Current partner codePEPTIDESDE
NCT03735979·Phase 3·INTERVENTIONAL

Multi-arm Optimization of Stroke Thrombolysis

Status

Completed

Phase

Phase 3

Enrollment

514

Locations

61

Results

Posted

Publications

6

Study summary

What the protocol is testing.

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.

Interventions

Treatment arms and agents.

DRUG

Argatroban

Direct Thrombin Inhibitor - Argatroban is a derivative of arginine that competitively binds to the active site of thrombin thereby preventing fibrin deposition. With a half-life of 30 minutes, argatroban has an immediate anticoagulant effect after IV administration which is rapidly reversed with discontinuation of the drug.

DRUG

Eptifibatide

GP 2b/3a Receptor Inhibitor - The final step of platelet aggregation is mediated via the GP2b/3a receptor. Eptifibatide was specifically developed to ensure rapid inhibition of platelet aggregation (within 15 minutes), a short half-life (\~2 hours) and rapid dissociation from platelets with 50% restoration of platelet function within 2-4 hours of discontinuation.

DRUG

Placebo

IV placebo solution

Timeline

From registration to results.

  1. First posted

    Nov 8, 2018

  2. Study start

    Oct 15, 2019

  3. Primary completion

    Dec 1, 2023

  4. Study completion

    Oct 31, 2024

  5. Results posted

    Nov 19, 2024

  6. Registry updated

    Feb 7, 2025

Outcomes

What the study measures.

Primary outcomes

90-day Utility Weighted Modified Rankin Scores (UW-mRS)

Time frame · 90 days after randomization

The modified Rankin scale is a 7 point ordinal scale ranging from 0="no symptoms" to 6="death" . For the primary analysis, the scale was analyzed with patient-centered utility weights. We assigned the following utility weights to the seven levels: 10, 9.1,, 7.6, 6.5, 3.3, 0, 0 (with higher scores indicating a better outcome).

Secondary outcomes

Percentage of Participants With NIHSS Less Than or Equal to 2 at 24 Hours

Time frame · 24 hours after randomization

National Institute of Health Stroke Scale (NIHSS) scores range from 0 to 42, with higher scores indicating worse neurologic deficit. This is a dichotomous analysis with a cutpoint of 0,1,2 defining the event.

Change From Baseline to 24-hour NIHSS

Time frame · 24 hours after randomization

National Institute of Health Stroke Scale (NIHSS) scores range from 0 to 42, with higher scores indicating worse neurologic deficit.

Percentage of Participants With 90-day mRS 0 or 1 (or Return to Their Historical mRS)

Time frame · 90 days after randomization

The modified Rankin scale (mRS) is a 7 point scale ranging from 0="no symptoms" to 6="death" where lower scores are better outcomes. For patients with a pre-stroke mRS of greater than 0 or 1, these patients had to return to their historical (pre-stroke) value to be counted as a success.

Percentage of Participants With 90-day mRS 0, 1 or 2 (or Return to Their Historical mRS)

Time frame · 90 days after randomization

modified Rankin scale is a 7 point scale ranging from 0="no symptoms" to 6="death" where lower scores are better outcomes.

90-day mRS

Time frame · 90 days after randomization

modified Rankin scale is a 7 point ordinal scale ranging from 0="no symptoms at all" to 6="death" where lower scores are better outcomes.

90-day EQ-5D

Time frame · 90 days after randomization

EuroQol Five-Dimension (EQ-5D) is a measure of health-related quality of life ranging from -0.59 to 1 where 1 is the best possible health state.

Pre-thrombectomy Modified TICI Score of 2B.

Time frame · baseline

The modified thrombolysis in cerebral infarction (TICI) score prior to endovascular thrombectomy procedure. The modified pre-thrombectomy TICI score is a 4 point scale with possible values of 0, 1, 2A, and 2B. The values are defined as follows: 0=No flow, 1=Penetration without distal branch filling, 2A=\<50% partial reperfusion, and 2B=50%-99% partial reperfusion.

Post-thrombectomy Modified TICI Score of 2B or 3

Time frame · baseline

The modified thrombolysis in cerebral infarction (TICI) score prior to endovascular thrombectomy procedure. The modified post-thrombectomy TICI score is a 5 point scale with possible values of 0, 1, 2A, 2B, 3. The values are defined as follows: 0=No flow, 1=Penetration without distal branch filling, 2A=\<50% partial reperfusion, 2B=50%-99% partial reperfusion, and 3=Completed reperfusion

Eligibility

Who can take part.

Minimum age
18 Years
Maximum age
Not reported
Sex
ALL
Healthy volunteers
No

Inclusion Criteria: 1. Acute ischemic stroke patients 2. 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 3. Age ≥ 18 4. NIHSS score ≥ 6 prior to IV thrombolysis 5. Able to receive assigned study drug within 60 minutes but no later than 75 minutes of initiation of IV thrombolysis Exclusion Criteria: 1. Known allergy or hypersensitivity to argatroban or eptifibatide 2. Previous stroke in the past 90 days 3. Previous intracranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation 4. Clinical presentation suggested a subarachnoid hemorrhage, even if initial CT scan was normal 5. Any surgery, or biopsy of parenchymal organ in the past 30 days 6. Trauma with internal injuries or ulcerative wounds in the past 30 days 7. Severe head trauma in the past 90 days 8. Systolic blood pressure persistently \>180mmHg post-IV thrombolysis despite antihypertensive intervention 9. Diastolic blood pressure persistently \>105mmHg post-IV thrombolysis despite antihypertensive intervention 10. Serious systemic hemorrhage in the past 30 days 11. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR \>1.5 12. Positive urine or serum pregnancy test for women of child bearing potential 13. Glucose \<50 or \>400 mg/dl 14. Platelets \<100,000/mm3 15. Hematocrit \<25 % 16. Elevated pre-thrombolysis PTT above laboratory upper limit of normal 17. Creatinine \> 4 mg/dl 18. Ongoing renal dialysis, regardless of creatinine 19. Received Low Molecular Weight heparins (such as Dalteparin, Enoxaparin, Tinzaparin) in full dose within the previous 24 hours 20. Abnormal PTT within 48 hours prior to randomization after receiving heparin or a direct thrombin inhibitor (such as bivalirudin, argatroban, dabigatran or lepirudin) 21. Received Factor Xa inhibitors (such as Fondaparinaux, apixaban or rivaroxaban) within the past 48 hours 22. Received glycoprotein IIb/IIIa inhibitors within the past 14 days 23. Pre-existing neurological or psychiatric disease which confounded the neurological or functional evaluations e.g., baseline modified Rankin score \>3 24. 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 25. Current participation in another research drug treatment or interventional device trial - Subjects could not start another experimental agent until after 90 days 26. Informed consent from the patient or the legally authorized representative was not or could not be obtained 27. High density lesion consistent with hemorrhage of any degree 28. 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

Study locations

61 registered sites.

United States. Showing up to 24 locations stored in the fast local snapshot.

University of Alabama Hospital

Birmingham, Alabama, United States

St. Jude Medical Center

Fullerton, California, United States

UCSD Health La Jolla

La Jolla, California, United States

Kaiser Permanente Los Angeles Medical Center

Los Angeles, California, United States

Cedars-Sinai Medical Center

Los Angeles, California, United States

UC Irvine Medical Center

Orange, California, United States

UCSD Medical Center - Hillcrest Hospital

San Diego, California, United States

San Francisco General Hospital

San Francisco, California, United States

UCSF Medical Center

San Francisco, California, United States

Santa Barbara Cottage Hospital

Santa Barbara, California, United States

Yale New Haven Hospital

New Haven, Connecticut, United States

Baptist Medical Center Jacksonville

Jacksonville, Florida, United States

Mayo Clinic Hospital

Jacksonville, Florida, United States

Jackson Memorial Hospital

Miami, Florida, United States

Sarasota Memorial Hospital

Sarasota, Florida, United States

Tampa General Hospital

Tampa, Florida, United States

Grady Memorial Hospital

Atlanta, Georgia, United States

University of Chicago Medical Center

Chicago, Illinois, United States

Loyola University Medical Center

Maywood, Illinois, United States

Javon Bea Hospital - Riverside

Rockford, Illinois, United States

Central DuPage Hospital

Winfield, Illinois, United States

University of Kansas Hospital

Kansas City, Kansas, United States

University of Kentucky Hospital

Lexington, Kentucky, United States

Massachusetts General Hospital

Boston, Massachusetts, United States

Publications

Results and literature.

PMID 41071964Roy A, Elm J, Ingles JR, Sabagha N, Huang JF, Bentho O, Ranasinghe T, Streib C, Concha M, Khatri P, Vagal A, Wintermark M, Derdeyn CP, Broderick JP, Barreto AD, Adeoye O, Grotta JC. Thrombolysis Alone vs With Argatroban or Eptifibatide: A Prespecified Subgroup Analysis of the MOST Trial. Neurology. 2025 Nov 11;105(9):e214228. doi: 10.1212/WNL.0000000000214228. Epub 2025 Oct 10.PMID 40824660Rines I, Adeoye O, Barreto AD, Broderick J, Carrozzella J, Chen H, Concha M, Elm J, Grotta JC, Jasne AS, Khatri P, Roy A, Vagal A, Wintermark M, Yoo AJ, Derdeyn CP; MOST Investigators. Intravenous Argatroban or Eptifibatide in Patients Undergoing Mechanical Thrombectomy: A Subgroup Analysis of the MOST Randomized Clinical Trial. JAMA Neurol. 2025 Aug 18;82(10):1004-12. doi: 10.1001/jamaneurol.2025.2794. Online ahead of print.PMID 40123511Shawkat A, Barreto AD, Broderick JP, Derdeyn CP, Grotta JC, Khatri P, Pizzella S, Rines I, Roy A, Wilson A, Wintermark M, Adeoye OM. Comparison of Local and Centrally Adjudicated Modified Rankin Scale Scores in the MOST Trial. Stroke. 2025 May;56(5):1280-1284. doi: 10.1161/STROKEAHA.124.049825. Epub 2025 Mar 24.PMID 39231343Adeoye O, Broderick J, Derdeyn CP, Grotta JC, Barsan W, Bentho O, Berry S, Concha M, Davis I, Demel S, Elm J, Gentile N, Graves T, Hoffman M, Huang J, Ingles J, Janis S, Jasne AS, Khatri P, Levine SR, Majjhoo A, Panagos P, Pancioli A, Pizzella S, Ranasinghe T, Sabagha N, Sivakumar S, Streib C, Vagal A, Wilson A, Wintermark M, Yoo AJ, Barreto AD. Adjunctive Intravenous Argatroban or Eptifibatide for Ischemic Stroke. N Engl J Med. 2024 Sep 5;391(9):810-820. doi: 10.1056/NEJMoa2314779.PMID 37256980Romano JG, Rundek T. Expanding Treatment for Acute Ischemic Stroke beyond Revascularization. N Engl J Med. 2023 Jun 1;388(22):2095-2096. doi: 10.1056/NEJMe2303184. No abstract available.PMID 33297893Deeds SI, Barreto A, Elm J, Derdeyn CP, Berry S, Khatri P, Moy C, Janis S, Broderick J, Grotta J, Adeoye O. The multiarm optimization of stroke thrombolysis phase 3 acute stroke randomized clinical trial: Rationale and methods. Int J Stroke. 2021 Oct;16(7):873-880. doi: 10.1177/1747493020978345. Epub 2020 Dec 9.

Primary links

Continue at the source.

Related trials

More studies on Eptifibatide.

Related PeptideStat pages

Put the record in context.

Research pages describe evidence. Vendor pages, where available, describe independently tracked research-product listings and are not clinical recommendations.