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Tenecteplase Pulmonary Embolism Italian Study

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00222651
Recruitment Status : Terminated (competitor study about to start)
First Posted : September 22, 2005
Last Update Posted : May 6, 2008
Information provided by:
University Of Perugia

Brief 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)

Condition or disease Intervention/treatment Phase
Pulmonary Embolism Drug: tenecteplase Phase 2

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.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
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 Start Date : July 2004
Estimated Study Completion Date : July 2006

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Clinically relevant reduction of RVD [ Time Frame: 24 hours from Tenecteplase or Placebo injection ]

Secondary Outcome Measures :
  1. Clinically relevant reduction of RVD; Clinical deterioration requiring escalation of treatment [ Time Frame: 7 days from Tenecteplase or Placebo ]
  2. PE recurrence [ Time Frame: 30 days ]
  3. Death [ Time Frame: 30 days ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00222651

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Sponsors and Collaborators
University Of Perugia
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Study Chair: Giancarlo Agnelli, MD Department of Internal Medicine - University of Perugia
Study Director: Cecilia Becattini, MD Department of Internal Medicine - University of Perugia
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Department of Internal Medicine, University of Perugia Identifier: NCT00222651    
Other Study ID Numbers: CRU-UniPg-01-02
First Posted: September 22, 2005    Key Record Dates
Last Update Posted: May 6, 2008
Last Verified: April 2008
Keywords provided by University Of Perugia:
pulmonary embolism
right ventricular dysfunction
Additional relevant MeSH terms:
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Pulmonary Embolism
Ventricular Dysfunction
Embolism and Thrombosis
Vascular Diseases
Cardiovascular Diseases
Lung Diseases
Respiratory Tract Diseases
Heart Diseases
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action