Now Available: Final Rule for FDAAA 801 and NIH Policy on Clinical Trial Reporting

Activated Protein C in Acute Stroke Trial (APCAST)

This study has been terminated.
(Lack of recruitment)
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
Curtis Benesch, University of Rochester Identifier:
First received: September 19, 2007
Last updated: September 1, 2016
Last verified: September 2016
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
Drug: Activated Protein C
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Activated Protein C in Acute Stroke Trial

Resource links provided by NLM:

Further study details as provided by University of Rochester:

Primary Outcome Measures:
  • Number of Participants With Intracranial Hemorrhage [ Time Frame: Measured within 36-48 hours of treatment ] [ Designated as safety issue: Yes ]

    Intracranial Hemorrhage (ICH):

    Fatal ICH: Death ascribed to ICH confirmed by autopsy or CT imaging. Major non-fatal ICH: Hemorrhage within brain parenchyma associated with neurological deterioration or evidence of subdural, epidural or intraventricular hemorrhage on CT imaging, with or without symptoms.

    Symptomatic ICH: Hemorrhage within the territory of qualifying infarction with neurological deterioration as measured by > 2 point increase in the National Institutes of Health Stroke Scale (NIHSS) from previous examination; hemorrhage in different vascular territory associated with new neurologic deficit. All symptomatic ICH will be defined as a major ICH.

    Asymptomatic ICH: Presence of hemorrhage within the territory of qualifying infarction without neurological deterioration ascribed to the hemorrhage or presence of hemorrhage within brain parenchyma outside the territory of qualifying infarction without new neurologic deficit (would not be considered a major ICH)

Secondary Outcome Measures:
  • Mean Modified Rankin Scale Score [ Time Frame: 90 days ] [ Designated as safety issue: No ]

    Measure of disability as determined by categorical assignment on modified Rankin Scale.. The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability.

    The scale runs from 0-6, running from perfect health without symptoms to death.

    0 - No symptoms.

    1. - No significant disability. Able to carry out all usual activities, despite some symptoms.
    2. - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.
    3. - Moderate disability. Requires some help, but able to walk unassisted.
    4. - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted.
    5. - Severe disability. Requires constant nursing care and attention, bedridden, incontinent.
    6. - Dead.

  • Mean Barthel Index Score [ Time Frame: 90 days ] [ Designated as safety issue: No ]

    Measure of functional recovery using Barthel Index (range 0-100). The Barthel scale or Barthel ADL index is an ordinal scale used to measure performance in activities of daily living (ADL). Each performance item is rated on this scale with a given number of points assigned to each level or ranking. It uses ten variables describing ADL and mobility with 10 points given to each variable for a total of 100 points. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital. The ten variables addressed in the Barthel scale are:

    presence or absence of fecal incontinence presence or absence of urinary incontinence help needed with grooming help needed with toilet use help needed with feeding help needed with transfers (e.g. from chair to bed) help needed with walking help needed with dressing help needed with climbing stairs and help needed with bathing

  • National Institutes of Health Stroke Scale (NIHSS) [ Time Frame: 90 days ] [ Designated as safety issue: No ]

    The NIHSS is a measure of neurologic deficit on a scale of 0-42, with 0 being normal. The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0. The 11 items are:

    Level of Consciousness Horizontal Eye Movement Visual field test Facial Palsy Motor Arm Motor Leg Limb Ataxia Sensory Language Speech Extinction and Inattention

Enrollment: 12
Study Start Date: September 2007
Study Completion Date: October 2010
Primary Completion Date: October 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Tier One
Participants will receive APC by intravenous injection, receiving 50% of dose as a bolus and the remainder as an infusion over one ho.
Drug: Activated Protein C
Intravenous APC (10, 15, 22, 33, 50, and 75 mcg/kg) administered to patients with acute ischemic stroke within 0 - 9 hours of symptom onset
Other Name: Xigris

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.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

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 0-9 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
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00533546

United States, California
University of California Irvine Medical Center
Orange, California, United States, 92868
United States, Illinois
Loyola University Medical Center
Maywood, Illinois, United States, 60153
United States, Missouri
Washington University--Barnes-Jewish Hospital
St. Louis, Missouri, United States, 63110
United States, New York
SUNY Downstate
Brooklyn, New York, United States, 11203
Maimonides Medical Center
Brooklyn, New York, United States, 11219
Mt. Sinai School of Medicine
New York, New York, United States, 10029
Rochester General Hospital
Rochester, New York, United States, 14621
University of Rochester
Rochester, New York, United States, 14642
United States, South Carolina
Palmetto Health Richland
Columbia, South Carolina, United States, 29203
Sponsors and Collaborators
University of Rochester
National Heart, Lung, and Blood Institute (NHLBI)
Study Chair: Curtis Benesch, MD, MPH University of Rochester
  More Information

Responsible Party: Curtis Benesch, Associate Professor of Neurology, University of Rochester Identifier: NCT00533546     History of Changes
Other Study ID Numbers: 537  5R01HL080107  5R01HL080107-05 
Study First Received: September 19, 2007
Results First Received: October 16, 2015
Last Updated: September 1, 2016
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Rochester:
Acute Ischemic Stroke

Additional relevant MeSH terms:
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Protein C
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action processed this record on October 26, 2016