Dabigatran Treatment Following Transient Ischemic Attack and Minor Stroke (DATAS)

Study Description

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Brief Summary:

Objective: Demonstrate the safety of early use of dabigatran following TIA/minor stroke.

Background: Although aggressive antithrombotic therapy has been shown to reduce the number of new ischemic events following stroke/TIA, this has always been offset by an increase in the risk of hemorrhagic transformation. Dabigatran is much safer than previously tested antithrombotic agents, with respect to intracranial bleeding and therefore offers a unique treatment opportunity in these high-risk patients. TIA/minor stroke represent the largest group of cerebrovascular disease patients. A short-term intervention such as 30 days of dabigatran treatment has the potential for a very large impact from the population health perspective, given the number of patients who may be treated if a benefit can be demonstrated.

Study design:

This is an open label, single arm study. Patients with TIA/minor stroke (National Institutes of Health Stroke Scale (NIHSS) score </=3) who can be treated within 24 hours of symptom onset will be eligible. All patients will be treated with dabigatran for 30 days. The dose of dabigatran will be determined by age and renal function (patients >80 years old and/or with GFR 30-50 ml/min will received 110 mg bid, and all other patients will receive 150 mg BID).The primary endpoint is symptomatic hemorrhagic transformation. Patients (n=50) with TIA/minor stroke, defined as having a National Institutes of Health Stroke Scale Score of </=3, will undergo an MRI, including diffusion-weighted imaging (DWI), as well as gradient recall echo (GRE) sequences, which will be used to assess for hemorrhagic transformation. Patients will have a repeat MRI examination at 7 and 30 days to assess for hemorrhagic transformation and new lesion development. The primary endpoint of of phase I is symptomatic hemorrhagic transformation, defined as a parenchymal hematoma on the day 7 MRI scan (GRE sequence), associated with clinical worsening (>/=4 point increase in National Institutes of Health Stroke Scale (NIHSS) score).

If dabigatran can be used safely in this population, a second phase aimed at demonstrating the rate of new ischemic lesion development following TIA can be reduced with aggressive antithrombotic therapy. A randomized open-label, blinded endpoint evaluation design will be employed. The investigators hypothesize that dabigatran therapy administered within 24 hours of symptom onset will reduce the rate of new ischemic lesions, relative to standard care, one week and 30 days after onset.

Condition or disease	Intervention/treatment	Phase
Transient Ischemic Attack; Minor Ischemic Stroke	Drug: Dabigatran 110/150 mg BID	Phase 2

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Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	53 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Dabigatran Treatment Following Transient Ischemic Attack and Minor Stroke
Study Start Date :	February 2012
Actual Primary Completion Date :	May 2014
Actual Study Completion Date :	May 2014

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Dabigatran	Drug: Dabigatran 110/150 mg BID; Dabigatran will be taken bid for 30 days post enrolment. The dose of dabigatran will be based on patient age and renal function.; Other Name: Pradax (Canada)/ Pradaxa (USA and rest of world)

Outcome Measures

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Primary Outcome Measures :

1. Symptomatic Hemorrhagic Transformation [ Time Frame: 30 days post-treatment ]
   The primary endpoint of phase I is the cumulative incidence of symptomatic hemorrhagic transformation, defined as a parenchymal hematoma on the day 7 and day 30 MRI scans (GRE sequence), associated with clinical worsening (≥4 point increase in National Institutes of Health Stroke Scale (NIHSS) score).

Eligibility Criteria

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

Criteria

Inclusion Criteria:

• All patients included in the study will have TIA or minor stroke (defined as NIHSS score </= 3).
• Patients must be treated within 24 hours of symptom onset. In cases where onset time cannot be established, it will be considered to be the time when the patient was last known to be well.
• All patients will be 18 years or older.
• All patients will have an MRI, with evidence of at least one DWI lesion, consistent with ischemia, prior to randomization.

Exclusion Criteria:

• Patients with stroke mimics (such as seizures, migraine etc.) will be excluded from the study.
• Patients with contraindications to MRI will also be excluded, including metallic implants.
• Patients with any past sensitivity to gadolinium contrast media will be eligible, but will not undergo PWI.
• Patients with renal failure, defined as Glomerular Filtration Rate (GFR) <30 ml/min, will be excluded as well.
• 93 Patients deemed to have any ongoing bleeding risks or unsuitable for dabigatran therapy by the attending stroke clinician will be ineligible.
• Patients in whom the MRI demonstrates additional pathology including arteriovenous malformations, intracranial aneurysms, tumours, or abscess will be excluded.

Additional Exclusion Criteria:

• Age <18 years
• Planned thrombolysis or endovascular intervention for the index event
• Thrombolysis for ischemic stroke within preceding 7 days
• Planned carotid endarterectomy/carotid artery stent within 30 days
• Any history of spontaneous intracranial bleeding
• Clear indication for anticoagulation, including atrial fibrillation, mechanical cardiac valves, deep venous thrombosis, pulmonary embolism or known hypercoagulable state
• Co-morbid illness with expected life expectancy of <30 days

Contacts and Locations

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Locations

Canada, Alberta
University of Alberta
Edmonton, Alberta, Canada, T6G2B7

Sponsors and Collaborators

University of Alberta

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Kate M, Gioia L, Buck B, Sivakumar L, Jeerakathil T, Shuaib A, Butcher K. Dabigatran Therapy in Acute Ischemic Stroke Patients Without Atrial Fibrillation. Stroke. 2015 Sep;46(9):2685-7. doi: 10.1161/STROKEAHA.115.010383. Epub 2015 Jul 30.

Responsible Party:	Ken Butcher, Associate Professor, University of Alberta
ClinicalTrials.gov Identifier:	NCT01769703 History of Changes
Other Study ID Numbers:	DATAS
First Posted:	January 17, 2013
Last Update Posted:	October 30, 2014
Last Verified:	October 2014

Additional relevant MeSH terms:

Ischemia; Ischemic Attack, Transient; Brain Ischemia; Stroke; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases	Cardiovascular Diseases; Pathologic Processes; Dabigatran; Antithrombins; Serine Proteinase Inhibitors; Protease Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Anticoagulants