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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04434807
Registration number
NCT04434807
Ethics application status
Date submitted
13/06/2020
Date registered
17/06/2020
Titles & IDs
Public title
Ultra-Early, Minimally inVAsive intraCerebral Haemorrhage evacUATion Versus Standard trEatment
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Scientific title
Ultra-Early, Minimally inVAsive intraCerebral Haemorrhage evacUATion Versus Standard trEatment (EVACUATE)
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Secondary ID [1]
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MBC2001
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Universal Trial Number (UTN)
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Trial acronym
EVACUATE
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Intra Cerebral Hemorrhage
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Stroke
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Condition category
Condition code
Stroke
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0
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Haemorrhagic
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Neurological
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0
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Other neurological disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Surgery - Minimally invasive hematoma evacuation
Experimental: Minimally invasive hematoma evacuation - Patients randomized to minimally invasive hematoma evacuation will have neurosurgery followed by standard medical therapy in a stroke care unit or intensive care unit, as appropriate to the patients clinical condition.
No intervention: Standard care (medical therapy) - Patients randomized to medical management will receive the standard medical therapies for the treatment of intracerebral hemorrhage in a stroke care unit or intensive care unit, as appropriate to the patients clinical condition, with no planned surgical intervention.
Treatment: Surgery: Minimally invasive hematoma evacuation
Neurosurgery performed via burr hole or minicraniotomy and using the Aurora surgiscope and evacuator (Integra Lifesciences)
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Intervention code [1]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Dichotomized Modified Rankin Scale Score 0-3 vs. 4-6 at 6 months post-onset (Adjusted)
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Assessment method [1]
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Modified Rankin Scale (mRS) 0-3 at 6 months, adjusted for age, baseline GCS, immediate pre-treatment ICH volume and immediate pre-treatment IVH volume.
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Timepoint [1]
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6 months post-stroke
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Secondary outcome [1]
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Dichotomized Modified Rankin Scale Score 0-2 or no change from baseline vs. 3-6 at 6 months post-onset (adjusted)
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Assessment method [1]
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Modified Rankin Scale (mRS) 0-2 or no change from baseline at 6 months, adjusted for age, baseline GCS, immediate pre-treatment ICH volume and immediate pre-treatment IVH volume
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Timepoint [1]
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6 months post-stroke
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Secondary outcome [2]
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Ordinal analysis of Modified Rankin Scale Score at 6 months post-onset (adjusted)
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Assessment method [2]
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Ordinal analysis of Modified Rankin Scale Score (merging mRS 5-6) at 6 months, adjusted for age, baseline GCS, immediate pre-treatment ICH volume and immediate pre-treatment IVH volume
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Timepoint [2]
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6 months post-stroke
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Secondary outcome [3]
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Utility-weighted analysis of Modified Rankin Scale Score at 6 months post-onset (adjusted)
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Assessment method [3]
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Utility-weighted analysis of Modified Rankin Scale Score at 6 months, adjusted for age, baseline GCS, immediate pre-treatment ICH volume and immediate pre-treatment IVH volume
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Timepoint [3]
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6 months post-stroke
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Secondary outcome [4]
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Reduction in hematoma volume at 24 hours >70% or <15mL residual volume (adjusted)
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Assessment method [4]
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Reduction in hematoma volume at 24 hours \>70% or \<15mL residual volume, adjusted for immediate pre-treatment ICH volume
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Timepoint [4]
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24 hours post-randomization
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Secondary outcome [5]
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Proportion of patients with early neurological improvement at 7 days (adjusted)
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Assessment method [5]
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Proportion of patients with =8 point reduction in National Institutes of Health Stroke Scale (NIHSS) score or reaching 0-1 at 7 days (or at discharge if earlier) adjusted for baseline NIHSS and age
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Timepoint [5]
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7 days post-stroke
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Eligibility
Key inclusion criteria
1. Patients with an acute supratentorial intracerebral hemorrhage (ICH) =20mL in volume
2. Age =18 years
3. Surgery can commence within 8 hours of symptom onset (the time the patient was last known to be well) or, in patients with wake-up onset, within 8 hours of the time the patient awoke with symptoms. Patients presenting with small ICH (volume <20mL) with clinical deterioration judged due to ICH hematoma expansion meeting volume criteria may be randomized if surgery can commence within 8 hours of clinical deterioration
4. Moderate neurological deficit (NIHSS=6)
5. Pre-stroke mRS =3 (independent function or requiring only minor domestic assistance and able to manage alone for at least 1 week).
6. CTA or MRA is performed and does not show an underlying vascular lesion
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Brainstem ICH
2. ICH secondary to trauma, where brain injury is judged more likely to be due to the broad effects of trauma rather than the focal ICH.
3. Hereditary or acquired hemorrhagic diathesis or coagulation factor deficiency (in liver disease, INR>1.4).
4. Platelet count <75,000
5. Unreversible heparinization or anticoagulation. If reversing warfarin, INR should be =1.4 before procedure commences. Reversal of heparin by protamine, dabigatran by idarucizumab and rivaroxaban, apixaban and enoxaparin by andexanet (where available) is permitted. Unreversed anticoagulation with a last dose within 48 hours is an exclusion.
6. Recent (<12 hours) parenteral GPIIb/IIIa antagonist.
7. Recent (<1 hour) thrombolysis. If the ICH has occurred between 1 and 12 hours following thrombolysis, cryoprecipitate (1U per 10kg) and tranexamic acid must be administered prior to treatment.
8. Participation in any investigational study in the last 30 days
9. Pregnant women (clinically evident)
10. Co-morbidities or advance care directive preventing general anaesthesia for the procedure.
11. Known terminal illness such that the patients would not be expected to survive a year.
12. Planned withdrawal of care or comfort care measures.
13. Any condition that, in the judgment of the investigator could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
15/11/2020
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/12/2026
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Actual
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Sample size
Target
240
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC
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Recruitment hospital [1]
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John Hunter Hospital - Newcastle
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Recruitment hospital [2]
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Prince of Wales Hospital - Sydney
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Recruitment hospital [3]
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Royal Prince Alfred Hospital - Sydney
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Recruitment hospital [4]
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Westmead Hospital - Sydney
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Recruitment hospital [5]
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Liverpool Hospital - Sydney
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Recruitment hospital [6]
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The Royal Brisbane and Women's Hospital - Brisbane
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Recruitment hospital [7]
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Princess Alexandra Hospital - Brisbane
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Recruitment hospital [8]
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Gold Coast University Hospital - Southport
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Recruitment hospital [9]
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The Royal Adelaide Hospital - Adelaide
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Recruitment hospital [10]
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The Alfred Hospital - Melbourne
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Recruitment hospital [11]
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The Austin Hospital - Melbourne
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Recruitment hospital [12]
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Monash Medical Centre - Melbourne
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Recruitment hospital [13]
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The Royal Melbourne Hospital - Parkville
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Recruitment postcode(s) [1]
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2305 - Newcastle
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Recruitment postcode(s) [2]
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2031 - Sydney
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Recruitment postcode(s) [3]
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2050 - Sydney
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Recruitment postcode(s) [4]
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2145 - Sydney
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Recruitment postcode(s) [5]
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2170 - Sydney
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Recruitment postcode(s) [6]
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4029 - Brisbane
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Recruitment postcode(s) [7]
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4102 - Brisbane
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Recruitment postcode(s) [8]
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4215 - Southport
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Recruitment postcode(s) [9]
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5000 - Adelaide
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Recruitment postcode(s) [10]
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3004 - Melbourne
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Recruitment postcode(s) [11]
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3084 - Melbourne
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Recruitment postcode(s) [12]
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3168 - Melbourne
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Recruitment postcode(s) [13]
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3050 - Parkville
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Melbourne
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
A randomized controlled trial of ultra-early, minimally invasive, hematoma evacuation versus standard care within 8 hours of intracerebral hemorrhage. Patients presenting to the emergency department with stroke due to supratentorial, spontaneous intracerebral hemorrhage \>20mL volume will be assessed to determine their eligibility for randomization into the trial. If the patient gives informed consent they will be randomized 50:50 using central computerized allocation to minimally invasive hematoma evacuation using the Aurora surgiscope and evacuator (Integra Lifesciences) versus standard medical therapy. The trial is prospective, randomized, open-label, blinded endpoint (PROBE) design with seamless phase 2b-3 transition if the intermediate endpoint (successful hematoma evacuation) is met in analysis of the first 52 patients. Adaptive sample size re-estimation (Mehta and Pocock) will be performed when 160 patients have completed 6 month follow-up (minimum sample size 240, maximum sample size 434).
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Trial website
https://clinicaltrials.gov/study/NCT04434807
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Timothy Kleinig
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Address
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Royal Adelaide Hospital/University of Adelaide
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Melbourne Brain Centre at the Royal Melbourne Hospital
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Address
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Country
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Phone
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+61 3 9342 4424
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Anonymized individual patient data will be uploaded to the Virtual Stroke Trials Archive (http://www.virtualtrialsarchives.org/vista/) 2 years after the publication of the primary manuscript. Qualified investigators can access data after submission of a project proposal that has been approved by the VISTA-ICH steering committee.
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When will data be available (start and end dates)?
2 years after the publication of the primary manuscript
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Available to whom?
Qualified investigators can access data after submission of a project proposal that has been approved by the VISTA-ICH steering committee.
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04434807