Clinical Trial: Treatment of Acute Respiratory Distress Syndrome With Tenecteplase: A Dose Escalation Pilot Study

Study Status: Withdrawn
Recruit Status: Withdrawn
Study Type: Interventional

Official Title: Treatment of Acute Respiratory Distress Syndrome With Tenecteplase: A Dose Escalation Pilot Study: Phase I

Brief Summary:

The pathogenesis of ARDS appears to be from damage to the alveolar-capillary barrier, which is composed of the microvascular endothelium and the alveolar epithelium. This damage may occur from direct or indirect lung injury. The mechanism of injury to the alveolar capillary barrier appears to be through neutrophil-mediated injury, pro-inflammatory cytokines, ventilator-induced lung injury with alveolar over distention and abnormalities of the coagulation system. This results in blood clot formation in the microcirculation of the lung. Thrombolytics can dissolve blood clots and result in increased blood flow to the organs. This treatment may benefit ARDS patients, thus the purpose of this study.

Hardaway, et al.studied the effects of thrombolytics on ARDS in pigs. The experimental group showed improved oxygenation and survival as compared to controls. There was no bleeding complications noted with this therapy. Dr. Hardaway followed this animal study with a phase I clinical trial involving 20 patients with ARDS. The patients were treated with IV streptokinase or urokinase. Nineteen of the 20 patients showed an increase in PA02 after thrombolytic therapy. There were no significant bleeding complications in patients that were critically ill on ventilators.

We propose an additional phase I pilot study to evaluate the effectiveness and safety of Tenecteplase for the treatment of ARDS. Unlike the other fibrinolytics studied in this disease state, Tenecteplase, is more fibrin specific and has increased resistance to plasminogen activator inhibitor (PAI-I) at greater levels than other available fibrinolytics. We have chosen an experimental dose escalation trial design of tenecteplase that has demonstrated initial safety trends in a Phase I acute ischemic stroke trial. The initial dose is 0.1 mg/kg IV and will increase to 0.2 mg/kg

Detailed Summary:

  1. Treatment of acute respiratory distress syndrome with tenecteplase, a dose escalation pilot study: phase I
  2. The study sample size will be 20 patients. The 20 patients will be divided into 4 groups with 5 patients in each group or cohort. The first cohort will received 0.1mg/kg of tenecteplase as a bolus via peripheral IV as described by the package insert and will be closely monitored for safety and efficacy. If there are no adverse events associated with tenecteplase, the second cohort of patients will be enrolled and will receive 0.2 mg/kg of tenecteplase IV bolus. If there are no safety issues, we will proceed with the next cohort at 0.3 mg/kg with a final cohort of patients receiving 0.4 mg/kg of tenecteplase IV bolus. Advancement of dose will occur if safety is not in question in the previous cohort.
  3. Tenecteplase will be given as a bolus via peripheral IV as described by package insert.
  4. Treatment will be initiated after informed consent is obtained and only >12 hrs after any subcutaneous Heparin has been stopped and >12 hrs after placement of a pulmonary artery catheter, central line or arterial line. Only patients meeting criteria for ARDS (see inclusion criteria) will be considered for the study.
  5. Pretreatment assessment: We will obtain informed consent, demographic data, physical examination and medical history, vital signs, PT, PTT, INR, ABG, hemoglobin hematocrit, liver enzymes, cardiac enzymes, creatinine, fibrinogen, fibrin split products, platelets, urine pregnancy test, EKG, chest x-ray, cardiac profile from Swan-Ganz catheter and ventilator settings before treatment begins.
  6. Assessment during treatment: Blood samples will be taken every 6 hours for 24 hours and analyzes for PT, PTT, INR, fibrinogen,
    Sponsor: Medical Center of Central Georgia

    Current Primary Outcome:

    • Survival to Discharge
    • Safety Analysis of Bleeding Complications


    Original Primary Outcome: Same as current

    Current Secondary Outcome:

    • Improved Pa02/Fi02 ratio
    • Improved cardiac profile
    • Incidence of organ failure
    • Decreased ventilator days
    • Decreased ICU days


    Original Secondary Outcome: Same as current

    Information By: Medical Center of Central Georgia

    Dates:
    Date Received: February 2, 2007
    Date Started: February 2007
    Date Completion:
    Last Updated: November 4, 2013
    Last Verified: November 2013