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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/ct2/show/NCT00887328
Registration number
NCT00887328
Ethics application status
Date submitted
22/04/2009
Date registered
23/04/2009
Date last updated
31/08/2018
Titles & IDs
Public title
Extending the Time for Thrombolysis in Emergency Neurological Deficits
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Scientific title
Extending the Time for Thrombolysis in Emergency Neurological Deficits
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Secondary ID [1]
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NTA0901
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Universal Trial Number (UTN)
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Trial acronym
EXTEND
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Stroke
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Condition category
Condition code
Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Tissue Plasminogen Activator (Alteplase)
Treatment: Drugs - Placebo
Experimental: IV tPA - intravenous tissue plasminogen activator
Placebo Comparator: Placebo -
Treatment: Drugs: Tissue Plasminogen Activator (Alteplase)
0.9 mg/kg up to a maximum of 90mg, intravenous, 10% as bolus and the remainder over 1 hour
Treatment: Drugs: Placebo
placebo provided as 50mg lyophilised powder to be reconstituted with sterile water in glass vials indistinguishable from active drug
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Intervention code [1]
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Treatment: Drugs
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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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Modified Rankin Scale (mRS) 0-1
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Assessment method [1]
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Timepoint [1]
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3 months
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Secondary outcome [1]
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Categorical shift in modified Rankin Score (mRS)
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Assessment method [1]
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Timepoint [1]
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3 months
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Secondary outcome [2]
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Change in = 8 NIHSS points or reaching = 1 on this scale
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Assessment method [2]
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0
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Timepoint [2]
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3 months
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Secondary outcome [3]
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Death due to any cause
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Assessment method [3]
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0
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Timepoint [3]
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3 months
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Secondary outcome [4]
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Symptomatic ICH
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Assessment method [4]
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Symptomatic hemorrhage defined by SITS-MOST criteria: type 2 parenchymal hematoma associated with =4 point increase in NIHSS
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Timepoint [4]
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24 hours
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Secondary outcome [5]
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Reperfusion
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Assessment method [5]
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0
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Timepoint [5]
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24 hours
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Secondary outcome [6]
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Recanalisation
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Assessment method [6]
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0
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Timepoint [6]
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24 hours
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Secondary outcome [7]
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Infarct growth
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Assessment method [7]
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Difference in volumetric DWI volume between baseline and 24 hour MRI
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Timepoint [7]
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24 hours
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Secondary outcome [8]
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Recurrent stroke
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Assessment method [8]
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0
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Timepoint [8]
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3 and 12 months
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Secondary outcome [9]
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Depression (Montgomery-Asberg Depression Rating Scale [MADRS])
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Assessment method [9]
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0
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Timepoint [9]
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3 and 12 months
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Secondary outcome [10]
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Quality of life (Stroke Impact Scale)
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Assessment method [10]
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Timepoint [10]
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3 and 12 months
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Eligibility
Key inclusion criteria
1. Patients presenting with hemispheric acute ischaemic stroke
2. Patient, family member or legally responsible person depending on local ethics
requirements has given informed consent
3. Patient's age is =18 years
4. Treatment onset can commence within = 3 - 9 hours after stroke onset according to
registered product information, or within 4.5 - 9 hours according to locally accepted
guidelines*.
(*Guidelines are currently under international review - advisory statement issued by
the Stroke Council, American Heart Association and American Stroke Association)
5. Patients who wake with stroke may be included if neurological and other exclusion
criteria are satisfied. These 'wake up' strokes are defined as having no symptoms at
sleep onset, but stroke symptoms on waking. The time of stroke onset is to be taken as
the mid-point between sleep onset (or last known to be normal) and time of waking. The
maximum time window for randomisation is then 9 hours from the mid-point as described.
6. NIHSS score of = 4 - 26 with clinical signs of hemispheric infarction.
7. Penumbral mismatch - A "hypo-perfusion to core" volume ratio of greater than 1.2 and
an absolute difference greater than 10mL (using a MR or CT Tmax > 6 second delay)
between perfusion lesion and MR-DWI or CT-CBF core lesion.
8. An ischaemic core lesion volume of less than or equal to 70 ml using MR-DWI or CT-CBF
** Patients may be consented before or after penumbral screening depending upon local
practice. The entire cohort of patients consented onto the study will be followed up
with clinical assessments and biomarker studies regardless of eligibility for
randomisation to treatment based on penumbral mismatch criteria
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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. Intracranial haemorrhage (ICH) identified by CT or MRI
2. Rapidly improving symptoms, particularly if in the judgment of the managing clinician
that the improvement is likely to result in the patient having an NIHSS score of < 4
at randomization
3. Pre-stroke MRS score of = 2 (indicating previous disability)
4. Contra indication to imaging with MR with contrast agents
5. Infarct core >1/3 MCA territory qualitatively
6. Participation in any investigational study in the previous 30 days
7. Any terminal illness such that patient would not be expected to survive more than 1
year
8. Any condition that could impose hazards to the patient if study therapy is initiated
or affect the participation of the patient in the study (this applies to patients with
severe microangiopathy such as haemolytic uremic syndrome or thrombotic
thrombocytopenic purpura). The judgment is left to the discretion of the Investigator.
9. Pregnant women (clinically evident)
10. Previous stroke within last three months
11. Recent past history or clinical presentation of ICH, subarachnoid haemorrhage (SAH),
arterio-venous (AV) malformation, aneurysm, or cerebral neoplasm. At the discretion of
each Investigator.
12. Current use of oral anticoagulants or a prolonged prothrombin time (INR > 1.7) if the
patient is on warfarin
13. Use of heparin, except for low dose subcutaneous heparin, in the previous 48 hours and
an activated prolonged partial thromboplastin time exceeding the upper limit of the
local laboratory normal range.
14. Use of glycoprotein IIb - IIIa inhibitors within the past 72 hours. Use of single or
dual agent oral platelet inhibitors (clopidogrel and/or low-dose aspirin) prior to
study entry is permitted.
15. Clinically significant hypoglycaemia.
16. Uncontrolled hypertension defined by a blood pressure > 185 mmHg systolic or >110 mmHg
diastolic on at least 2 separate occasions at least 10 minutes apart, or requiring
aggressive treatment to reduce the blood pressure to within these limits. The
definition of "aggressive treatment" is left to the discretion of the responsible
Investigator.
17. Hereditary or acquired haemorrhagic diathesis
18. Gastrointestinal or urinary bleeding within the preceding 21 days
19. Major surgery within the preceding 14 days which poses risk in the opinion of the
investigator.
20. Exposure to a thrombolytic agent within the previous 72 hours
21. Clinically deemed eligible for Endovascular Clot Retrieval (ECR) treatment by the
treating team
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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 receiving the treatment/s
The people administering the treatment/s
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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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
1/06/2010
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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
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Actual
27/08/2018
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Sample size
Target
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Accrual to date
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Final
180
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC,WA
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Recruitment hospital [1]
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Gosford Hospital - Kanwal
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Recruitment hospital [2]
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John Hunter Hospital - Newcastle
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Recruitment hospital [3]
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Royal North Shore Hospital - St. Leonards
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Recruitment hospital [4]
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St. Vincent's Hospital - Sydney
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Recruitment hospital [5]
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Westmead Hospital - Westmead
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Recruitment hospital [6]
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Royal Brisbane & Women's Hospital - Brisbane
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Recruitment hospital [7]
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Gold Coast University Hospital - Gold Coast
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Recruitment hospital [8]
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Sunshine Coast University Hospital - Nambour
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Recruitment hospital [9]
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Royal Adelaide Hospital - Adelaide
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Recruitment hospital [10]
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Flinders Medical Centre - Bedford Park
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Recruitment hospital [11]
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Lyell McEwin Hospital - Elizabeth Vale
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Recruitment hospital [12]
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Box Hill Hospital - Box Hill
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Recruitment hospital [13]
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Monash Medical Centre - Clayton
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Recruitment hospital [14]
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Western Hospital - Footscray
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Recruitment hospital [15]
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Geelong Hospital - Geelong
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Recruitment hospital [16]
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Austin Hospital - Heidelberg
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Recruitment hospital [17]
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Royal Melbourne Hospital - Melbourne
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Recruitment hospital [18]
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Epworth Healthcare - Richmond
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Recruitment hospital [19]
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Sir Charles Gairdner Hospital - Nedlands
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Recruitment hospital [20]
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Royal Perth Hospital - Perth
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Recruitment postcode(s) [1]
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2259 - Kanwal
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Recruitment postcode(s) [2]
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- Newcastle
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Recruitment postcode(s) [3]
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2065 - St. Leonards
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Recruitment postcode(s) [4]
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6009 - Sydney
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Recruitment postcode(s) [5]
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2145 - Westmead
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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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- Gold Coast
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Recruitment postcode(s) [8]
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4560 - Nambour
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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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5042 - Bedford Park
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Recruitment postcode(s) [11]
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5112 - Elizabeth Vale
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Recruitment postcode(s) [12]
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3128 - Box Hill
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Recruitment postcode(s) [13]
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3168 - Clayton
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Recruitment postcode(s) [14]
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3011 - Footscray
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Recruitment postcode(s) [15]
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3220 - Geelong
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Recruitment postcode(s) [16]
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- Heidelberg
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Recruitment postcode(s) [17]
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3050 - Melbourne
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Recruitment postcode(s) [18]
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3121 - Richmond
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Recruitment postcode(s) [19]
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6009 - Nedlands
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Recruitment postcode(s) [20]
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6000 - Perth
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Recruitment outside Australia
Country [1]
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Finland
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State/province [1]
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Helsinki
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Country [2]
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New Zealand
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State/province [2]
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Auckland
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Funding & Sponsors
Primary sponsor type
Other
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Name
Neuroscience Trials Australia
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Commonwealth Scientific and Industrial Research Organisation, Australia
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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University of Melbourne
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Address [2]
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Country [2]
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Other collaborator category [3]
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Other
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Name [3]
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Melbourne Health
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Address [3]
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Country [3]
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Other collaborator category [4]
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Other
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Name [4]
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The Florey Institute of Neuroscience and Mental Health
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Address [4]
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Country [4]
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Ethics approval
Ethics application status
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Summary
Brief summary
The primary hypothesis being tested in this trial is that ischaemic stroke patients selected
with significant penumbral mismatch (measured by MRI criteria) at 3 - 9 hours post onset of
stroke will have improved clinical outcomes when given intravenous tissue plasminogen
activator (tPA) compared to placebo.
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Trial website
https://clinicaltrials.gov/ct2/show/NCT00887328
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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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Geoffrey Donnan, MD FRACP
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Address
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The Florey Institute of Neuroscence and Mental Health
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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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Address
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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 scientific queries
Summary Results
For IPD and results data, please see
https://clinicaltrials.gov/ct2/show/NCT00887328
Download to PDF