The Effect of Vonoprazan-based Dual Eradication Therapy vs PPI Treatment on Gastrointestinal Bleeding in ACS Patients With Hp Infection and Coronary Stents: an Open-label, Randomized, Controlled Trial
试验速览
- 阶段
- 4 期
- 状态
- 招募中
- 入组人数
- 2,600
- 试验地点
- 42
- 主要终点
- Gastrointestinal bleeding of 6 months in patients with ACS after PCI
研究概览
简要总结
Patients with acute coronary syndrome (ACS) after Percutaneous Coronary Intervention (PCI) require routine treatment with dual antiplatelet (DAPT) treatment, but with the high risk of bleeding, gastrointestinal bleeding is the most common type of major bleeding. Helicobacter pylori (Hp) infection is a high-risk factor for gastrointestinal bleeding, with an incidence of about 50%. Foreign authoritative DAPT guidelines do not give individual guidance to Hp-infected patients. It is recommended that those with high bleeding risk should be combined with proton pump inhibitors (PPI), but long-term compliance with PPI is not ideal. Authoritative experts in China have agreed to recommend Hp detection and eradication therapy for DAPT patients, but loss of evidence. Vonoprazan is a novel potassium ion competitive acid blocker, based on Vonoprazan's dual Hp eradication therapy is simple and effective. Our team will conduct a multi-center, open-label, randomized controlled clinical trial using a non-inferior design to compare the combination of Vonoprazan + amoxicillin combined with pantoprazole (PPI) for 6 months after PCI on the bleeding events of the digestive tract.
详细描述
This study plans to enroll 2600 patients, 1300 patients in each group, in the project participating hospitals who received coronary stenting and are expected to undergo DAPT ≥6 months after operation. Hp13C-urea breath test and serum Hp antibody scores Type detection, patients with positive Hp infection.
Antiplatelet drugs (DAPT) use aspirin 100 mg qd, plus clopidogrel 75 mg qd or aspirin 100mg qd plus ticagrelor 90 mg bid. The specific medication is evaluated and decided by the interventional doctor.
After the subjects in each center signed a written informed consent form, they randomly divided each test case into a test group or a control group at a 1:1 ratio:
- Test group:
In the project participating hospitals who received coronary stenting and are expected to undergo DAPT ≥6 months after operation. Hp13C-urea breath test and serum Hp antibody scores Type detection, patients with positive Hp infection. Antiplatelet drugs (DAPT) use aspirin 100 mg qd, plus clopidogrel 75 mg qd or aspirin 100 mg qd, plus ticagrelor 90 mg bid. The specific medication is evaluated and decided by the interventional doctor.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with ACS and PCI treatment and postoperative DAPT ≥ 6 months;
- •Hp infection is positive;
- •Age ≥18 years old;
- •The patient himself or his authorized client signs the subject's consent.
排除标准
- •Previous history of gastrointestinal ulcer bleeding;
- •Long-term use of PPI and H2 receptor inhibitors in the past;
- •Complicated with gastroesophageal varices, or after gastrectomy;
- •Those who are taking anti-coagulation drugs such as vitamin K antagonists (warfarin) ,factor X or factor II inhibitors;
- •Recently received fibrinolytic therapy (using fibrin-specific drugs within 24 hours before randomization, or using non-fibrin-specific drugs within 48 hours before randomization);
- •Recently accepted (within 30 days before randomization) or planned to undergo coronary artery bypass grafting (CABG);
- •Combining active bleeding or coagulation dysfunction (indicator);
- •In patients with liver and kidney disease, serum creatinine is greater than 150 μmol/L, GFR <60ml/min/1.73m2, alanine aminotransferase and aspartate aminotransferase increase ≥3 times from the normal value;
- •Complicated with hemorrhagic stroke, intracranial tumor, arteriovenous malformation or aneurysm;
- •Anemia (adult male hemoglobin less than 120 g/L or red blood cells less than 4×10^12/L,adult female hemoglobin less than 105 g/L or red blood cells less than 3.5×10^12/L);
- •Systemic glucocorticoid application;
- •Have taken antibiotics and other drugs that affect the flora in the stomach within the past month;
- •A history of allergy to aspirin, clopidogrel, ticagrelor, pantoprazole, penicillin and other test drugs;
- •Pregnancy or breastfeeding women and subjects of childbearing age who do not want to take contraceptive measures;
- •With malignant tumors and other diseases, the expected survival time is less than 1 year;
- •Patients who participated in clinical trials of other drugs or are participating in clinical studies of other new drugs within 30 days before enrollment;
- •Complicated with mental illness or severe neurosis;
- •Can't express subjective discomfort symptoms;
- •The investigator decides that it is not suitable to participate in this research.
研究组 & 干预措施
Vonoprazan-based dual eradication therapy
H. pylori eradication using a dual eradication regimen, a course of 14 days, followed up to 6 months after randomization; the treatment regimen is as follows: routine use of Vonoprazan 20mg bid + amoxicillin 1g tid, a course of 14 days .
干预措施: Vonoprazan-based dual eradication therapy for two weeks (Drug)
Vonoprazan-based dual eradication therapy
H. pylori eradication using a dual eradication regimen, a course of 14 days, followed up to 6 months after randomization; the treatment regimen is as follows: routine use of Vonoprazan 20mg bid + amoxicillin 1g tid, a course of 14 days .
干预措施: amoxicillin (Drug)
Pantoprazole
To take pantoprazole 40 mg daily, followed up to 6 months after randomization.
干预措施: Pantoprazole (Drug)
结局指标
主要结局
Gastrointestinal bleeding of 6 months in patients with ACS after PCI
时间窗: 6 months
To compare the effects of the combination of vonoprazan + amoxicillin and pantoprazole on gastrointestinal bleeding events within 6 months in patients with ACS after PCI，The primary endpoint was gastrointestinal bleeding, including gastroduodenal bleeding, gastrointestinal bleeding with unknown bleeding site, and occult gastrointestinal bleeding.
次要结局
- major adverse cardiovascular and cerebrovascular events (MACCE)(6 month)
- complex gastrointestinal event(6month)