Arterial Occlusive Diseases
Conditions
Keywords
PAO, acute peripheral arterial occlusion, thrombolysis, blood clot, leg attack, alfimeprase, thrombus, embolism, thromboembolism, claudication, thrombolytic, thrombosis, plasminogen activator, arterial flow
Brief summary
The purpose of this study is to directly compare the safety and efficacy of intra-thrombus alfimeprase 0.3 mg/kg with placebo in acute peripheral arterial occlusion (PAO) as measured by a 30 day open vascular free surgery rate.
Detailed description
There is an unmet medical need to improve thrombolytic therapy in acute peripheral arterial occlusion (PAO). Currently used plasminogen activators can result in increased circulating levels of plasmin that result in a systemic lytic state that does not distinguish between physiologic and pathologic thrombosis. In general, mean plasminogen activator infusion durations of greater than 24 hours in order to achieve successful thrombolysis are problematic in a disease where delayed restoration of arterial flow can lead to irreversible ischemic damage. A direct thrombolytic agent like alfimeprase, with a rapid mechanism of action and a potentially safer bleeding risk profile, could facilitate a rapid restoration of arterial flow and avoidance of open vascular surgery.
Interventions
DRUGalfimeprase
Sponsors
ARCA Biopharma, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Must give written informed consent * Ages 18 or older * Acute PAO of a lower extremity with onset of symptoms within 14 days prior to randomization * Acute index limb ischemia classified as SVS/ISCVS Class I or IIA caused by occlusion of a native artery and/or bypass graft (vein or prosthetic) * Need for open vascular surgical intervention in the event of unsuccessful thrombolysis * Available for follow-up assessments
Exclusion criteria
* Contraindication to systemic anticoagulation * History of endovascular procedure or open vascular surgery on the index limb within the last 30 days * History of significant acute or chronic kidney disease that would preclude contrast angiography * Known allergy to contrast agents * History of heparin-induced thrombocytopenia (HIT) * Participation in any study of an investigational device, medication, biologic, or other agent within 30 days prior to randomization * Any thrombolytic therapy within 30 days prior to randomization * Past participation in any alfimeprase clinical trial * History of hypersensitivity to aspirin * Pregnant, lactating, or actively menstruating women and women of child-bearing potential who are not using adequate contraceptive precautions (e.g. intrauterine device, oral contraceptives, barrier methods, or other contraception deemed adequate by the investigator) * Uncontrolled hypertension: systolic blood pressure (BP) \> 180 mmHg, or diastolic BP \> 110 mmHg at the time of baseline assessment * Hematocrit \< 30%; subjects with a low hematocrit who are not actively bleeding can be entered into this study if after transfusion their hematocrit is \>= 30% * Platelet count \<100 X 10(9)/L on baseline labs * Investigator inability to advance guidewire through index occlusion * Medically unable to withstand an open vascular surgical procedure * Any other feature that, in the opinion of the investigator, should preclude study participation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 30 day open vascular surgery free rate | — |
Secondary
| Measure | Time frame |
|---|---|
| Rate of improvement in index limb ABI by >=0.15 at 30 days | — |
| Change in the severity of planned surgical procedures at 30 days | — |
| Change in index limb pain severity score at 30 days | — |
| Rate of arterial flow restoration at 4 hours after initiation of study drug | — |
| Length of hospital stay | — |
| Length of intensive care unit (ICU) stay | — |
| Safety | — |
| 30 day open vascular surgery free survival rate | — |
Countries
United States
Outcome results
None listed