Safety, Tolerability, and Preliminary Efficacy of HRS-7450 Injection in the Treatment of Acute Ischemic Stroke: a Multi-center, Randomized, Double-blind, Double-dummy, Placebo-controlled Clinical Trial

Prior treatment

• Treatment with ateplase, teneplase, or other thrombolytic drugs;
• Previous history of intracranial hemorrhage;
• Major surgical procedures or severe injuries within the past 2 weeks;
• Received therapeutic or prophylactic doses of heparin treatment within 24 hours;
• Use thrombin inhibitors, Xa factor inhibitors, or other anticoagulant drugs under study within48 hours;
• Participate in clinical studies of other drugs or devices within the first three months of the screening period (sign an informed consent form and receive treatment with the trial drug/device);

Other illness

• Intracranial hemorrhagic diseases;
• Epileptic seizures or neurological dysfunction after seizures, or combined with other neurological/psychiatric disorders leading to uncooperative or non cooperative physical examinations;
• Have a history of ischemic stroke, severe traumatic brain injury, or intracranial or spinal surgery in the past month;
• Gastrointestinal or urinary system bleeding within the past 2 weeks;
• Arterial puncture that is difficult to compress and stop bleeding within the past week;
• Active visceral bleeding;
• Subjects with known potential bleeding constitution or coagulation dysfunction;
• Known to be allergic to any component of HRS-7450 or its formulations or placebo;
• The terminal state of the disease, with an expected survival period of no more than 1 year;

Lab values

• Screening period examination: Blood glucose\<2.8 or\>22.2mmol/L, platelet\<100 \* 109/L, other findings suggestive of a high risk of bleeding;
• Within the past 3 months, acute ST segment elevation myocardial infarction (MI) and/or acute decompensated heart failure occurred, and/or QTc\>520 milliseconds, and/or due to acute coronary syndrome MI、 Hospitalization or involuntary coronary intervention for cardiac arrest; Or New York Heart Association Grade III/IV heart failure; Or known to have ventricular tachycardia;
• History of severe liver disease, or aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) and/or glutamyltransferase (GGT) ≥ 3 x ULN and/or total bilirubin (TBIL) ≥ 2 x ULN.
• Severe kidney disease with clinical significance, or eGFR\<45mL/min/1.73 m2;
• Subjects with a known history of glucose-6-phosphate dehydrogenase deficiency or a family history;
• Oral coumarin anticoagulants with an international standardized ratio INR\>2.7;
• Use platelet IIb/IIIa receptor inhibitors within 48 hours;

Age

• Pregnant women, or women of childbearing age who test positive for pregnancy, or those who are breastfeeding;

Other

• Proposed endovascular treatment;
• Aortic arch dissection;
• NIHSS awareness score 1a\>2 points;
• Non enhanced CT shows a low-density shadow greater than one-third of the blood supply area of the middle cerebral artery or an ASPECT score of less than 6 points in the anterior circulation;
• Intracranial tumors, arteriovenous malformations, and giant aneurysms;
• Acute occlusion of the internal carotid artery due to carotid artery dissection;
• Multiple infarcts in areas supplied by multiple large blood vessels;
• After actively reducing blood pressure, systolic blood pressure ≥ 180mmHg and/or diastolic blood pressure ≥ 100mmHg;
• Other situations where the researcher deems it inappropriate to participate in this experiment.

• Fully understand and voluntarily participate in this study, and sign an informed consent form (the informed consent form can be voluntarily signed by the individual or legal representative);
• 18 ≤ Age ≤ 80 years old;
• The onset time is within 4.5 to 24 hours, and medication can be completed within 24 hours of onset (onset time is defined as the patient's last normal time);
• Clinically diagnosed as acute ischemic stroke (diagnosis follows the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2023);
• mRS score ≤ 2 before the first episode;
• When screening, the National Institutes of Health Stroke Scale (NIHSS) scores from 3 to 25 (including both ends);
• Female and male participants with fertility must agree to use efficient contraception measures from the signing of the informed consent form until one month after the last administration of the investigational drug, without a birth plan, and without donating sperm/eggs. (See "Contraceptive methods" in the attachment for details).