Dabigatran Treatment Following Transient Ischemic Attack and Minor Stroke

• Status: Completed
• Trial end date: 2014-05-01
• Target enrollment: 0
• Participant gender: All

Summary

Objective: Demonstrate the safety of early use of dabigatran following TIA/minor stroke.

Background: Although aggressive antithrombotic therapy has been shown to reduce the number of new ischemic events following stroke/TIA, this has always been offset by an increase in the risk of hemorrhagic transformation. Dabigatran is much safer than previously tested antithrombotic agents, with respect to intracranial bleeding and therefore offers a unique treatment opportunity in these high-risk patients. TIA/minor stroke represent the largest group of cerebrovascular disease patients. A short-term intervention such as 30 days of dabigatran treatment has the potential for a very large impact from the population health perspective, given the number of patients who may be treated if a benefit can be demonstrated.

Study design:

This is an open label, single arm study. Patients with TIA/minor stroke (National Institutes of Health Stroke Scale (NIHSS) score80 years old and/or with GFR 30-50 ml/min will received 110 mg bid, and all other patients will receive 150 mg BID).The primary endpoint is symptomatic hemorrhagic transformation. Patients (n=50) with TIA/minor stroke, defined as having a National Institutes of Health Stroke Scale Score of/=4 point increase in National Institutes of Health Stroke Scale (NIHSS) score).

If dabigatran can be used safely in this population, a second phase aimed at demonstrating the rate of new ischemic lesion development following TIA can be reduced with aggressive antithrombotic therapy. A randomized open-label, blinded endpoint evaluation design will be employed. The investigators hypothesize that dabigatran therapy administered within 24 hours of symptom onset will reduce the rate of new ischemic lesions, relative to standard care, one week and 30 days after onset.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Alberta
• Treatments: Dabigatran

Criteria

Inclusion Criteria:

• All patients included in the study will have TIA or minor stroke (defined as NIHSS score
• Patients must be treated within 24 hours of symptom onset. In cases where onset time cannot be established, it will be considered to be the time when the patient was last known to be well.

• All patients will be 18 years or older.

• All patients will have an MRI, with evidence of at least one DWI lesion, consistent with ischemia, prior to randomization.

Exclusion Criteria:

• Patients with stroke mimics (such as seizures, migraine etc.) will be excluded from the study.

• Patients with contraindications to MRI will also be excluded, including metallic implants.

• Patients with any past sensitivity to gadolinium contrast media will be eligible, but will not undergo PWI.

• Patients with renal failure, defined as Glomerular Filtration Rate (GFR) <30 ml/min, will be excluded as well.

• 93 Patients deemed to have any ongoing bleeding risks or unsuitable for dabigatran therapy by the attending stroke clinician will be ineligible.

• Patients in whom the MRI demonstrates additional pathology including arteriovenous malformations, intracranial aneurysms, tumours, or abscess will be excluded.

Additional Exclusion Criteria:

• Age <18 years

• Planned thrombolysis or endovascular intervention for the index event

• Thrombolysis for ischemic stroke within preceding 7 days

• Planned carotid endarterectomy/carotid artery stent within 30 days

• Any history of spontaneous intracranial bleeding

• Clear indication for anticoagulation, including atrial fibrillation, mechanical cardiac valves, deep venous thrombosis, pulmonary embolism or known hypercoagulable state

• Co-morbid illness with expected life expectancy of <30 days