's Hospital

Shenzhen, Guangzhou, China

Site Status RECRUITING

Affiliated Hospital of Chengde Medical College

Chengde, Hebei, China

Site Status RECRUITING

The first hospital of Handan city Hebei Province

Handan, Hebei, China

Site Status RECRUITING

Hebei Hengshui international Heping Hospital

Hengshui, Hebei, China

Site Status RECRUITING

Hebei Affiliated Hospital of North China Coal Medical University

Shijiazhuang, Hebei, China

Site Status RECRUITING

Hebei Medical University Second Hospital

Shijiazhuang, Hebei, China

Site Status RECRUITING

No.2 Affiliated Hospital of Harbin Medical University

Harbin, Heilongjiang, China

Site Status RECRUITING

The Third Affiliated Hospital of Inner Mongolia Medical College

Baotou, Inner Mongolia, China

Site Status RECRUITING

Hospital of Inner Mongolia Autonomous Region

Hohhot, Inner Mongolia, China

Site Status RECRUITING

Anshan Iron and Steel Company General Hospital

Anshan, Liaoning, China

Site Status RECRUITING

The first hospital of Dalian Medical University

Dalian, Liaoning, China

Site Status RECRUITING

Liaoning General Hospital of Shenyang Military Region

Shenyang, Liaoning, China

Site Status RECRUITING

Shenyang Medical College affiliated Fengtian Hospital

Shenyang, Liaoning, China

Site Status RECRUITING

Affiliated Hospital of Ningxia Medical University

Yinchuan, Ningxia, China

Site Status RECRUITING

The Fourth Military Medical University, Xijing Hospital

Xi'an, Shan'xi, China

Site Status RECRUITING

Shandong Jining Medical University Affiliated Hospital

Jining, Shandong, China

Site Status RECRUITING

Shandong Medical College Affiliated Hospital of Qiingdao University

Qingdao, Shandong, China

Site Status RECRUITING

Shandong Yantai city Yantai Mountain hospital

Yantai, Shandong, China

Site Status RECRUITING

Ruijin Hospital Affiliated to Shanghai Jiao Tong University

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Second Military Medical University Changhai Hospital

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Zhongshan Hospital Affiliated to Shanghai Fudan University

Shanghai, Shanghai Municipality, China

Site Status RECRUITING

Shanxi Medical University Second Hospital

Taiyuan, Shanxi, China

Site Status RECRUITING

The first hospital of Shanxi Medical University

Taiyuan, Shanxi, China

Site Status RECRUITING

Sichuan University, West China Hospital

Chengdu, Sichuan, China

Site Status RECRUITING

The first hospital of Xinjiang Medical University

Ürümqi, Xinjiang, China

Site Status RECRUITING

The Xinjiang Uygur Autonomous Region people's Hospital

Ürümqi, Xinjiang, China

Site Status RECRUITING

Zhejiang Sir Run Run Shaw Hospital

Hangzhou, Zhejiang, China

Site Status RECRUITING

The First Affiliated Hospital of Wenzhou Medical College in Zhejiang

Wenzhou, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Chen Wang, PhD,MD

Role: CONTACT

8610-85231893

Tuguang Kuang, PhD,MD

Role: CONTACT

8610-85231451

Facility Contacts

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Yuanhua Yang, PhD,MD

Role: primary

8610-65060167

Yongxiang Zhang, MD

Role: primary

Zhihong Liu, MD

Role: primary

Baomin Fang, MD

Role: primary

Mian Zeng, MD

Role: primary

yulin Zhou, MD

Role: primary

shengze Long, MD

Role: primary

Chen Qiu, MD

Role: primary

Guifang Pang, MD

Role: primary

Jinghui Ye, MD

Role: primary

Zhaobo Cui, MD

Role: primary

Baibing Liu, MD

Role: primary

Yadong Yuan, MD

Role: primary

Hong Chen, MD

Role: primary

Ling Wang, MD

Role: primary

Weilie Wang, MD

Role: primary

Hongyu Zhou, MD

Role: primary

Yingqun Ji, MD

Role: primary

Liang Shi, MD

Role: primary

Shuyue Xia, MD

Role: primary

Zheng Yang, MD

Role: primary

Shengqing Li, PhD, MD

Role: primary

Luning Jiang, MD

Role: primary

Li Tong, MD

Role: primary

Lijun Kang, MD

Role: primary

Guochao Shi, MD

Role: primary

Wei Zhang, MD

Role: primary

Jinjun Jiang, MD

Role: primary

Xu Wang, MD

Role: primary

Xiaoyun Hu, MD

Role: primary

Qun Yi, MD

Role: primary

Zaiyi Wang, MD

Role: primary

Ying Chen, MD

Role: primary

Guofeng Ma, MD

Role: primary

Yupeng Xie, MD

Role: primary

Other Identifiers

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BJCYH1893

Identifier Type: -

Identifier Source: org_study_id

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