Condition category
Circulatory System
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Plain English Summary

Not provided at time of registration

Trial website

Contact information



Primary contact

Mrs Claire Macdonald


Contact details

Newcastle Clinical Trials Unit
Institute of Health and Society
4th Floor William Leech Building
Framlington Place
Newcastle Upon Tyne
United Kingdom

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

ARTSS-2: A pilot, phase IIb, randomised, multi-center trial of Argatroban in combination with recombinant tissue plasminogen activator for acute stroke



Study hypothesis

A pilot, phase IIb, randomised, multicentre trial of Argatroban in combination with recombinant tissue plasminogen activator for acute stroke.

Recombinant tissue plasminogen activator (rtPA), the only proven treatment for acute ischemic stroke, fails to reperfuse the brain in most patients with large thrombi. In a Phase IIa low dose safety study (n=65), conducted by University of Texas Houston, delivering Argatroban with rtPA indicated that both drugs appear safe when delivered concomitantly and recanalisation rates were greater than with historical controls.

The purpose of the trial is to estimate the overall treatment benefit (improvement in disability) among stroke patients treated with rtPA (Alteplase) who are randomised to receive either lowdose Argatroban, highdose Argatroban or neither.

This study will provide evidence based hypotheses and data needed to design a larger definitive trial. The study will be conducted in six hospitals across the UK and will recruit males and females over 18 years of age with acute ischemic stroke.

Ethics approval

NRES Committee North West – Greater Manchester South, 24/07/2012, ref:12/NW/0425

Study design

Pilot phase IIb randomised multicentre trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet




Three treatment arms (n=35 each) will be enrolled:
1. Low-dose Argatroban* (1.0µg/kg/min continuous infusion of Argatroban, preceded by a 100 µg/kg bolus administered over 3-5 minutes Infusion will be titrated to achieve an aPTT of 1.75 times baseline - not to exceed 10 µg/kg/min) + usual care IV-rt-PA;
2. High-dose Argatroban* 3.0 µg/kg/min continuous infusion of Argatroban, preceded by a 100 µg/kg bolus administered over 3-5 minutes Infusion will be titrated to achieve an aPTT of 2.25 times baseline - not to exceed 10 µg/kg/min) + usual care IV-rt-PA;
3. Intravenous-rt-PA alone (usual care).
*Argatroban infusions will continue for a maximum of 48 hours.

During the course of the treatment, patients will be evaluated via Computed Tomography (CT) angiogram, CT scans, vital signs, laboratory measurements, and neurological and unctional outcomes. Patients will also be evaluated at 24 hours following the onset of the stroke, Day 7 or discharge (whichever comes first) and at day 90.

Sponsor's EEA representative:
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Freeman Hospital
Freeman Road
High Heaton
Newcastle upon Tyne
email: Trust.R&

Intervention type



Phase II

Drug names


Primary outcome measure

Excellent functional outcome as measured by the percentage of patients with a 0 or 1 on the modified Rankin Scale (mRS) at day 90 as assessed by study personnel blinded to treatment

Secondary outcome measures

1. Safety as measured by the incidence of:
1.1. Symptomatic intracranial haemorrhage (sICH)
1.2. Parenchymal Haemorrhage 2 (PH-2)
1.3. Major systemic haemorrhage.
2. Rates and completeness of arterial recanalisation assessed at baseline and 2-3 hours by CT-Angiogram (CTA)
3. Neurological deficits improvement from baseline to 2 hours, 24 hours, end of Argatroban infusion, Day 7/discharge and day 90 as measured by NIHSS
4. Quality of Life obtained by standard gamble, time-trade-off method and visual analogue scale (VAS)
5. Cost and cost-effectiveness analysis
5.1 Medical costs associated with each treatment
5.2 Incremental cost-effectiveness ratio (change in cost divided by quality of life gained)

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. Disabling ischemic stroke symptoms with onset < 3 hours treated with IV rtPA (alteplase) by local standards*.
* or <= 4.5 hours according to local standard of care
2. Age >= 18
3. National Institutes of Health Stroke Scale (NIHSS) >= 10* or any NIHSS with an intracranial clot should be demonstrated on neurovascular imaging (TCD or CTA) in any one of the following areas: distal ICA, MCA (M1 or M2), PCA (P1 or P2), distal vertebral or basilar artery
3.1. TCD criteria: TIBI 0, 1, 2 or 3
3.2. CTAngiogram: TIMI 0 or 1
* NIHSS = 10, demonstration of clot on neuroimaging is not necessary (i.e., enrollment can proceed with noncontrast head CT alone), but if performed, a clot must be demonstrated
4. For those patients who will undergo repeat CT Angiogram at 23 hours, estimated glomerular filtration rate (eGFR) must be >= 60 mL/min/1.73m2
5. Females of childbearing potential must have a negative serum pregnancy test prior to the administration of trial medication
6. Signed (written) informed consent by the patient or the patient’s legal representative and/or guardian

Participant type


Age group




Target number of participants

UK Sample Size: 50

Participant exclusion criteria

1. Patients whom the treating physician is planning (or could plan) to treat with intraarterial thrombolysis or other endovascular procedures (i.e., mechanical clot retrieval) aimed at recanalisation
2. Evidence of intracranial haemorrhage (ICH) on baseline CT scan or diagnosis of a nonvascular cause of neurologic deficit
3. NIHSS Level of Consciousness score (1a) >= 2
4. Preexisting disability with mRS >= 2
5. CT scan findings of hypoattenuation of the xray signal (hypodensity) involving >= 1/3 of the MCA territory
6. Any evidence of clinically significant bleeding, or known coagulopathy
7. INR >1.5
8. Patients with an elevated activated partial thromboplastin time (aPTT) greater than the upper limit of normal
9. Patients currently, or within the previous 24 hours, on an oral direct thrombin inhibitor
10. Heparin flush required for an IV line. Line flushes with saline only.
11. Any history of intracranial haemorrhage, known arteriovenous malformation or unsecured cerebral aneurysms
12. Significant bleeding episode within the 3 weeks before study enrollment
13. Major surgery or serious trauma in last 2 weeks
14. Patients who have had an arterial puncture at a noncompressible site, biopsy of parenchymal organ, or lumbar puncture within the last 2 weeks
15. Previous stroke, myocardial infarction (MI), post myocardial infarction pericarditis, intracranial surgery, or significant head trauma within 3 months
16. Uncontrolled hypertension (SBP > 185 mmHg or DBP >110 mmHg) that does not respond to intravenous antihypertensive agents
17. Surgical intervention (any reason) anticipated within the next 48 hours
18. Known history of clinically significant hepatic dysfunction or liver disease – including a current history of alcohol abuse
19. Abnormal blood glucose <50 mg/dL (2.7 mmol/L)
20. History of primary or metastatic brain tumor
21. Current platelet count < 100,000/mm3
22. Life expectancy < 3 months
23.Patients who, in the judgment of the investigator, needs to be on concomitant (i.e., during the Argatroban infusion) anticoagulants other than Argatroban, including any form of heparin, unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), defibrinogenating agent, dextran, other direct thrombin inhibitors or thrombolytic agents, GPIIb/IIIa inhibitor or warfarin. [*Caveat: However, if in the judgment of the investigator a patient needs to be anticoagulated, but this can be deferred for 48 hours, then they could be included.]
24. Currently participating or has participated in any investigational drug or device study within 30 days before the first dose of study medication
25. Known hypersensitivity to Argatroban or its agents
26. Additional exclusion criteria if patient presents between 34.5 hours:
26.1. Age >80
26.2. Currently taking oral anticoagulants (regardless of INR)
26.3. A history of stroke and diabetes.
26.4. NIHSS > 25

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Newcastle Clinical Trials Unit
Newcastle Upon Tyne
United Kingdom

Sponsor information


The University of Texas Health Science Center at Houston (USA)

Sponsor details

7000 Fannin
Suite 1200
United States of America

Sponsor type




Funder type


Funder name

National Institutes of Health (USA)

Alternative name(s)

The National Institutes of Health, NIH

Funding Body Type

government organisation

Funding Body Subtype

National government


United States of America

Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

2015 results in:

Publication citations

Additional files

Editorial Notes

20/01/2020: Internal review. 13/02/2017: Publication reference added. 10/04/2014: The overall trial end date was changed from 30/04/2014 to 31/07/2014.