Ignite Creation Date:
2024-05-05 @ 11:29 AM
Last Modification Date:
2024-10-26 @ 9:08 AM
Study NCT ID:
NCT00055159
Status:
COMPLETED
Last Update Posted:
2017-07-02
First Post:
2003-02-20
Brief Title:
Low-Dose rtPA to Treat Blood Clots in Major Arm or Neck Veins
Sponsor:
National Institutes of Health Clinical Center CC
Organization:
National Institutes of Health Clinical Center CC
Study Overview
Official Title:
Treatment of Jugular Subclavian andor Innominate Vein Thrombosis With Low Dose Recombinant Tissue Plasminogen Activator Plus Anticoagulation
Status:
COMPLETED
Status Verified Date:
2007-12-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study will test the effectiveness of low-dose recombinant tissue plasminogen activator rtPA or alteplase in dissolving blood clots in major arm or neck veins rtPA is given to patients with heart attacks to dissolve blood clots in blocked coronary arteries Blood clots that develop in major arm or neck veins usually develop after a venous access device VAD or catheter has been placed in the vein The clot often causes arm shoulder or neck swelling and pressure or discomfort Current treatments include removing the VAD using blood thinners such as heparin and warfarin or using rtPA to dissolve the clot All these options have disadvantages however including the risk of abnormal bleeding This study will evaluate whether lower doses of rtPA can effectively dissolve clots without requiring an extended hospital stay as is needed with the current higher-dose regimen
Patients 18 years of age and older who are enrolled in or are being evaluated for a Clinical Center study and who have a blocked jugular axillary subclavian or brachiocephalic vein may be eligible for this study The blockage may or may not be associated with use of a VAD
Participants will have one or two treatments with a low dose of rtPA followed by a blood thinner taken by mouth or by injection for 5 to 7 weeks On the first treatment day the patient has a venogram in which a catheter is placed in an arm vein and passed up to and through the blood clot that is blocking the blood flow in the vein This is done under an x-ray machine so the radiologist can see exactly where the tube is going Then rtPA is injected into the clot about every 30 seconds for 15 to 30 minutes The catheter is kept in place to maintain access to the vein for additional treatment the next day if needed The patient then begins treatment with heparin either as an outpatient or an inpatient A second venogram is done the next day If the venogram shows that the vein is open anti-clotting treatment with heparin or warfarin continues If the venogram shows that the vein is still blocked the rtPA treatment is repeated while the blood thinner treatment continues The patient has a third venogram the following day If the vein has opened heparin and warfarin treatment continues If the vein is still blocked the patients participation in the study ends Although the patient is no longer formally in the study he or she may choose to receive additional treatments with rtPA in higher doses at NIH or to continue using blood thinners under the direction of the primary physician
Blood tests are done during blood thinning therapy to monitor and adjust the dosage Additional blood samples are taken before and at timed intervals after each rtPA treatment to measure the response to therapy Patients who benefit from rtPA treatment remain on blood thinners for 5 to 7 weeks and then return to NIH for a follow-up venogram to see if the vein is still open During warfarin therapy blood tests are done every few days during the first week or two and every 2 weeks thereafter to ensure the optimal drug dose is being administered If the repeat venogram at 5 to 7 weeks shows that the vein has closed the blood thinners warfarin or heparin will be stopped and the patients participation in this study will end If the vein has remained open the patients doctor will decide whether or not to continue anti-clotting therapy
Patients 18 years of age and older who are enrolled in or are being evaluated for a Clinical Center study and who have a blocked jugular axillary subclavian or brachiocephalic vein may be eligible for this study The blockage may or may not be associated with use of a VAD
Participants will have one or two treatments with a low dose of rtPA followed by a blood thinner taken by mouth or by injection for 5 to 7 weeks On the first treatment day the patient has a venogram in which a catheter is placed in an arm vein and passed up to and through the blood clot that is blocking the blood flow in the vein This is done under an x-ray machine so the radiologist can see exactly where the tube is going Then rtPA is injected into the clot about every 30 seconds for 15 to 30 minutes The catheter is kept in place to maintain access to the vein for additional treatment the next day if needed The patient then begins treatment with heparin either as an outpatient or an inpatient A second venogram is done the next day If the venogram shows that the vein is open anti-clotting treatment with heparin or warfarin continues If the venogram shows that the vein is still blocked the rtPA treatment is repeated while the blood thinner treatment continues The patient has a third venogram the following day If the vein has opened heparin and warfarin treatment continues If the vein is still blocked the patients participation in the study ends Although the patient is no longer formally in the study he or she may choose to receive additional treatments with rtPA in higher doses at NIH or to continue using blood thinners under the direction of the primary physician
Blood tests are done during blood thinning therapy to monitor and adjust the dosage Additional blood samples are taken before and at timed intervals after each rtPA treatment to measure the response to therapy Patients who benefit from rtPA treatment remain on blood thinners for 5 to 7 weeks and then return to NIH for a follow-up venogram to see if the vein is still open During warfarin therapy blood tests are done every few days during the first week or two and every 2 weeks thereafter to ensure the optimal drug dose is being administered If the repeat venogram at 5 to 7 weeks shows that the vein has closed the blood thinners warfarin or heparin will be stopped and the patients participation in this study will end If the vein has remained open the patients doctor will decide whether or not to continue anti-clotting therapy
Detailed Description:
Deep vein thrombosis of the central veins of the upper extremity and neck is most commonly seen at the Clinical Center as a consequence of use of central venous access devices VADs required for intravenous medication treatment programs at the NIH In order to relieve discomfort associated with this condition or restore patency of the central veins we successfully developed a treatment program employing intraclot pulse-sprayed injection of recombinant tissue plasminogen activator rtPA and anticoagulation with heparin plus warfarin Protocol 95-CC-0053 Recent laboratory kinetic studies of thrombolysis with rtPA suggest that more rapid thrombolysis can be achieved with rtPA doses that are more than 10 times lower than the doses used in our earlier protocol The purpose of this protocol is to evaluate whether these lower doses translate into more effective thrombolysis in the clinical setting so that we may modify our thrombolysis treatment to make it more effective potentially safer and less costly than our previous protocol This proposed protocol still utilizes pulse spray injection of rtPA directly into the thrombus as before but evaluates the efficacy and safety of using a total of 4 mg or less of rtPA each day for thrombolytic therapy As this lower dose of rtPA has been found to be safe in catheter clearance applications hospitalization will not be required as part of the protocol Patients who elect to have this procedure performed as outpatients will also receive anticoagulation with standard regimens using subcutaneous low molecular weight heparin LMWH alone or with gradual conversion to oral warfarin
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 03-CC-0113 | None | None | None |