- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02520921
Aspirin Twice a Day in Patients With Diabetes and Acute Coronary Syndrome (ANDAMAN)
Aspirin With a Novel Twice-a-day Administration in Diabetic Patients With Acute Coronary Syndrome to Minimize Recurrence of Acute Ischemic Events or New Urgent Revascularization
Study Overview
Status
Intervention / Treatment
Detailed Description
Patients who show high persistent platelet reactivity under aspirin are increasingly becoming an issue of clinical concern. Several studies have suggested that giving aspirin more frequently is very effective for reducing aspirin high persistent platelet reactivity, especially in diabetic patientsor in patients with a known risk factor. The aim of the study is to evaluate low dose of aspirin twice a day (compared to once a day) for the reduction of ischemic events in diabetic patients or in patients with a known risk factor, with acute coronary syndrome.
Experimental Design:
A multicenter, randomised, parallel group comparing aspirin given twice a day compared to once per day in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.
Primary objective:
To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on a composite end-point of ischemic events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.
Secondary objectives:
- To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on net clinical benefit combining the ischemic and bleeding events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.
- To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on cardiac events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.
- To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day in each of individual component of the main criterion.
- To confirm the safety of the innovative strategy (aspirin twice a day) concerning major bleeding events.
Study enrollment:
Multicentric national study involving 42 centers in France The duration is expected to be 24 months of recruitment. Patients will be randomized during the index hospitalization for acute coronary syndrome and before discharge between a conventional strategy of enteric coated aspirin 100mg per day with the standard of care or a innovative strategy of enteric coated aspirin 100mg morning and evening. Patients will be followed at one month, six months, one year and 18 months
Statistical analysis:
The study will include 2574 patients. We hypothesized that at 18 months, there will be an event rate of 22% for "death, MI, stroke, urgent revascularization, or acute arterial thrombotic event in the group treated with aspirin and we expect a decrease of the primary event of 20% (relative variation) using aspirin twice a day corresponding to an event rate of 17.6%.
A sample size of 1287 patients /group will allow an 80% power to detect this difference using a log-rank test at a two-sided 5% significance level. The study will include 2574 diabetic patients, or patients with a known risk factor for non-optimal aspirin response.
The primary analysis is based on the Intention To Treat population and the primary endpoint. The primary analysis on the primary endpoint will be carried out using a log-rank test for survival analysis. The 95% confidence interval of the hazard ratio will be presented. In addition the survival status during 18 months follow-up will be described by showing Kaplan-Meier curves.
Primary outcome according to pre-specified subgroups:
- Age: patients < 75 years or patient ≥75 years
- Gender: male or female
- Insulin vs no insulin treatment
- Type of acute coronary syndrome : STEMI vs NSTEMI
- Type of ADP inhibitor cotreatment
- Treatment strategy medical vs invasive (angioplasty or CABG surgery)
- Peripheral artery disease Yes/No
- GRACE score > or ≤140
- Left ventricular ejection fraction > or ≤ 40%
- Prior stroke Yes/No
- previous treatment with aspirin Yes/No
- initial HbA1C level > or ≤8%
- duration of diabetes > or ≤10 years
- Weight <60; 60-90; >90kg
- PPI use Yes/No
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Patrick HENRY, MD, PhD
- Phone Number: (33) 1 49 95 82 24
- Email: patrick.henry@lrb.aphp.fr
Study Contact Backup
- Name: Jean Guillaume DILLINGER, MD
- Phone Number: (33) 1 49 95 85 74
- Email: jean-guillaume.dillinger@lrb.aphp.fr
Study Locations
-
-
-
Paris, France, 75010
- Department of Cardiology - Lariboisiere Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
_ Diabetes mellitus defined as (≥ 1 item)
- Treated diabetes mellitus
- 2 fasting glucose levels ≥ 7 mmol/l after admission
- glucose level ≥ 11 mmol/l after admission (any moment)
- HbA1C ≥ 6.5%
OR
Factor of aspirin lack of efficacy defined as (≥ 1 item)
- Obesity defined as BMI≥27kg/m2
- Waist circumference ≥ 88cm for women or ≥102cm for men
- Index event occurring under chronic low dose of aspirin (<300mg)
Acute coronary syndrome defined as
- Acute coronary syndrome with ST-segment elevation (STEMI) is defined as chest pain (≥ 30min) with persistent ST-segment elevation in at least two contiguous leads (≥1mm) or a new left bundle-branch block and the intention to perform primary PCI or thrombolysis.
- Acute coronary syndrome without ST-segment elevation (NSTEMI) is defined as universal myocardial definition: Detection of cardiac biomarker values elevation [preferably cardiac troponin (cTn)] with at least one value above the 99th percentile upper reference limit (URL) and with at least one of the following:
- Symptoms of ischemia
- New or presumed new significant ST-segment-T wave (ST-T) changes except ST elevation
- Development of pathological Q waves in the ECG
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
- Identification of an intracoronary thrombus by angiography
- included after the angiography showing stenosis ≥50% and before discharge
- signed informed consent and ≥18 years old
Exclusion Criteria:
- Allergy or contraindication to aspirin (Hypersensitivity to aspirin or any of the excipients, history of asthma induced by the administration of salicylates, ongoing peptic ulcer, constitutional or acquired haemorrhagic disease including gastrointestinal bleeding, history of hemorrhagic stroke and thrombocytopenia, pregnancy after 24 weeks of gestation, risk of bleeding, severe renal failure, severe hepatic impairment, uncontrolled severe heart failure
- Concomitant anticoagulation therapy that cannot be stopped
- Fibrinolytic therapy less than 24 hours.
- Unstable patients according to investigator: use of amine or mechanical device (IABP, ECMO or similar) or mechanical ventilation during index hospitalization
- Index event is an acute complication of coronary revascularization (PCI or CABG)
- Known serious hematological disorder
- Proven gastric or duodenal ulcer in the past 3 months
- Previous hemorrhagic stroke, previous cranial bleeding, intracranial neoplasia, arterio-venous malformation
- Any condition that may put the patient at risk or influence study result in the investigators' opinion (active cancer ….) or that increase the risk for non-compliance or being lost to follow-up
- Concomitant treatment with methotrexate or with chronic non-steroidal anti-inflammatory drug
- Pregnancy or lactation or woman of childbearing age without contraception
- Participant in an another investigational drug study within 30 days
- Patients under curatorship
- No social security
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Arm 1 : Novel strategy
enteric coated aspirin 100 mg in the morning and 100 mg in the evening
|
Aspirin twice a day : enteric coated enteric coated aspirin given twice a day, 100 mg in the morning and 100 mg in the evening (i.e.
200mg/day)
|
Active Comparator: Arm 2 : Conventional strategy
enteric coated aspirin 100 mg in the morning
|
Aspirin once day: enteric coated aspirin 100 mg in the morning (i.e.
100mg/day)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
first main vascular event occurring within the 18 months after randomization among the following: Death (any), Myocardial infarction, Stroke, Urgent coronary revascularization and/or stent thrombosis, Acute arterial thrombotic event
Time Frame: at18 months
|
at18 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Major bleeding (type 3 to 5 following BARC classification
Time Frame: at18 months
|
at18 months
|
Net clinical benefit: Death (any), Myocardial infarction, Stroke, Urgent coronary revascularization and/or stent thrombosis, Acute arterial thrombotic event, Major bleeding
Time Frame: at18 months
|
at18 months
|
Cardiac endpoint: Cardiovascular death / Myocardial infarction
Time Frame: at18 months
|
at18 months
|
Death, myocardial infarction, stroke, urgent revascularization, stent thrombosis, acute arterial thrombotic event and major bleeding analyzed specifically and separately
Time Frame: at18 months
|
at18 months
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Patrick HENRY, MD, PhD, Assistance Publique
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Heart Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Glucose Metabolism Disorders
- Metabolic Diseases
- Arteriosclerosis
- Arterial Occlusive Diseases
- Endocrine System Diseases
- Disease
- Coronary Artery Disease
- Myocardial Ischemia
- Coronary Disease
- Diabetes Mellitus
- Syndrome
- Acute Coronary Syndrome
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Anti-Inflammatory Agents, Non-Steroidal
- Analgesics, Non-Narcotic
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Fibrinolytic Agents
- Fibrin Modulating Agents
- Platelet Aggregation Inhibitors
- Cyclooxygenase Inhibitors
- Antipyretics
- Aspirin
Other Study ID Numbers
- P141005
- 2015-000947-18 (EudraCT Number)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Coronary Artery Disease
-
Elixir Medical CorporationIstituto Clinico HumanitasActive, not recruitingCoronary Artery Disease | Chronic Total Occlusion of Coronary Artery | Multi Vessel Coronary Artery Disease | Bifurcation of Coronary Artery | Long Lesions Coronary Artery DiseaseItaly
-
Fundación EPICActive, not recruitingCoronary Artery Disease | Left Main Coronary Artery Disease | Left Main Coronary Artery Stenosis | Restenosis, CoronarySpain
-
Peking Union Medical College HospitalRecruitingCoronary Artery Disease | Inflammation | Coronary Artery Disease Progression | Coronary Artery Stenosis | Coronary Artery Restenosis | Inflammatory Disease | Inflammation VascularChina
-
Peking Union Medical College HospitalNot yet recruitingCoronary Artery Disease | Inflammation | Coronary Artery Disease Progression | Coronary Artery Stenosis | Coronary Artery Restenosis | Inflammatory Disease | Inflammation VascularChina
-
IGLESIAS Juan FernandoUniversity of BernNot yet recruiting
-
National Institutes of Health Clinical Center (CC)National Heart, Lung, and Blood Institute (NHLBI)CompletedCoronary Arteriosclerosis | Coronary Artery Disease (CAD) | Obstructive Coronary Artery DiseaseUnited States
-
Barts & The London NHS TrustImperial College London; Brunel UniversityNot yet recruitingCORONARY ARTERY DISEASE
-
Abbott Medical DevicesCompletedCoronary Artery Disease | Coronary Disease | Coronary Occlusion | Chronic Total Occlusion of Coronary Artery | Coronary Restenosis | Coronary Artery Stenosis | Coronary Artery RestenosisBelgium
-
Fundación EPICRecruitingCoronary Artery Disease | Coronary Disease | Coronary Occlusion | Left Main Coronary Artery Disease | Coronary Artery StenosisSpain
-
San Luigi Gonzaga HospitalRecruitingCoronary Disease | STEMI | Coronary Artery Ectasia | Right Coronary Artery Occlusion | Right Coronary Artery StenosisSpain, Italy
Clinical Trials on Novel strategy Aspirin
-
Tianjin Nankai HospitalCompletedAcute PancreatitisChina
-
The First Affiliated Hospital of Nanchang UniversityNot yet recruitingAcute Pancreatitis | Necrotizing Pancreatitis | Walled-Off NecrosisChina
-
Hospices Civils de LyonNot yet recruiting
-
China National Center for Cardiovascular DiseasesUnknown
-
Centre Hospitalier Universitaire de NīmesCompletedCentral Venous CatheterizationFrance
-
Assistance Publique - Hôpitaux de ParisMinistry of Health, FranceCompleted
-
Yale UniversityNational Institute of Allergy and Infectious Diseases (NIAID); National Heart...CompletedTuberculosis | Tuberculosis, PulmonaryUganda
-
Medical University of South CarolinaCompleted
-
Alliance for International Medical ActionHarvard School of Public Health (HSPH); University of Bordeaux, INSERM, Bordeaux...CompletedAcute Malnutrition in Infancy (Disorder)Niger
-
University Hospital, AngersRecruitingPhysical Activity | AgedFrance