Aneurysmal Subarachnoid HemorrhagePhase 1/2iSPASM-2NCT07493577
Induced Suppression of Platelet Activity in Aneurysmal Subarachnoid Hemorrhage Management-2 (iSPASM-2)
A Phase 1/2 study testing Tirofiban in people with Aneurysmal Subarachnoid Hemorrhage, run by Dr David Hasan, M.D. at 2 sites in United States.
Trial summary
An exploratory, randomized, double-blinded, placebo-controlled, two-center clinical trial to determine the maximum tolerated dosage of intravenous tirofiban in patients with aneurysmal subarachnoid hemorrhage (aSAH) post-endovascular coiling. Read more about this study
- Who is it for?
- Ages 18 to 85 years
- Conditions the study is for
- Aneurysmal Subarachnoid Hemorrhage
- What is being tested?
- Tirofiban
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 82 participants
- Where
- 2 sitesUnited States
- Study dates
- 5 Nov 2026to 5 May 2032
- Phase
- Phase 1/2
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 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age 18-85
- Baseline Modified Rankin Scale (mRS) 0-3 (pre-SAH)
- SAH attributed to ruptured cerebral aneurysm
- Admission Computed Tomography (CT) scan shows Modified Fisher grade 1-4 due to aSAH primarily in the supratentorial space
- World Federation of Neurosurgical Societies (WFNS) scale grade ≤4 at randomization
- Onset of symptoms of aSAH (ictus) occurred <72 hours prior to presentation
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- If External Ventricular Drain (EVD) placed, placement is ≥12 hours prior to enrollment
- All aneurysm(s) suspected to be responsible for the hemorrhage must be secured via Endovascular Coil Embolization with a post-embolization Raymond-Roy Score of 1 (Complete) or 2 (Residual Neck) prior to enrollment
- Participant can be randomized within 48 hours of aneurysm treatment
- Participant or participant's legally-authorized representative (LAR) has provided documented informed consent
Who cannot join
- Angio-negative SAH, defined as a SAH with a digital subtraction angiogram that does not show an intracranial aneurysm
- Surgical clipping prior of the ruptured aneurysm or any non-ruptured aneurysm on the same admission to enrollment
- Remaining untreated aneurysm(s) that could reasonably be considered a possible alternate cause of the aSAH based on the observed bleeding pattern
- Uncontrollable hypertension (>180 systolic and/or >110 diastolic) that is not correctable prior to enrollment
- Active internal bleeding, or history of bleeding diathesis, major surgical procedure, or severe physical trauma within the previous month (30 days)
- A medical diagnosis that requires continuous use of aspirin, clopidogrel, ticagrelor, or tirofiban during the study drug infusion
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- New parenchymal hemorrhage or new infarction larger than 15 cubic centimeters (cc) in volume by CT
- Thrombolytic therapy within 24 hours prior to enrollment (alteplase, tenecteplase, or urokinase)
- Previous intracranial hemorrhage, intracranial neoplasm, subarachnoid hemorrhage, or arterial-venous malformation
- Thrombocytopenia (platelet count <100,000/microliter (µL) assuming clumping is ruled out
- Allergy or intolerance to tirofiban
- Pregnant or lactating
- Chronic kidney disease with creatinine clearance (CrCl ≤ 30 milliliters per minute [ml/min]) or acute kidney injury (AKI) at study screening. AKI is defined as:
- Increase in serum creatinine by 0.3 milligrams per deciliter (mg/dL) or more (26.5 micromoles per liter [μmol/L] or more) within 48 hour period; OR ii) Increase in serum creatinine to 1.5 times or more than the baseline of the prior 7 day period; OR iii) Urine volume less than 0.5 ml/kg/hour for at least 6 hours
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
United States2 sites
Duke University Health System
Durham, North Carolina, 27710
Hazani Benitez-Rosas, AS, 919-681-4974, hazani.benitez-rosas@duke.edu
Beth A Perry, RN, 919-681-2695, beth.perry@duke.edu
University of Texas Health Sciences Center
Houston, Texas, 77030
Sprios Blackburn, MD, 713-486-8000, Spiros.Blackburn@uth.tmc.edu
Spiros Blackburn, MD
About this study
Official title: Induced Suppression of Platelet Activity in Aneurysmal Subarachnoid Hemorrhage Management-2
An exploratory, randomized, double-blinded, placebo-controlled, two-center clinical trial to determine the maximum tolerated dosage of intravenous tirofiban in patients with aneurysmal subarachnoid hemorrhage (aSAH) post-endovascular coiling. The study will also assess pharmacology and safety, with exploratory endpoints including delayed cerebral ischemia (DCI), vasospasm, and functional outcomes.
Read the detailed description
This is an exploratory, two-center, randomized, double-blinded study. The primary objective is to determine the maximum tolerated dosage (MTD) of tirofiban in the context of patients with aSAH status post-endovascular coiling. The dosage regimen of tirofiban will be 0.10µg/kg/min (actual weight) within 48 hours of aneurysm securing and within 72 hours of ictus.
The study will involve a dose escalation stage and a cohort expansion stage. During the dosage-escalation stage, the intervention doses include continuous intravenous (IV) tirofiban or IV placebo for 1 day, 3 days, 5 days, or 7 days. Dose-escalation will follow the time-to-event Bayesian Optimal Intervention (TITE-BOIN) design. Unlike the majority of existing phase I designs, which require suspending the accrual after treating each cohort of patients, the TITE-BOIN design allows for real-time dose assignment decisions for new patients while the toxicity data are still pending for some patients under treatment. This shortens the trial duration and reduces the logistical difficulties caused by frequent suspensions of accrual. For parallel comparison under real-world conditions, patients will be randomly assigned to tirofiban and placebo in a 2:1 ratio in the dose escalation stage. The data from the placebo patients will not be analyzed to inform dose escalation but included in the final analysis upon study completion. Upon the completion of the dose escalation stage, the MTD will be selected using isotonic regression. MTD will be selected as the dosage for which the isotonic estimate of the toxicity rate is closest to the target dosage-limiting toxicity rate (30%). If there is a tie, we will select the higher dosage level when the isotonic estimate is lower than the target toxicity rate, and we will select the lower dosage level when the isotonic estimate is greater than or equal to the target toxicity rate.
During the cohort expansion stage, patients will be randomized to tirofiban at MTD and placebo at the corresponding dosage level to achieve balanced sample sizes (30 tirofiban at MTD and 30 placebo for any infusion duration, combined from both phases) across the two groups. The analysis of the exploratory endpoints will be performed on the tirofiban patients at MTD and placebo patients with any infusion duration.
An interim pharmacokinetic (PK) analysis will be performed after 10 evaluable patients are treated with tirofiban to determine possible dose modification. At the completion of the study, PK and pharmacodynamic (PD) analysis will be conducted using all evaluable patients treated with tirofiban to determine whether augmented renal clearance in aSAH interacts with the pharmacokinetics and pharmacodynamics of tirofiban.
- Conditions
- Aneurysmal Subarachnoid Hemorrhage
- Being tested
- Tirofiban, Placebo
- Keywords
- Subarachnoid Hemorrhage, Delayed Cerebral Ischemia, Tirofiban, Brain Aneurysm Rupture
- Medical subject headings
- Subarachnoid Hemorrhage
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TirofibanDrug
Also called Aggrastat ®
IV infusion at 0.10 microgram/kilogram/minute (mcg/kg/min) for 1 day, 3 days, 5 days, or 7 days according to the dose escalation procedure.
PlaceboDrug
Also called Normal Saline
IV infusion at the same infusion duration as the study drug; same adjustments
| Study group | Role | What they receive |
|---|---|---|
| Tirofiban | Experimental | Continuous IV infusion of tirofiban for 1, 3, 5, or 7 days post-endovascular coiling. Receives: Drug: Tirofiban |
| Placebo | Placebo comparator | Continuous IV infusion of saline placebo for 1, 3, 5, or 7 days post-endovascular coiling. Receives: Drug: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Tirofiban dosage-limiting toxicity (DLT)
Presence of any of the following: any intracranial hemorrhage, major extracranial hemorrhage (defined as clinically overt bleeding leading to death; OR clinically overt bleeding causing a reduction in hemoglobin of ≥2g/dl; OR clinically overt bleeding necessitating transfusion of ≥2 units of packed red cells or whole blood; OR clinically overt bleeding in a critical area or organ other than the intracranial compartment (including intraspinal, intraocular, pericardial, intra-articular, retroperitoneal, intramuscular [with compartment syndrome])), thrombocytopenia, or serious adverse event (SAE) due to tirofiban.
Measured: Within 14 days post-randomization
Secondary outcomes (7)
Pharmacokinetic parameters - total clearance (Cltot)
Measured: Up to 7 hours after drug discontinuation
Pharmacokinetic parameters - Volume of distribution (Vd)
Measured: Up to 7 hours after drug discontinuation
Pharmacokinetic parameters - Maximum (peak) plasma concentration (Cmax)
Highest concentration of tirofiban in the blood after a dose is administered
Measured: Up to 7 hours after drug discontinuation
Pharmacokinetic parameters - Minimum (trough) plasma concentration (Cmin)
Lowest observed concentration of tirofiban in the blood after a dose is administered
Measured: Up to 7 hours after drug discontinuation
Pharmacokinetic parameters - Average Plasma Concentration (Cavg)
Average tirofiban concentration in the blood at steady state
Measured: Up to 7 hours after drug discontinuation
Pharmacokinetic parameters - Area Under the Concentration (AUC)Time Curve
Area under the curve from time 0 extrapolated to infinite time
Measured: Up to 7 hours after drug discontinuation
Pharmacodynamic parameters - adenosine diphosphate (ADP)
The percent inhibition of ADP-induced platelet aggregation
Measured: Baseline, 2, 6, and every 24 hours and at drug cessation
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Mar 2026
- Study start5 Nov 2026 (estimated)
- Primary completion5 May 2029 (estimated)
- Study completion5 May 2032 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Aneurysmal Subarachnoid HemorrhageStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 1/2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 82 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Dr David Hasan, M.D.
- Sponsor type
- University, hospital or other
- Collaborators
- National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS)
- Responsible party
- Sponsor-investigator, Dr David Hasan, M.D., Duke University
- Investigators
- Emad Hasan, MD, Principal investigator, Duke UniversityBrian Mac Grory, MD, Principal investigator, Duke University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07493577
- Sponsor's protocol ID
- Pro00119469
- Other IDs
- UG3NS138219
- Acronym
- iSPASM-2
- Status last verified
- Oct 2026
- First submitted
- 10 Mar 2026
- Last updated
- 19 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No