- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT02201771
Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery (DACAB)
Compare the Efficacy of Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery
The study population will include all patients undergoing elective CABG. Consent and randomization will occur before surgery. Total 500 patients undergoing elective CABG will be randomly assigned into three groups with 1:1:1 ratio(167 patients per group) in this open-label study. All the enrolled patients will stop oral antiplatelet drugs according to local protocol before the surgery. Within the first 24 hours after surgery, study medication should be restarted and continued for 12 months. Arm A will restart oral antiplatelet drugs by giving aspirin 100mg qd, Arm B will also restart oral antiplatelet drugs by giving ticagrelor 90mg bid plus aspirin 100mg qd and Arm C will also restart oral antiplatelet drugs by giving ticagrelor 90mg bid. Treatment will continue for 12 months, at which time patients will undergo a multislice computed tomography angiography to assess vein graft patency.
This study is designed to show the superiority of ticagrelor and ticagrelor plus aspirin as compared with aspirin monotherapy respectively for the 1-year primary efficacy end point of vein graft patency.
Descripción general del estudio
Estado
Intervención / Tratamiento
Descripción detallada
The study is designed to show the superiority of ticagrelor and ticagrelor plus aspirin as compared with aspirin monotherapy respectively for the 1-year primary efficacy end point of vein graft patency. The primary comparison includes two separate parts. One is to demonstrate T+A better than A and the other is T better than A.
One year rate of vein graft patency in the aspirin group is estimated as 80%. The assumed rate of ticagrelor plus aspirin is 90%. With a two-sided alpha level 0.05 and 80% power, 199 grafts to each group are required. On the other hand, if we assume the rate of ticagrelor monotherapy has the 1-year vein graft patency rate of 87%, under the same two-sided 0.05 alpha 441 grafts in each arm will offer 80% power to show the superiority of ticagrelor along for the primary efficacy end point.
Combined the above two assumptions, if the allocation rate is 1:1:1, this study needs to recruit 1,323 grafts in total (441 in each) to achieve the pre-specified power for both the two comparisons (T+A vs. A and T vs. A).
The principle investigator assumes that the average number of the vien grafts in one patient is 2.7-3.0. With this assumption, 500 patients are to be recruited, which will provide us a total of 1350 - 1500 grafts.
According to the above, this study will be a confirmatory clinical trial to the primary endpoint.
Tipo de estudio
Inscripción (Actual)
Fase
- Fase 4
Contactos y Ubicaciones
Ubicaciones de estudio
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Henan
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Zhengzhou, Henan, Porcelana
- Henan Provincial People's Hospital
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Jiangsu
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Nanjing, Jiangsu, Porcelana
- Jiangsu Province Hospital
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Nanjing, Jiangsu, Porcelana
- Nan Jing First Hospital
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Shanghai
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Shanghai, Shanghai, Porcelana, 200433
- Changhai Hospital of Shanghai
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Shanghai, Shanghai, Porcelana, 200025
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine
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Shanghai, Shanghai, Porcelana, 200092
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Patients able to provide written informed consent
- Provision of informed consent prior to any study specific procedures
- Female and male patients aged 18-80 years
- Indication for CABG surgery
Exclusion Criteria:
- Cardiogenic shock, haemodynamic instability
- Need for urgent revascularization within 5 days from presentation
- Single vessel disease
- Two vessel disease with normal left ventricular function (> 50%)
- Need for concomitant other cardiac surgery (e.g. valve replacement)
- Need for dual antiplatelet treatment for the patients undergoing CABG after acute coronary syndrome(ACS)
- Contraindication for aspirin and ticagrelor use(e.g. known allergy)
- History of bleeding diathesis within 3 months prior presentation
- History of significant GI bleed within 1 year prior presentation
- History of peptic ulcer without GI bleeding in past 3 years
- History of intracranial hemorrhage
- History of moderate to severe liver impairment
- Patient requires dialysis
- Patient with an increased risk of bradycardic events (as patients without a pacemaker who have sick sinus syndrome, 2nd or 3rd degree arteriolar-venular block or bradycardic-related syncope)
- Need vitamin K antagonist therapy after bypass surgery eg. persistent atrial fibrillation, mechanical valves
- Known, clinically important thrombocytopenia(i.e. < 100*109/L)
- Known, clinically important anaemia (i.e. <100g/L)
- Participation in another investigational drug or device study in the last 30 days
- Pregnancy or lactation(for premenopausal women 2 methods of reliable contraception, one of which must barrier method, are required)
- Concomitant oral or intravenous therapy with strong cytochrome P450 3A4(CYP3A4) inhibitors, CYP3A4 substrates with narrow therapeutic indices, or strong CYP3A4 inducers which cannot be stopped for the course of the study (strong inhibitors: ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazadone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir, over 1 litre daily of grapefruit juice. Substrates with narrow therapeutic index: cyclosporine, quinidine. Strong inducers: rifampin, phenytoin, carbamazepine. )
- Any other condition such as active cancer
- Life expectancy less than 12 months that may result in protocol non-compliance or a risk for being lost to follow up
- Indication for major surgery(e.g. cancer treatment, carotid surgery, cerebral surgery, major vascular surgery)
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
---|---|
Comparador activo: Aspirin
aspirin 100mg tablet by mouth daily for 12 months
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Experimental: Ticagrelor plus Aspirin
ticagrelor 90mg tablet by mouth twice daily and aspirin 100mg tablet by mouth daily for 12 months
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|
Experimental: Ticagrelor
ticagrelor 90mg tablet by mouth twice daily for 12 months
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
The Patency of Saphenous Vein Grafts
Periodo de tiempo: up to 12 months
|
assessed by multislice computed tomography angiography (MSCTA) or coronary angiography(CAG).
FitzGibbon grade A (stenosis <50%) is defined as "patency".
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up to 12 months
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
The Patency of Saphenous Vein Grafts
Periodo de tiempo: up to 7 days
|
assessed by MSCTA or CAG.
FitzGibbon grade A (stenosis <50%) is defined as "patency".
|
up to 7 days
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The Rate of Post-operative Atrial Fibrillation After CABG.
Periodo de tiempo: up to 7 days
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Number of Participants with Post-operative Atrial Fibrillation after CABG
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up to 7 days
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The Rate of Freedom From Angina According to Canadian Cardiovascular Society (CCS) Classification
Periodo de tiempo: up to 12 months
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Number of Participants Free of Angina per CCS Classification
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up to 12 months
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The Number of Major Adverse Cardiovascular Event (MACE)
Periodo de tiempo: up to 12 months
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MACE, composite of CV death, myocardial infarction or stroke (ischaemic or unknown etiology)
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up to 12 months
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Number of the Major Bleeding Events
Periodo de tiempo: up to 12 months
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According to modified TIMI criteria, the "Major Bleeding Events" is defined as the combination of CABG-related bleeding and non-CABG-related major bleeding(Intracranial bleeding, Clinically overt signs of hemorrhage with hemoglobin drop ≥5 g/dL and Fatal bleeding).
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up to 12 months
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Otras medidas de resultado
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
The Rate of Gastroduodenal Injury Assessed by Esophagogastroduodenoscopy (EGD)
Periodo de tiempo: at 12 months
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Not all but the patients recruited in Ruijin Hospital
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at 12 months
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Qiang Zhao, MD.PhD, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Director de estudio: Yunpeng Zhu, MD., Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Efectos fisiológicos de las drogas
- Agentes neurotransmisores
- Mecanismos moleculares de acción farmacológica
- Agentes del sistema nervioso periférico
- Inhibidores de enzimas
- Analgésicos
- Agentes del sistema sensorial
- Agentes antiinflamatorios no esteroideos
- Analgésicos no narcóticos
- Agentes antiinflamatorios
- Agentes antirreumáticos
- Agentes fibrinolíticos
- Agentes moduladores de fibrina
- Inhibidores de la agregación plaquetaria
- Inhibidores de la ciclooxigenasa
- Antipiréticos
- Antagonistas del receptor P2Y purinérgico
- Antagonistas del receptor P2 purinérgico
- Antagonistas purinérgicos
- Agentes Purinérgicos
- Aspirina
- Ticagrelor
Otros números de identificación del estudio
- ISSBRIL0211
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
producto fabricado y exportado desde los EE. UU.
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .
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