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The multiarm optimization of stroke thrombolysis phase 3 acute stroke randomized clinical trial: Rationale and methods.

  • Deeds, S Iris1
  • Barreto, Andrew2
  • Elm, Jordan3
  • Derdeyn, Colin P4
  • Berry, Scott5
  • Khatri, Pooja6
  • Moy, Claudia7
  • Janis, Scott7
  • Broderick, Joseph6, 8
  • Grotta, James9
  • Adeoye, Opeolu1
  • 1 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
  • 2 Department of Neurology, University of Texas Health Science Center, Houston, TX, USA.
  • 3 Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
  • 4 Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
  • 5 Berry Consultants, LLC., Austin, TX, USA.
  • 6 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, USA.
  • 7 35046National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
  • 8 UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, OH, USA.
  • 9 Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA.
Published Article
International Journal of Stroke
SAGE Publications
Publication Date
Oct 01, 2021
DOI: 10.1177/1747493020978345
PMID: 33297893


Intravenous recombinant tissue plasminogen activator is the only proven effective medication for the treatment of acute ischemic stroke. Two approaches that may augment recombinant tissue plasminogen activator thrombolysis and prevent arterial reocclusion are direct thrombin inhibition with argatroban and inhibition of the glycoprotein 2b/3a receptor with eptifibatide. The multi-arm optimization of stroke thrombolysis trial aims to determine the safety and efficacy of intravenous therapy with argatroban or eptifibatide as compared with placebo in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator within 3 h of symptom onset. A maximum of 1200 randomized subjects to test the superiority of argatroban or eptifibatide to placebo in improving 90-day modified Rankin scores. Multiarm optimization of stroke thrombolysis is a multicenter, multiarm, adaptive, single blind, randomized controlled phase 3 clinical trial conducted within the National Institutes of Health StrokeNet clinical trial network. Patients treated with 0.9 mg/kg intravenous recombinant tissue plasminogen activator within 3 h of stroke symptom onset are randomized to receive intravenous argatroban (100 µg/kg bolus followed by 3 µg/kg/min for 12 h), intravenous eptifibatide (135 µg/kg bolus followed by 0.75 µg/kg/min infusion for 2 h) or IV placebo. Patients may receive endovascular thrombectomy per usual care. The primary efficacy outcome is improved modified Rankin score assessed at 90 days post-randomization. Multiarm optimization of stroke thrombolysis is an innovative and collaborative project that is the culmination of many years of dedicated efforts to improve outcomes for stroke patients.

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