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Minor StrokePhase 3TRUSTNCT04420351

Thrombolysis of Urokinase for Minor Stroke

A Phase 3 study testing Urokinase thrombolysis and Aspirin;Clopidogrel in people with Minor Stroke, run by The First Affiliated Hospital of Zhengzhou University at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This trial will enroll patients that have been diagnosed with minor stroke, which has occurred within the past 6 hours. TRUST is a prospective multicenter, randomized, blinded-endpoint study to evaluate the efficacy and safety of Urokinase Thrombolysis for patients with minor stroke. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Minor Stroke
What is being tested?
Urokinase thrombolysis and Aspirin;Clopidogrel
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,005 participants
Where
1 siteChina
Study dates
4 Oct 2020to 18 Feb 2023
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patients: 18-80 years old
  • The time from last seen well to treatment < 6 hours
  • Minor stroke defined as a baseline NIHSS ≤5 at the time of randomization..
  • First onset or pre-stroke mRS≤1
  • Informed consent signed

Who cannot join

  • 1.Hyperdensity on CT suggesting intracranial hemorrhage
  • 2.Large acute stroke >1/3 middle cerebral artery (MCA) territory visible on CT or MRI
  • 3.Other contraindications of intravenous thrombolysis, including but not limited to:
  • Intracranial tumor, arteriovenous malformation
  • Coma or confirmed as severe stroke by clinical assessment (e.g. NIHSS ≥25) or proper imaging methods
  • With seizure
Show all 31Show fewer
  • Stroke attack within past three months
  • Heparin administration within 48h before onset, with APTT longer than upper limit
  • Stroke history with diabetes
  • Platelet count ≤100×10^9/L
  • Difficult to control hypertension, defined by systolic pressure ≥185mmHg or diastolic pressure ≥110 mmHg in 3 tests with at least ten minutes interval, under well guided medications.
  • Blood glucose <50mg/dl(2.7mmol/l)or >400mg/dl(22.2mmol/l)
  • Obvious hemorrhage within past 6 months
  • Oral anti-coagulation drug administration (e.g. warfarin) with INR>1.5
  • Intracranial hemorrhage or suspected intracranial hemorrhage (including subarachnoid hemorrhage)
  • Pregnancy or lactation.
  • History of severe CNS damage (e.g. tumor, arterial aneurysm or CNS surgery)
  • Hemorrhagic retinopathy, e.g. diabetes (hemorrhages suggested by optic impairment) or other hemorrhagic ocular lesions.
  • Bacterial endocarditis or pericarditis.
  • Prolonged or traumatic CPR (>2min), puncture in nonstress vessels within past 10 days, such as subclavian vein puncture.
  • Acute pancreatitis.
  • Confirmed ulcerative gastric or intestinal problems within 3 months.
  • Arterial aneurysm or arteriovenous malformation.
  • Any tumor that increase risk of hemorrhage.
  • Severe hepatic diseases, like hepatic failure, liver cirrhosis, portal hypertension, esophageal varices or active hepatitis.
  • Major surgery, severe trauma or craniocerebral trauma within past 10 days.
  • Allergy to any components of urokinase.
  • 4.Severe, fatal diseases with less than 3 month expected survival.
  • 5.Intended to receive standard rt-PA thrombolysis or intravascular therapy.
  • 6.Already participating in other studies that conflict to this study.
  • 7.Unable to accomplish the follow-up.

Trial locations and contacts

1 site in 1 country.

China1 site
  • The First Affiliated Hospital of Zhengzhou University

    Zhengzhou, Henan, 0371

Other trials in China

About this study

Official title: A Phase ⅢB, Prospective, Randomized, Open Label, Blinded-endpoint, Multicenter Trial of the Efficacy and Safety of Urokinase Thrombolysis Comparing With Antiplatelet Agents for Patients With Minor Stroke.

This trial will enroll patients that have been diagnosed with minor stroke, which has occurred within the past 6 hours. TRUST is a prospective multicenter, randomized, blinded-endpoint study to evaluate the efficacy and safety of Urokinase Thrombolysis for patients with minor stroke.

Read the detailed description

China is currently faced with the heaviest stroke burden due to the tremendous population and susceptibility to cerebrovascular disease. As has been assessed, deaths caused by cerebrovascular disease are three times of cardiovascular disease. Within whole population with cerebrovascular disease, minor stoke have taken a significant part of the disease burden. Thus the population with minor stoke is one of the most important parts in efficient prevention of cerebrovascular disease. According to phase I and II data from national stoke registration in China, 35.25% to 42.23% cases were minor ischemic strokes. However, in clinical practice, the minor ischemic stroke patients are likely to be ignored and some might have poor prognosis. As has been demonstrated by a number of studies, up to one third of the acute non-disabling ischemic stroke without in-time thrombolysis may suffer from disabling or death at 90-day follow-up.

Several studies have demonstrated the potential benefits of thrombolysis compared usually with placebo, including the Third International Stroke Trail ( IST-3, rt-PA to placebo, patients within 3 hours after attack, with blood pressure lower than 185/110mmHg and NIHSS≤5),National Institute of Neurological Disorders and Stroke rt-PA Stroke Study( NINDS, rt-PA to placebo, patients with mild ischemic stroke recognized by 5 different definitions).

Urokinase is a kind of non-selective plasminogen activator, urokinase acted as effective catalyzer in the transferring of both free and protein-binding plasminogen to plasmin, thus inducing thrombolysis. As one of the widely used medication for intravenous thrombolysis in China, urokinase has been suggested the the efficacy and safety for ischemic stroke. With easier availability and lower price, urokinase has provided a promising alternation to patients who need thrombolysis in China, especially in less developed areas. The Chinese guideline for diagnosis and treatment of acute ischemic stroke 2018 has recommended urokinase as an alternation in the treatment of acute ischemic stroke within 6-hour time window as well, if rt-PA is not available or affordable. However, randomized and multicenter clinical trial of urokinase thrombolysis for minor stroke is still vacant, which couldn't provide more persuasive evidence.

TRUST is a prospective multicenter, randomized, single-blind evaluation study to evaluate the efficacy and safety of Urokinase Thrombolysis for patients with minor stroke. The trail will enroll a total of 1002 minor stroke patients within a 6 hour time window with a NIHSS score ≤5 at the time of randomization. Randomization will be 1:1 to Urokinase Thrombolysis (experimental) or Antiplatelet agents (control). Patients will receive 1 million units urokinase dissolved by 100ml saline through intravenous infusion within 30min or oral antiplatelet agents. All patients will undergo CT or MRI before treatment and will undergo the second CT within 36 hours after treatment. Patients will be followed up at 36h, 7d and 90 days. The primary outcome measures including the proportion of patients with a modified Rankin Scale(mRS) of 0 or 1 at 90-day follow-up and the patients with symptomatic intracranial hemorrhage within 36 hours. Secondary outcome measures cover new vascular events, the Progress of MRS score, Neurological impairment, Daily function evaluations, Quality of life assessments, Overall mortality and Adverse events and severe adverse events within 90 days.

Conditions
Minor Stroke
Being tested
Urokinase thrombolysis, Aspirin;Clopidogrel
Keywords
Thrombolysis, Urokinase, Ischemic stroke
Medical subject headings
Ischemic Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Urokinase thrombolysisDrug

    Also called Urokinase

    The patients of intervention group will receive 1 millions units urokinase dissolved by 100 saline through intravenous infusion within 30 minutes.

  • Aspirin;ClopidogrelDrug

    Also called Antiplatelet treatment

    The control group will receive antiplatelet agents as decided by the physicians according to Chinese guideline for diagnosis and treatment of acute ischemic stroke 2018.

Study groups in NCT04420351
Study groupRoleWhat they receive
Urokinase thrombolysisExperimentalThe patients of intervention group will receive 1 millions units urokinase dissolved by 100 saline through intravenous infusion within 30 minutes.
Receives: Drug: Urokinase thrombolysis
Antiplatelet treatmentOtherThe control group will receive antiplatelet agents as decided by the physicians according to Chinese guideline for diagnosis and treatment of acute ischemic stroke 2018
Receives: Drug: Aspirin;Clopidogrel

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of patients with a modified Rankin Scale(mRS) of 0 or 1 at 90-day follow-up

    mRS has 0-6 points, the higher the worse outcome.

    Measured: 90 Days

  2. Proportion of patients with symptomatic intracranial hemorrhage within 36 hours

    Symptomatic intracranial haemorrhage within 36 hours

    Measured: 36 hours

Secondary outcomes (8)
  1. Proportion of patients with new vascular events

    Proportion of patients with new vascular events within 90 days(Ischemic stroke / hemorrhagic stroke / TIA / myocardial infarction / vascular death)

    Measured: 90 days

  2. MRS score

    To evaluate the progress of MRS score

    Measured: 90 days

  3. The ratio of patients with MRS 0-1 during the last visit in two groups

    mRS has 0-6 points, the higher the worse outcome.

    Measured: 90 days

  4. Changes in National Institutes of Health Stroke Scale(NIHSS) score

    Neurological impairment in two groups (changes in NIHSS score at 90-day follow-up). NIHSS has 0-42 points, the higher the worse outcome.

    Measured: 90 days

  5. Barthel index (BI) score

    Daily function evaluations(BI score at 90 days). BI has 0-100 points,the higher the bettter outcome.

    Measured: 90 days

  6. Quality of life assessments

    EuroQol five dimensional questionnaire (EQ-5D scale).

    Measured: 90 days

  7. Overall mortality

    Overall mortality within 90 days

    Measured: 90 days

  8. Adverse events and severe adverse events

    Adverse events and severe adverse events in two groups during 90 days

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Jun 2020
  2. Study start4 Oct 2020
  3. Primary completion18 Feb 2023
  4. Study completion18 Feb 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
1,005 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04420351
Sponsor's protocol ID
2017YFC1308202
Acronym
TRUST
Status last verified
Nov 2023
First submitted
4 Jun 2020
Last updated
14 Nov 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Liu M, Wu B, Wang WZ, Lee LM, Zhang SH, Kong LZ. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol. 2007 May;6(5):456-64. doi: 10.1016/S1474-4422(07)70004-2.

    PubMed 17434100
  • Wu Z, Yao C, Zhao D, Wu G, Wang W, Liu J, Zeng Z, Wu Y. Sino-MONICA project: a collaborative study on trends and determinants in cardiovascular diseases in China, Part i: morbidity and mortality monitoring. Circulation. 2001 Jan 23;103(3):462-8. doi: 10.1161/01.cir.103.3.462.

    PubMed 11157701
  • Liu L, Wang D, Wong KS, Wang Y. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011 Dec;42(12):3651-4. doi: 10.1161/STROKEAHA.111.635755. Epub 2011 Nov 3.

    PubMed 22052510
  • Smith EE, Fonarow GC, Reeves MJ, Cox M, Olson DM, Hernandez AF, Schwamm LH. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator: findings from Get With The Guidelines-Stroke. Stroke. 2011 Nov;42(11):3110-5. doi: 10.1161/STROKEAHA.111.613208. Epub 2011 Sep 8.

    PubMed 21903949
  • Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM. Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001 Apr 24;56(8):1015-20. doi: 10.1212/wnl.56.8.1015.

    PubMed 11320171
  • Nedeltchev K, Schwegler B, Haefeli T, Brekenfeld C, Gralla J, Fischer U, Arnold M, Remonda L, Schroth G, Mattle HP. Outcome of stroke with mild or rapidly improving symptoms. Stroke. 2007 Sep;38(9):2531-5. doi: 10.1161/STROKEAHA.107.482554. Epub 2007 Aug 2.

    PubMed 17673713
  • Smith EE, Abdullah AR, Petkovska I, Rosenthal E, Koroshetz WJ, Schwamm LH. Poor outcomes in patients who do not receive intravenous tissue plasminogen activator because of mild or improving ischemic stroke. Stroke. 2005 Nov;36(11):2497-9. doi: 10.1161/01.STR.0000185798.78817.f3. Epub 2005 Oct 6.

    PubMed 16210552
  • Coutts SB, Dubuc V, Mandzia J, Kenney C, Demchuk AM, Smith EE, Subramaniam S, Goyal M, Patil S, Menon BK, Barber PA, Dowlatshahi D, Field T, Asdaghi N, Camden MC, Hill MD; TEMPO-1 Investigators. Tenecteplase-tissue-type plasminogen activator evaluation for minor ischemic stroke with proven occlusion. Stroke. 2015 Mar;46(3):769-74. doi: 10.1161/STROKEAHA.114.008504. Epub 2015 Feb 12.

    PubMed 25677596
  • Khatri P, Tayama D, Cohen G, Lindley RI, Wardlaw JM, Yeatts SD, Broderick JP, Sandercock P; PRISMS and IST-3 Collaborative Groups. Effect of Intravenous Recombinant Tissue-Type Plasminogen Activator in Patients With Mild Stroke in the Third International Stroke Trial-3: Post Hoc Analysis. Stroke. 2015 Aug;46(8):2325-7. doi: 10.1161/STROKEAHA.115.009951. Epub 2015 Jun 23.

    PubMed 26106113
  • National Institute of Neurological Disorders Stroke rt-PA Stroke Study Group. Recombinant tissue plasminogen activator for minor strokes: the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study experience. Ann Emerg Med. 2005 Sep;46(3):243-52. doi: 10.1016/j.annemergmed.2005.02.013.

    PubMed 16126134
  • Khatri P, Kleindorfer DO, Yeatts SD, Saver JL, Levine SR, Lyden PD, Moomaw CJ, Palesch YY, Jauch EC, Broderick JP. Strokes with minor symptoms: an exploratory analysis of the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trials. Stroke. 2010 Nov;41(11):2581-6. doi: 10.1161/STROKEAHA.110.593632. Epub 2010 Sep 2.

    PubMed 20814000
  • Tao Y, Gao Y, Zhao L, Xu Y, Jiang C, Liu K, Fang H, Pei L, Wang X, Zhang R, Wu J, Yang J, Han X, Guo H, Xue B, Li J, Liu Y, Gu H, Du K, Cheng X, Dong Q, Wang D, Buonanno FS, Ning M, Xu Y, Song B; TRUST Trial Investigators. Effect of intravenous urokinase vs best medicine treatment on functional outcome for patients with acute minor stroke (TRUST): a randomized controlled trial. BMC Med. 2025 Jan 6;23(1):6. doi: 10.1186/s12916-024-03820-2.

    PubMed 39757192

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Urokinase thrombolysis and Aspirin;Clopidogrel in people with Minor Stroke, run by The First Affiliated Hospital of Zhengzhou University at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 31 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of patients with a modified Rankin Scale(mRS) of 0 or 1 at 90-day follow-up (time frame: 90 Days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04420351, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Nov 2023; AzTrials last refreshed its copy on 7 Nov 2026.

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