Phase 3
Completed N=514
Multi-arm Optimization of Stroke Thrombolysis
Source: ClinicalTrials.gov NCT03735979 ↗Enrolled (actual)
514
Serious AEs
36.8%
Results posted
Nov 2024
Primary outcomePrimary: 90-day Utility Weighted Modified Rankin Scores (UW-mRS) — 5.2; 6.3; 6.8 score on a scale — p=0.002
◆ Published Evidence
Established
58citations · ~29 / year
Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke.
Summary
The primary efficacy objective of the MOST trial is to determine if argatroban (100µg/kg bolus followed by 3µg/kg per minute for 12 hours) or eptifibatide (135µg/kg bolus followed by 0.75µg/kg/min infusion for two hours) results in improved 90-day modified Rankin scores (mRS) as compared with placebo in acute ischemic stroke (AIS) patients treated with standard of care thrombolysis (0.9mg/kg IV rt-PA or 0.25mg/kg IV tenecteplase or TNK) within three hours of symptom onset. Patients may also receive endovascular thrombectomy (ET) per usual care. Time of onset is defined as the last time the patient was last known to be well.
Linked Publications (5)
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Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke.
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Expanding Treatment for Acute Ischemic Stroke beyond Revascularization.
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Intravenous Argatroban or Eptifibatide in Patients Undergoing Mechanical Thrombectomy: A Subgroup Analysis of the MOST Randomized Clinical Trial.
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Thrombolysis Alone vs With Argatroban or Eptifibatide: A Prespecified Subgroup Analysis of the MOST Trial.
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Comparison of Local and Centrally Adjudicated Modified Rankin Scale Scores in the MOST Trial.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY 90-day Utility Weighted Modified Rankin Scores (UW-mRS) |
5.2; 6.3; 6.8 | 0.002 sig |
| SECONDARY Percentage of Participants With NIHSS Less Than or Equal to 2 at 24 Hours |
14; 84; 89 | — |
| SECONDARY Change From Baseline to 24-hour NIHSS |
-5.1; -6.1; -6.3 | — |
| SECONDARY Percentage of Participants With 90-day mRS 0 or 1 (or Return to Their Historical mRS) |
14; 82; 92 | — |
| SECONDARY Percentage of Participants With 90-day mRS 0, 1 or 2 (or Return to Their Historical mRS) |
26; 126; 139 | — |
| SECONDARY 90-day mRS |
3; 2; 2 | — |
| SECONDARY 90-day EQ-5D |
0.6; 0.6; 0.7 | — |
| SECONDARY Pre-thrombectomy Modified TICI Score of 2B. |
2; 5; 6 | — |
| SECONDARY Post-thrombectomy Modified TICI Score of 2B or 3 |
22; 92; 93 | — |
Eligibility Criteria
Inclusion Criteria
- Acute ischemic stroke patients
- Treated with 0.9mg/kg IV rt-PA or 0.25mg/kg IV TNK within 3 hours of stroke onset or time last known well
- Age ≥ 18
- NIHSS score ≥ 6 prior to IV thrombolysis
- Able to receive assigned study drug within 60 minutes but no later than 75 minutes of initiation of IV thrombolysis
Exclusion Criteria
- Known allergy or hypersensitivity to argatroban or eptifibatide
- Previous stroke in the past 90 days
- Previous intracranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation
- Clinical presentation suggested a subarachnoid hemorrhage, even if initial CT scan was normal
- Any surgery, or biopsy of parenchymal organ in the past 30 days
- Trauma with internal injuries or ulcerative wounds in the past 30 days
- Severe head trauma in the past 90 days
- Systolic blood pressure persistently >180mmHg post-IV thrombolysis despite antihypertensive intervention
- Diastolic blood pressure persistently >105mmHg post-IV thrombolysis despite antihypertensive intervention
- Serious systemic hemorrhage in the past 30 days
- Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR >1.5
- Positive urine or serum pregnancy test for women of child bearing potential
- Glucose 400 mg/dl
- Platelets 4 mg/dl
- Ongoing renal dialysis, regardless of creatinine
- Received Low Molecular Weight heparins (such as Dalteparin, Enoxaparin, Tinzaparin) in full dose within the previous 24 hours
- Abnormal PTT within 48 hours prior to randomization after receiving heparin or a direct thrombin inhibitor (such as bivalirudin, argatroban, dabigatran or lepirudin)
- Received Factor Xa inhibitors (such as Fondaparinaux, apixaban or rivaroxaban) within the past 48 hours
- Received glycoprotein IIb/IIIa inhibitors within the past 14 days
- Pre-existing neurological or psychiatric disease which confounded the neurological or functional evaluations e.g., baseline modified Rankin score >3
- Other serious, advanced, or terminal illness or any other condition that the investigator felt would pose a significant hazard to the patient if rt-PA, TNK, eptifibatide or argatroban therapy was initiated
a. Example: known cirrhosis or clinically significant hepatic disease
- Current participation in another research drug treatment or interventional device trial - Subjects could not start another experimental agent until after 90 days
- Informed consent from the patient or the legally authorized representative was not or could not be obtained
- High density lesion consistent with hemorrhage of any degree
- Large (more than 1/3 of the middle cerebral artery) regions of clear hypodensity on the baseline CT Scan. Sulcal effacement and/or loss of grey-white differentiation alone are not contraindications for treatment
Data sourced from ClinicalTrials.gov (NCT03735979) and the linked publication. Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.