To compare two medication therapies to prevent thrombus (blood cloth) formation following the successful treatment of a coronary heart disease with expansion of coronary stent (metallic tube) covered with medication (Drug Eluting Stent-DES): a shortened versus a prolonged dual antiplatelet therapy (DAPT, drugs that inhibit bloodplatelets, blood cells involved in the thrombus formation process).
- Conditions
- High bleeding risk population represents a significant proportion of coronary artery disease (CAD) patients undergoing coronary stent implantation. Decisions regarding the duration of dual antiplatelet therapy (DAPT) after stent implantation are difficult, especially after implantation of newer generation drug eluting stents (DES) due to conflicting results from recent trials. High bleeding risk patients either male or female eligible for percutaneous coronary intervention will be included.MedDRA version: 20.0Level: SOCClassification code 10007541Term: Cardiac disordersSystem Organ Class: 10007541 - Cardiac disordersTherapeutic area: Diseases [C] - Cardiovascular Diseases [C14]
- Registration Number
- EUCTR2017-001834-25-SE
- Lead Sponsor
- ECRI-9
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Authorised-recruitment may be ongoing or finished
- Sex
- All
- Target Recruitment
- 4300
After index PCI, patients aged 18 years or more are eligible for inclusion into the study if the following criteria are met:
1) At least one among the High Bleeding Risk (HBR) criteria (as defined below) is met.
2) All lesions are successfully treated with Ultimaster stent in the context of routine clinical care, i.e. post-procedural angiographic diameter stenosis <20% by visual estimation
3) Free from any flow-limiting angiographic complications (i.e. significant untreated dissection or major side-branch occlusion), which require prolonged DAPT duration based on operator’s opinion.
4) All stages of PCI are complete (if any) and no further PCI is planned.
Inclusion criteria at one-month randomization visit
At randomization visit (one month after index PCI), the following criteria must be met:
1) Fulfilment of at least one HBR criterion (as defined below), or on the basis of post-PCI actionable (i.e. requiring medical attention) non-access site related bleeding episode
2) Uneventful 30-day clinical course, i.e. free from spontaneous MI, symptomatic restenosis, stent thrombosis, stroke and any revascularization (coronary and non-coronary) requiring prolonged DAPT
3) If not on OAC,
a.Patient is on a DAPT regimen of aspirin and a P2Y12 inhibitor
b.Patient with one type of P2Y12 inhibitor for at least 7 days (i.e. no switching between oral P2Y12 inhibitors has occurred in the previous 7 days)
4)If on OAC
a.Patient is on the same type of OAC (e.g. Vitamin K antagonist or NOAC) for at least 7 days
b.Patient is on clopidogrel for at least 7 days
Definition of HBR
Post-PCI patients are at HBR if at least one of the following criteria applies:
•Clinical indication for treatment with oral anticoagulants (OAC) for at least 12 months
•Recent (<12 months) non-access site bleeding episode(s), which required medical attention (i.e. actionable bleeding).
•Previous bleeding episode(s) which required hospitalization if the underlying cause has not been definitively treated (i.e. surgical removal of the bleeding source)
•Age equal or greater than 75 years
•Systemic conditions associated with an increased bleeding risk (e.g. haematological disorders, including a history of or current thrombocytopaenia defined as a platelet count <100,000/mm3 (<100 x 109/L), or any known coagulation disorder associated with increased bleeding risk.
•Documented anaemia defined as repeated haemoglobin levels <11 g/dl or transfusion within 4 weeks before inclusion.
•Need for chronic treatment with steroids or non-steroidal anti-inflammatory drugs
•Diagnosed malignancy (other than skin) considered at high bleeding risk including gastro-intestinal, genito-urethral/renal and pulmonary.
•Stroke at any time or TIA in the previous 6 months
•PRECISE DAPT score of 25 or greater
Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 430
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 3870
Patients are not eligible if any of the following applies
1)Treated with stents other than Ultimaster stent within 6 months prior to index procedure
2)Treated for in-stent restenosis or stent thrombosis at index PCI or within 6 months before
3)Treated with a bioresorbable scaffold at any time prior to index procedure
4)Cannot provide written informed consent
5)Under judicial protection, tutorship or curatorship
6)Unable to understand and follow study-related instructions or unable to comply with study protocol
7)Active bleeding requiring medical attention (BARC=2) on randomization visit
8)Life expectancy less than one year
9)Known hypersensitivity or allergy for aspirin, clopidogrel, ticagrelor, prasugrel, cobalt chromium or sirolimus
10)Any planned and anticipated PCI
11)Participation in another trial
12)Pregnant or breast feeding women
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method