Efficacy and Safety Study of Desmoteplase to Treat Acute Ischemic Stroke (DIAS-4)

Acute stroke is a major cause of mortality and long-term disability in the developed world.
The only currently approved thrombolytic intervention for acute ischemic stroke, which
constitutes the majority of strokes, is alteplase (recombinant tissue plasminogen activator;
rtPA). The use of alteplase is limited as it is approved for use within 3 hours after
symptom onset and by the risk of inducing intracerebral haemorrhage; consequently fewer than
3% of acute stroke subjects are treated. The thrombolytic agent desmoteplase (recombinant
Desmodus Salivary Plasminogen Activator alpha-1; rDSPAalpha-1) produced by recombinant
biotechnology has its naturally occurring counterpart in the saliva of the vampire bat
Desmodus rotundus. Compared to alteplase, desmoteplase has a more favourable profile in
terms of high fibrin specificity and non neurotoxicity.

The study aims to confirm efficacy and safety of desmoteplase for thrombolytic therapy of
patients with acute ischaemic stroke in the extended time window of 3 to 9 hours after onset
of stroke symptoms.

Inclusion Criteria:

- Diagnosis of acute ischemic stroke

- Informed consent

- Age between 18 and 85 years

- Treatment can be initiated within 3 to 9 hours after the onset of stroke symptoms

- NIHSS Score of 4 to 24

- Vessel occlusion or high-grade stenosis on MRI or CTA in proximal cerebral arteries

Exclusion Criteria:

- Pre-stroke mRS >1

- Previous exposure to desmoteplase

- Extensive early infarction on MRI or CT in any affected area

- Imaging evidence of ICH or SAH; AV malformation; cerebral aneurysm; or cerebral
neoplasm

- Internal carotid artery occlusion on the side of the stroke lesion

- Treatment with heparin in the past 48 hours and a prolonged partial thromboplastin
time

- Treatment with oral anticoagulants and a prolonged prothrombin time

- Treatment with glycoprotein IIb - IIIa inhibitors within the past 72 hours. Use of
single agent oral platelet inhibitors is permitted

- Treatment with a thrombolytic agent within the past 72 hours