Stroke, Ischemic Clinical Trial
Official title:
The Efficacy of Citalopram Treatment in Acute Stroke
We wish to conduct a prospective, randomized, double blind, placebo controlled multi center
study of the combined neuroprotective and antithrombotic effects of SSRI treatment after
stroke.
Hypotheses:
SSRI treatment commenced in the acute phase of stroke (day 0-7) protects against new
thromboembolic events and leads to better rehabilitation. 600 stroke patients will be
randomized in a 1:1 ratio.
The treatment and follow up period is 6 months. During these 6 months there will be 2
clinical follow up visits, one telephone control and one visit to evaluate compliance
regarding medication.
Design TALOS is an investigator-initiated, national multicenter randomized- and
placebo-controlled, double blind trial testing citalopram in acute ischemic stroke.
Randomization Eligible patients will be randomized 1:1 to treatment with either citalopram
or placebo. Treatment allocation is double-blinded based on computer-generated algorithm via
a dedicated website. Patients whose treatment is stopped within 31 days after inclusion will
be replaced.
Intervention and follow-up Patients randomized to citalopram will receive oral treatment
with 20 mg tablets (10 mg if age ≥65 and/or reduced liver function) for 6 months with
telephone contact after 2 weeks and 3 months and follow-up visits at 1 and 6 months. If
patients develop depression dosage is initially doubled, followed by an additional control
to evaluate effect and, if necessary, shifted to open-label antidepressant treatment. After
6 months, treatment will either stop or switch to open-label antidepressants at the
discretion of the investigator.
Substudy 120 of patients will begin treatment within 12 hours after treatment with
recombinant tissue plasminogen activator. These patients will receive a standard acute
magnetic resonance imaging (MRI) with additional perfusion and angio sequences. The 24-hour
control scan will be done using MRI instead of conventional CT.
Data monitoring When 300 patients have been included in the trial, an interim analysis will
be performed. The unblinded results of this analysis will be reviewed by an independent data
monitoring committee.
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