- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT03012906
Registry of the Combination of Antiplatelet Agents and Anticoagulant in Atrial Fibrillation Patients With a CHA2DS2VASc Score >1 Undergoing Percutaneous Coronary Interventions
Prospective Multicenter Registry of the Combination of Antiplatelet Agents and Anticoagulant in Atrial Fibrillation Patients With a CHA2DS2VASc Score >1 Undergoing Percutaneous Coronary Interventions
Patients undergoing percutaneous coronary intervention (PCI) with stent implantation and requiring chronic anticoagulation for atrial fibrillation (AF) with a CHA2DS2-VASc >1 are required to receive triple antithrombotic therapy . This triple therapy includes dual antiplatelet therapy with clopidogrel and aspirin in combination with an oral anticoagulant with either a vitamin K antagonist (VKA) or an oral anticoagulant (NOAC).
Recently NOAC, inhibiting the IIa (dabigatran) or Xa (rivaroxaban and apixaban) in the coagulation cascade have demonstrated non inferiority compared to VKA to prevent thrombo-embolic events in non-valvular AF for patients with a CHA2DS2-VASc >1 . Interestingly, NOAC are associated with a reduced fatal bleeding rate compared to VKA. Overall they seem to result in a lower bleeding rate compared to VKA in association with antiplatelet agents.
Recently European guidelines regarding patients requiring chronic anticoagulant therapy and undergoing coronary stent implantation have been updated. However they are based on an expert consensus because of the scarce data available.
These guidelines advocate the combination of dual antiplatelet therapy with clopidogrel and aspirin in combination with the lower dose of OAC or VKA with a target INR between 2 and 2.5 . The triple therapy should be prescribed for 1 to 6 months depending on the bleeding and thrombotic risk and the clinical setting. In patients with high bleeding risk the guidelines suggest that a sole antiplatelet agent could be used in addition to anticoagulation following the WOEST study . In the recently published ESC guidelines on the management of atrial fibrillation, despite the lack of new data, the expert advocate triple therapy followed by dual antiplatelet therapy in most patients for 12 months.
The recently published PIONEER study reinforced the possibility of the use of rivaroxaban in these patients. In this trial including ACS and not ACS patients undergoing PCI rivaroxaban 15 mg in addition to a P2Y12 ADP receptor antagonist was associated with less clinically relevant bleeding compared to triple therapy with VKA- aspirin and clopidogrel and similar efficacy .
Studieöversikt
Status
Betingelser
Intervention / Behandling
Studietyp
Inskrivning (Förväntat)
Kontakter och platser
Studieorter
-
-
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Marseille, Frankrike, 13354
- Rekrytering
- Assistance Publique Hopitaux de Marseille
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Testmetod
Studera befolkning
Beskrivning
Inclusion Criteria:
- age over 18 years old
- signed informed consent
- requiring PCI (with stent placement) with subsequent need for antiplatelet therapy
- FA requiring chronic anticoagulation (CHA2DS2-VASc >1, except women with a score =1).
Exclusion Criteria:
- pregnancy or lactation
- age <18 or not able to give an informed consent
- no informed consent
- no health insurance
- prisoners
- contra indication to antiplatelet therapy
- intra cardiac thrombus
- active bleeding Known bleeding diathesis (i.e. history of ICH, GI bleeding)
- severe kidney failure (eGFR < 30 mL/min/1.73 m²)
- severe hepatic failure (Child-Pugh class B or C)
- contra indication to OAC or VKA
- hypertrophic myocardiopathy
- valvular prosthesis
- history of peptic ulcer
Studieplan
Hur är studien utformad?
Designdetaljer
- Observationsmodeller: Kohort
- Tidsperspektiv: Blivande
Vad mäter studien?
Primära resultatmått
Resultatmått |
Tidsram |
---|---|
Number of deaths
Tidsram: 2 years
|
2 years
|
Number of myocardial infarctions
Tidsram: 2 years
|
2 years
|
Number of strokes
Tidsram: 2 years
|
2 years
|
Sekundära resultatmått
Resultatmått |
Tidsram |
---|---|
The prevalence of bleeding events
Tidsram: 2 years
|
2 years
|
Samarbetspartners och utredare
Utredare
- Huvudutredare: LAURENT BONELLO, Assistance Publique Hopitaux de Marseille
Studieavstämningsdatum
Studera stora datum
Studiestart
Primärt slutförande (Förväntat)
Avslutad studie (Förväntat)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Uppskatta)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- 2016-16
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
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