NCT05577988 Assessment of an Early De-Escalation to a Low-potency Single Antiplatelet Therapy Guided by Genetics Versus a Systematic High-Potency Single Antiplatelet Therapy to Neutralize Bleeding Complications in Patients With High Bleeding Risk Beyond One Month After an Acute Coronary Syndrome
| NCT ID | NCT05577988 |
| Status | Recruiting |
| Phase | Phase 3 |
| Sponsor | Assistance Publique - Hôpitaux de Paris |
| Condition | MYOCARDIAL INFARCTION |
| Study Type | INTERVENTIONAL |
| Enrollment | 2,468 participants |
| Start Date | 2024-06-18 |
| Primary Completion | 2027-06 |
Eligibility & Interventions
Eligibility Fast-Check
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What to Expect as a Participant
You will actively receive the study intervention — which may be a drug, biologic, device, or procedure.
Phase 3 trials are large pivotal studies comparing the treatment to current standard of care or placebo. Your participation directly contributes to the evidence needed for regulatory approval.
This trial targets 2,468 participants in total. It began in 2024-06-18 with a primary completion date of 2027-06.
⚠ This information is for research awareness only. Always consult your physician before joining any clinical trial. Participation is voluntary and you may withdraw at any time.
Brief Summary
Patients who suffered from acute coronary syndrome (ACS) are usually treated with a long-term dual antiplatelet therapy (DAPT) to reduce stent thrombosis and recurrent ischemic event. Nonetheless, recent important data have demonstrated the efficacy of a short term DAPT and an early single antiplatelet therapy in high bleeding and ischemic risk patients. The bleeding risk is associated with a significant mortality. This risk is especially high in patients treated with potent P2Y12 inhibitors like ticagrelor or prasugrel after an ACS. As a result of the abounding data regarding the safety of an early single antiplatelet therapy with high potency antiplatelet therapy (ticagrelor or prasugrel), it is likely that such strategy will soon be implemented in the guidelines. The benefits of these high-potency P2Y12 inhibitors over clopidogrel mostly occur in patients with genetic polymorphisms of CYP2Y12 associated with a loss of function in clopidogrel metabolism. Furthermore, the anti-ischemic benefit of potent P2Y12 inhibitors over clopidogrel occurs early, while excess bleeding events often arise during chronic treatment. Our hypothesis is that a systematic and rapid genetic screening of CYP2C90 \*2 or \*17 polymorphism to guide an early single therapy with low potency antiplatelet (aspirin or clopidogrel) could lead to less bleeding events with a consistent efficacy towards cardiac events compared with high potency antiplatelet therapies (prasugrel or ticagrelor) in high bleeding risk patients treated for ACS.
Eligibility Criteria
Inclusion Criteria: * Being 18-year-old or older * Admission for type 1 acute myocardial infarction (STEMI or NSTEMI) * Bedside genetic testing for clopidogrel resistance that can be performed during hospital stay for ACS (oral swab kit with result within 1 hour) * Treated with aspirin and ticagrelor, or aspirin and prasugrel at the screening phase and at the randomization visit. * High bleeding risk as defined below (criteria adapted from the Consensus Document From the Academic Research Consortium for High Bleeding Risk) (at least one criterion) : * Age ≥75 years old. * Baseline haemoglobin \<11 g/dl (or anaemia requiring transfusion during the 4 weeks prior to randomization). * Chronic Kidney Disease with estimated glomerular filtration rate ≤ 30 ml/min. * Thrombocytopenia with platelet count \< 100 x 109 / L * Chronic bleeding diatheses: inherited or acquired conditions known to be associated with increased bleeding risk such as platelet dysfunction, von Willebrand disease (prevalence of 1%-2% in the general population), inherited or acquired clotting factor deficiencies (including factors VII, VIII \[hemophilia A\], IX \[hemophilia B\], and XI), or acquired antibodies to clotting factors, among others. * Cirrhosis with portal hypertension. * PCI after major traumatism or surgery. * Any documented stroke in the last 12 months. * Hospital admission for bleeding or transfusion within last 6 months. * Nonskin cancer diagnosed or treated ≤3 years. * Planned daily nonsteroidal anti-inflammatory drugs (other than aspirin) or steroids for ≥30 days after PCI. * patient affiliated to a social security system * signed informed consent form * Women of childbearing capacity with effective contraception for the duration of the research OR man, OR woman not of childbearing capacity Exclusion Criteria: * Currently participating in any interventional investigational device or drug trial * Any prior documented intracerebral bleed * Contra-indication, known allergy or expected interactions with clopidogrel. Baseline treatment (at screening) should not include an antiplatelet therapy for which a contra-indication, known allergy or expected interactions is known (example history of stroke and use of prasugrel, or concomitant use of ticagrelor and ritonavir) * Patients on concomitant treatment with an anticoagulant agent (Vitamin-K antagonists or novel oral anticoagulants such as rivaroxaban, dabigatran or apixaban) * Planned surgery within 12 coming months * Patient under guardianship or curatorship * Pregnancy or breastfeeding * Inability to sign the informed consent form
Contact & Investigator
Michel ZEITOUNI, MD, PhD
STUDY CHAIR
Assistance Publique - Hôpitaux de Paris
Frequently Asked Questions
Who can join the NCT05577988 clinical trial?
This trial is open to participants of all sexes, aged 18 Years or older, studying MYOCARDIAL INFARCTION. Full inclusion and exclusion criteria are listed in the Eligibility Criteria section. Always confirm your eligibility with the research team before applying.
What phase is the NCT05577988 trial and what does that mean for participants?
Phase 3 trials are large-scale studies comparing the new treatment to existing standards of care or a placebo. They provide the evidence needed for regulatory approval. This trial targets 2,468 participants.
Is NCT05577988 currently recruiting?
Yes, NCT05577988 is actively recruiting participants. Contact the research team at michel.zeitouni@aphp.fr for enrollment information.
Where is the NCT05577988 trial being conducted?
This trial is being conducted at Paris, France.
Who is sponsoring the NCT05577988 clinical trial?
NCT05577988 is sponsored by Assistance Publique - Hôpitaux de Paris. The principal investigator is Michel ZEITOUNI, MD, PhD at Assistance Publique - Hôpitaux de Paris. The trial plans to enroll 2,468 participants.