Desmoteplase is another plasminogen activator that is an isolate of saliva from vampire bats. It has high fibrin specificity and a long half-life (34). The Desmoteplase in acute ischemic stroke trial (DIAS) was undertaken to study the safety and efficacy of desmoteplase in patients with ischemic stroke and an magnetic resonance imagining (MRI) perfusion/diffusion mismatch at between 3 and 9 hr from stroke onset (35). Using initial doses of between 25 and 50 mg, the rates of symptomatic ICH within 72 hr were high (23.5-30.8%). After a protocol amendment, the trial was continued using a body-weight adjusted dose-escalation design (Part 2). Of the 45 desmoteplase-treated patients in this portion of the trial, one (2.2%) experienced symptomatic ICH. A greater improvement in reperfusion was observed in the desmoteplase-treated patients (20 of 42; 47.6%), as compared to patients in the placebo group (2 of 10; 20%). In a comparison of treatment groups from Part 2 of the trial, the patients who received a dose of 125 |g/kg of desmoteplase had a more favorable outcome at 90 days (60.0%) than did patients in the placebo group (18.2%, p = 0.009). However, in a comparison of all patients, the difference between placebo and desmoteplase was not significant. Currently, DIAS-2 is underway. Patients will be randomized to receive either placebo, or one of two doses (90 or 125 |/kg) of desmoteplase.

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