Potassium-Competitive Acid Blocker versus pROton-Pump Inhibitor for GastroproTECTion Strategies In Patients at High Bleeding Risk Receiving Antithrombotic Therapy
- Conditions
- Diseases of the circulatory system
- Registration Number
- KCT0008146
- Lead Sponsor
- Asan Medical Center
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Recruiting
- Sex
- All
- Target Recruitment
- 3100
Inclusion Criteria
1. Patients 19 years of age or older with known cardiac and vascular disease who are receiving chronic use of antithrombotic drugs (either antiplatelets, oral anticoagulant (OAC), and its combinations). Specific clinical conditions that may confer a need for long-term antithrombotic therapy may include documented coronary artery disease (stable or unstable angina, acute coronary syndrome, a history of myocardial infarction, or any coronary revascularization), documented cerebrovascular disease (stroke or transient ischemic attack), known peripheral arterial disease or a history of peripheral arterial revascularization, atrial fibrillation, or valvular heart disease requiring interventions (transcatheter aortic valve replacement or transcatheter mitral-valve repair). Concomitant use of a proton pump inhibitor is strongly recommended in patients receiving aspirin monotherapy, DAPT (dual antiplatelet therapy; aspirin plus any P2Y12 inhibitors), DAT (dual antithrombotic therapy; antiplatelet drug plus OAC), TAT (triple antithrombotic therapy; DAPT plus OAC), or OAC monotherapy (warfarin or direct oral anticoagulants) who are at high risk of GI bleeding in order to reduce the risk of gastric bleed or GI events.
2. On the basis of clinical guidelines and expert consensus documents, we defined study population with increased risk of gastrointestinal bleeding if they had a least 1 or more criteria of the following characteristics. Eligible patients for randomization must meet at least 1 characteristic of these criteria:
*Definition of patients who are at high risk of gastrointestinal bleeding
Age =65 years
Concomitant use of OAC and any antiplatelet therapy (mono or DAPT) (i.e., DAT or TAT)
Long-term use of oral NSAIDs (non-steroidal anti-inflammatory drugs) or steroids or high dose NSAID therapy even during a relatively short-term period.
History of prior GI bleeding events at any time
History of a previously complicated ulcer
History of peptic ulcer disease or a previously uncomplicated ulcer
Documented Helicobacter pylori infection
3. Patients who voluntarily participated in the written agreement
Exclusion Criteria
1. Active bleeding at the time of inclusion or a history of hereditary or acquired hemostatic disorder
2. Any clinical contraindication to using of antithrombotic therapies (antiplatelet agents or OAC)
3. Concurrent use of PPI or P-CAB within 4 weeks before randomization
4. Hemodynamically unstable conditions at the time of inclusion: cardiogenic shock at the time of randomization, refractory ventricular arrhythmias, or congestive heart failure (New York Heart Association class IV).
5. Baseline severe anemia (Hgb <8 g/dl at baseline) or transfusion within 4 weeks before randomization
6. Baseline severe thrombocytopenia (platelet count <50,000/mm3)
7. Renal failure dependent on dialysis or severe renal insufficiency (creatinine clearance <15 ml/min)
8. Severe chronic liver disease (defined as variceal haemorrhage, ascites, hepatic encephalopathy, or jaundice)
9. Hypersensitivity or contraindication to PPI, P-CAB, any of the product components, or substituted benzimidazoles
10. Use of clarithromycin and hypersensitivity to macrolide antibiotics for Helicobacter pylori eradication
11. Concomitant use of clarithromycin with terfenadine, cisapride, astemizole, or pimozide for Helicobacter pylori eradication
12. Systemic treatment with strong CYP 3A4 and p-glycoprotein (P-GP) inhibitors (e.g., systemic azole antimycotics, such as ketoconazole, and human immunodeficiency virus [HIV]-protease inhibitors, such as ritonavir)
13. Patients who take atazanavir, nelfinavir, or rilpivirine-containing products (see Drug-Drug interaction section)
14. Clinically significant laboratory abnormality at screening (estimated glomerular filtration rate (eGFR) <15 mL/min or elevated liver enzyme [AST, ALT, ALP, total bilirubin] > 3 times upper normal limit [UNL] or any other condition that, in the opinion of the Investigator, precludes participation in the study
15. Any known or suspected malignancy
16. Subjects with non-cardiac co-morbidities with a life expectancy of less than 12 months
17. Subjects with active treatment for H-pylori infection
18. Women who are pregnant or breastfeeding or female subjects, premenopausal who are not surgically sterile, or, if sexually active not practicing an effective method of birth control (e.g., prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, contraceptive patch, male partner sterilization) before entry and throughout the study; and, for those of childbearing potential, who have a positive pregnancy test at screening
19. Participation in another clinical study within 12 months. However, where at least one or more conditions are satisfied, it could be an exception according to an investigator's discretion;
-Participated in the observational study expected no effect on the safety and/or effectiveness evaluation of this trial
-Screening failed before any interventional factor is involved
-Participated in academic trials like strategic or medical device comparison studies conducted under standard therapy provided that there is no additional risk or a specific procedure to a subject and no interference between this trial and other studies
Study & Design
- Study Type
- Interventional Study
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method 1.Overt upper gastrointestinal bleeding (confirmed by means of upper endoscopy or CT); ;2.Overt upper gastrointestinal bleeding of unknown origin; ;3.Bleeding of presumed occult gastrointestinal origin with documented decrease in hemoglobin of = 2 g/dL or decrease in hematocrit = 10% from baseline;;4.Symptomatic gastroduodenal ulcer (confirmed by means of endoscopy or CT) without evidence of gastrointestinal bleeding;;5.Persistent pain of presumed gastrointestinal origin (duration = 3 days) with underlying multiple erosive disease (5 or more gastroduodenal erosions confirmed by means of endoscopy); ;6.Obstruction; or ;7.Perforation.
- Secondary Outcome Measures
Name Time Method 1.Each component of the primary efficacy end point; ;2.Time from randomization to discontinuation of study medication attributed to gastrointestinal signs or symptoms;;3.Gastroesophageal reflux disease, as evidenced by symptomatic endoscopically confirmed erosive esophagitis; ;4.Composite cardiovascular safety end point (death from cardiovascular causes, non-fatal myocardial infarction, or non-fatal stroke);;5.Each component of composite cardiovascular end point;;6.Any coronary or peripheral revascularization;;7.All-cause mortality;