Table 1.
Inclusion criteria |
1. Patients must have had a serious measurable neurological deficit on the NIH Stroke Scale caused by focal brain ischemia |
2. An NIH Stroke Scale score >5 at the time the rt-PA was begun |
3. Age: 18 to 85 y (ie, candidates must have had their 18th birthday, but not had their 86th birthday) |
4. Intravenous rt-PA therapy must have been initiated within 3 h of onset of stroke symptoms |
Exclusion criteria |
Clinical |
1. History of stroke in the past 3 mo |
2. Previous intracranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation |
3. Clinical presentation suggested a subarachnoid hemorrhage, even if initial CT scan was normal |
4. Hypertension at time of treatment; systolic BP >185 or diastolic >110 mm Hg, or aggressive measures to lower blood pressure to below these limits were needed |
5. Presumed septic embolus |
6. Presumed pericarditis, including pericarditis after acute myocardial infarction |
7. Recent (within 30 d) surgery or biopsy of parenchymal organ |
8. Recent (within 30 d) trauma, with internal injuries or ulcerative wounds |
9. Recent (within 90 d) severe head trauma or head trauma with loss of consciousness |
10. Any active or recent (within 30 d) serious systemic hemorrhage |
11. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR >1.7 |
12. Baseline laboratory values: positive urine pregnancy test, glucose <50 or >400 mg/dL, platelets <100 000/mm3, Hct <25%, or creatinine >4 mg/dL |
13. Ongoing renal dialysis, regardless of creatinine |
14. If heparin was administered within 48 h from screening, the patient must have had a normal partial thromboplastin time (PTT) |
15. Subjects who received low molecular weight heparins (such as dalteparin, enoxaparin, and tinzaparin) as DVT prophylaxis or in full dose within the previous 24 h |
16. Subjects who received heparin or a direct thrombin inhibitor (such as bivalirudin, argrtroban, or lepirudin) within 48 h from screening must have had a normal PTT |
17. Subjects took Factor Xa inhibitors (such as fondaparinux) within the last 4 d |
18. Subjects who received glycoprotein IIb/IIIa inhibitors within the past 2 wk |
19. Arterial puncture at a noncompressible site or a lumbar puncture in the previous 7 d |
20. Seizure at onset of stroke |
21. Preexisting neurological or psychiatric disease which confounded the neurological or functional evaluations |
22. 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 or eptifibatide therapy was initiated |
23. Patients whose peripheral venous access was so poor that they were unable to have 2 standard peripheral intravenous lines started |
24. Current participation in another research drug treatment protocol. Subjects could not start another experimental agent until after 90 d |
25. Informed consent was not or could not be obtained |
26. Any known history of amyloid angiopathy |
CT scan exclusions |
1. High-density lesion consistent with hemorrhage of any degree |
2. Significant mass effect with midline shift |
3. Large (more than one third of the middle cerebral artery) regions of clear hypodensity on the baseline CT scan. Sulcal effacement and loss of gray-white differentiation alone were not contraindications for treatment |
BP indicates blood pressure; CT, computed tomography; DVT, deep venous thrombosis; INR, international normalized ratio; NIH, National institutes of Health; and rt-PA, recombinant tissue plasminogen activator.