Trial reportStroke2013
Combined approach to lysis utilizing eptifibatide and recombinant tissue plasminogen activator in acute ischemic stroke-enhanced regimen stroke trial.
Trial report in Stroke, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00894803 (The "Combined Approach to Lysis Utilizing Eptifibatide and Rt-PA in Acute Ischemic Stroke-Enhanced Regimen"), which is not on this map. Cited by 40 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The "Combined Approach to Lysis Utilizing Eptifibatide and Rt-PA in Acute Ischemic Stroke-Enhanced Regimen" (CLEAR-ER Stroke Trial)
Who cites it
40 citing papers in PubMed, 5 syntheses or guidelines pooled it, 123 citations in OpenAlex.
- Eptifibatide as an adjuvant therapy to thrombolysis versus thrombolysis alone in stroke management: a systematic review and meta-analysis of randomized controlled trials.Journal of thrombosis and thrombolysis · 2025Pooled it
- Comparing Early National Institutes of Health Stroke Scale Versus 90-Day Modified Rankin Scale Outcomes in Acute Ischemic Stroke Trials: A Systematic Review and Analysis.Journal of the American Heart Association · 2025Pooled it
- Early antiplatelet therapy after intravenous thrombolysis for acute ischemic stroke: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Pooled it
- Effect of waivers of consent on recruitment in acute stroke trials: A systematic review.Neurology · 2016Pooled it
- Safety of Glycoprotein IIb-IIIa Inhibitors Used in Stroke-Related Treatment: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke.The New England journal of medicine · 2024Trial
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- A matched comparison of eptifibatide plus rt-PA versus rt-PA alone in acute ischemic stroke.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke AssociationTrial
- Optimizing Early Antithrombotic Therapy Within 24 Hours of Intravenous Thrombolysis in Acute Ischemic Stroke.CNS drugs · 2026Review
- CT perfusion ischemic core predicts PH-2 hemorrhagic transformation following intravenous alteplase bridging treatment prior to endovascular thrombectomy.Therapeutic advances in neurological disorders · 2026Article
- Thrombus Composition and the Evolving Role of Tenecteplase in Acute Ischemic Stroke.Journal of clinical medicine · 2025Article
- Adjunctive Antithrombotic Medications to Acute Reperfusion Therapy: Current Evidence and Future Directions.Stroke · 2025Review
- Comparative Effects of Glenzocimab and Eptifibatide on Bleeding Severity in 2 Mouse Models of Intracranial Hemorrhage.Journal of the American Heart Association · 2025Article
- Drip and ship in patients with acute ischemic stroke: a narrative review.Therapeutic advances in neurological disorders · 2025Review
- Eptifibatide use in ischemic stroke patients undergoing endovascular thrombectomy: A matched cohort analysis.Frontiers in neurology · 2022Article
- The multiarm optimization of stroke thrombolysis phase 3 acute stroke randomized clinical trial: Rationale and methods.International journal of stroke : official journal of the International Stroke Society · 2021Article
- European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.European stroke journal · 2021Article
- Effects of two different glycoprotein platelet IIb/IIIa inhibitors and the clinical endpoints in patients with intracranial Pipeline flow diverter implant.Journal of interventional medicine · 2020Article
- The "distal-to-proximal" strategy for the treatment of posterior circulation tandem occlusions: a single-centre experience.Neuroradiology · 2020Article
Corrections and comments
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Authors and funding
24 authors at 20 institutions in 17 countries.
Funding
Abstract
background and purposeIn a previous study, 0.3 and 0.45 mg/kg of intravenous recombinant tissue plasminogen activator (rt-PA) were safe when combined with eptifibatide 75 mcg/kg bolus and a 2-hour infusion (0.75 mcg/kg per minute). The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER) trial sought to determine the safety of a higher-dose regimen and to establish evidence for a phase III trial.
methodsCLEAR-ER was a multicenter, double-blind, randomized safety study. Ischemic stroke patients were randomized to 0.6 mg/kg rt-PA plus eptifibatide (135 mcg/kg bolus and a 2-hour infusion at 0.75 mcg/kg per minute) versus standard rt-PA (0.9 mg/kg). The primary safety end point was the incidence of symptomatic intracranial hemorrhage within 36 hours. The primary efficacy outcome measure was the modified Rankin Scale (mRS) score ≤1 or return to baseline mRS at 90 days. Analysis of the safety and efficacy outcomes was done with multiple logistic regression.
resultsOf 126 subjects, 101 received combination therapy, and 25 received standard rt-PA. Two (2%) patients in the combination group and 3 (12%) in the standard group had symptomatic intracranial hemorrhage (odds ratio, 0.15; 95% confidence interval, 0.01-1.40; P=0.053). At 90 days, 49.5% of the combination group had mRS ≤1 or return to baseline mRS versus 36.0% in the standard group (odds ratio, 1.74; 95% confidence interval, 0.70-4.31; P=0.23). After adjusting for age, baseline National Institutes of Health Stroke Scale, time to intravenous rt-PA, and baseline mRS, the odds ratio was 1.38 (95% confidence interval, 0.51-3.76; P=0.52).
conclusionsThe combined regimen of intravenous rt-PA and eptifibatide studied in this trial was safe and provides evidence that a phase III trial is warranted to determine efficacy of the regimen. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00894803.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.