Clot Dissolving Treatment for Blood Clots in the Lungs

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: NCT00680628
Recruitment Status : Terminated (PI changed institution and impossible to solve problem with contract's sites)
First Posted : May 20, 2008
Results First Posted : August 11, 2014
Last Update Posted : August 11, 2014
Information provided by (Responsible Party):
Jeffrey Kline, Carolinas Healthcare System

May 16, 2008
May 20, 2008
October 29, 2013
August 11, 2014
August 11, 2014
May 2008
May 2012   (Final data collection date for primary outcome measure)
  • Number of Patients With Cardiogenic Shock or Respiratory Failure From Pulmonary Embolism and Number of Patietnts With Major Hemorrhage [ Time Frame: 1,2,3,4, and 5 days ]
  • Number With Functional Cardiopulmonary Limitations Assessed With a Composite Measurement (Six Minute Walk Distance, Right Ventricular Function and Quality of Life Score on the SF-36) [ Time Frame: 90 days ]
  • Number With Recurrent Venous Thromboembolism and/or Severe Post-phlebitic Syndrome [ Time Frame: 90 days ]
  • Evidence of PE-related and Hemorrhage-related serious adverse outcomes [ Time Frame: 1,2,3,4, and 5 days ]
  • Evidence of functional cardiopulmonary limitations and death [ Time Frame: 90 days ]
Complete list of historical versions of study NCT00680628 on Archive Site
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Evidence of recurrent venous thromboembolism and/or severe post-phlebitic syndrome [ Time Frame: 90 days ]
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Clot Dissolving Treatment for Blood Clots in the Lungs
Randomized Trial of Tenecteplase to Treat Severe Submassive Pulmonary Embolism
The purpose of this study is to determine if tenecteplase plus enoxaparin is safe and effective in the treatment of patients with severe submassive pulmonary embolism.
This project is a phase III, six-center, randomized trial of tenecteplase to treat severe submassive (systolic blood pressure >90 mm Hg) pulmonary embolism (PE). "Severe" requires one of the following predictors of a adverse outcome: right ventricular (RV) hypokinesis on echocardiography, hypoxemia (pulse oximetry reading <95%, <1000 feet above sea level), serum troponin I (abnormal at local threshold) or brain natriuretic peptide concentration >90 pg/mL (or NT proBNP >900 pg/mL). Patients from the emergency department or inpatients can be enrolled within 24 hours of a diagnostic positive CT angiography. After informed consent, eligible patients will be randomized to the study or placebo arm. All patients will a receive a 1mg/kg enoxaparin, SQ followed by a syringe prepared in pharmacy containing either a body weight-adjusted dose of tenecteplase or a 0.9% saline placebo, given IV push. Patients will be followed for five days post-treatment for composite acute adverse outcomes: PE-related (death, any ACLS intervention, circulatory shock, respiratory failure, need for vasopressors with organ dysfunction) and hemorrhage-related (intracranial or intraspinal hemorrhage and any other hemorrhage requiring transfusion, surgical or endoscopic intervention or a hemostatic drug). Survivors will return at three months for assessment of a delayed adverse outcomes of death or cardiopulmonary functional limitation (CFL): interval medical care for dyspnea + RV dysfunction or pulmonary hypertension on echo + either a NYHA score ≥3 or a 6 minute walk distance <330 m. Together, the acute and delayed outcomes represent composite serious adverse outcomes (SAOs). We hypothesize an absolute 20% reduction in composite serious adverse outcomes in the study arm compared with the placebo arm. The six hospitals represent geographic diversity: Boston, Charlotte, Chicago, Denver, New Haven, and Springfield, MA. To help maintain balance between sites, the six sites will each enroll a maximum of 40 patients until the sample size of N=200 is reached, which allows the 20% effect size to be tested at α =0.05 and β=0.20 with 15% loss to follow-up. The study will employ an intent-to treat analysis. Secondary endpoints include recurrent venous thromboembolism within three months, scores from two validated quality of life questionnaire (VEINES-QOL and SF-36TM) at three months. Human subject safety include requirement that a study MD verify the presence of all inclusion and absence of exclusions in real-time, a method to allow unblinding to the clinical care team, an independent DSMB that will perform 6 interim analyses and will enforce predefined stopping criteria for either safety or efficacy.
Phase 3
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Pulmonary Embolism
  • Drug: Tenecteplase + Enoxaparin

    Enoxaparin: 1 mg/kg within 12 hours before receiving tenecteplase.Subsequently, patients will receive 1 mg/kg enoxaparin SQ Q12 hours until discontinuation is clinically indicated.

    Tenecteplase:will be administered using a tiered-dosing schedule according to patient weight: <60Kg=30mg; ≥60Kg to <70Kg=35mg; ≥70Kg to <80Kg=40mg; ≥80Kg to <90Kg=45mg; ≥90Kg=50mg

  • Drug: 0.9% Saline + Enoxaparin
    Enoxaparin: 1 mg/kg within 12 hours before receiving saline.
  • Placebo Comparator: 2
    Saline + Enoxaparin
    Intervention: Drug: 0.9% Saline + Enoxaparin
  • Experimental: 1
    Tenecteplase + Enoxaparin
    Intervention: Drug: Tenecteplase + Enoxaparin
Stewart LK, Peitz GW, Nordenholz KE, Courtney DM, Kabrhel C, Jones AE, Rondina MT, Diercks DB, Klinger JR, Kline JA. Contribution of fibrinolysis to the physical component summary of the SF-36 after acute submassive pulmonary embolism. J Thromb Thrombolysis. 2015 Aug;40(2):161-6. doi: 10.1007/s11239-014-1155-5.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
October 2012
May 2012   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Pulmonary vascular imaging positive for PE within the previous 24 hours
  • Ability to provide written informed consent and comply with study assessments for the full duration of the study
  • Age >17 years
  • Evidence of severe PE: RV hypokinesis on echocardiography, abnormal troponin I or T (any non-normal including indeterminate values, using local reference thresholds) or BNP measurement >90 pg/mL or NT proBNP >900 pg/ml (not more than 6 hours prior to CT angiography and not more than 30 hours before enrollment) or a pulse oximetry reading <95% within previous two hours (<93% in Denver).

Exclusion Criteria:

  • Systolic blood pressure < 90 mm Hg at time of informed consent
  • Do not resuscitate or do not intubate order
  • Systemic fibrinolytic treatment within previous 7 days
  • Inability to follow-up at 3 months
  • Documented gastrointestinal bleeding within previous 30 days
  • Active hemorrhage in any of the following sites at the time of enrollment: intraperitoneal, retroperitoneal, pulmonary, uterine, bladder, or nose.
  • Head trauma causing loss of consciousness within previous 7 days
  • Any history of hemorrhagic stroke
  • Ischemic stroke within the past year
  • Prior history of heparin-induced thrombocytopenia
  • History of intraocular hemorrhage
  • Intracranial metastasis
  • Known inherited bleeding disorder, e.g., hemophilia
  • Platelet count < 50,000/uL
  • Prothrombin time with an INR >1.7
  • Chest, abdominal, intracranial or spinal surgery within the previous 14 days
  • Subacute bacterial endocarditis
  • Pregnancy (positive pregnancy test)
  • Prior enrollment in the study
  • Current treatment with fondiparinux, dalteparin, a direct thrombin inhibitor or administration of a glycoprotein inhibitor within the previous 48 hours.
  • Known pericarditis
  • Allergy to heparins,or tenecteplase
  • Elapsed time that would preclude drug or placebo administration within 24 hours after diagnosis
  • Evidence of non-end stage kidney injury (creatinine clearance < 30 ml/min without chronic hemodialysis treatment; chronic hemodialysis-treated patients are eligible)
  • Preexisting end-stage cardiopulmonary disease (heart failure with left ventricular ejection fraction <20%, known severe pulmonary hypertension or other lung disease causing permanent dependence upon oxygen)
  • Any other condition that the investigator believes would pose a significant hazard to the subject
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
United States
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Jeffrey Kline, Carolinas Healthcare System
Jeffrey Kline
Not Provided
Principal Investigator: Jeffrey A Kline, MD Carolinas Medical Center
Carolinas Healthcare System
July 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP