Safety and Efficacy of Bivalirudin During Short-term Intervention of Non-infarction Related Artery After PPCI of STEMI

NCT ID: NCT04475835

Last Updated: 2022-05-02

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-01-12
• Study Completion Date: 2022-12-31

Brief Summary

This is a randomized, open label, cohort study, in which a total of 100 patients will be enrolled and randomly assigned to receive bivalirudin or heparin in a 1:1 ratio during short-term intervention of non-infarction related artery for acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention.

NACE, MACE, any type of BARC bleeding, stent thrombosis will be evaluated in 30 days and 6 months after recruitment.

Detailed Description

The 2017 guideline gives a class IIA recommendation ('should be considered') for complete revascularisation in patients presenting with STEMI and multivessel disease, which is approximately 50% of the STEMI population. Staged multivessel PCI during hospitalization (3-5 days after PPCI) is common in contemporary practice.

Patients undergoing primary PCI should receive enhanced antithrombotic therapy, includes DAPT and and parenteral anticoagulant, which caused an increased bleeding risk. In addition, repeated use of heparin in a short time may increase the incidence of HIT. Direct thrombin inhibitor bivalirudin, demonstrated a reduced risk of bleeding and an overall favorable profile including reduced NACE.

This is a randomized, open label, cohort study, which is aimed to investigate the safety and efficacy of bivalirudin during short-term intervention of non-infarction related artery for acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention.

Conditions

STEMI With Multivessel Coronary Disease

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Bivalirudin

Bivalirudin with prolonged full dose infusion during PCI

Group Type: EXPERIMENTAL

Bivalirudin

Intervention Type: DRUG

Bivaliruding 0.75 mg/kg intravenous bolus loading dose, and immediately followed by intravenous infusion of 1.75 mg/kg/h until 4 hours after PCI. A prolonged infusion of 0.2 mg/kg/h for ≤20h could be considered at the operator's discretion. It is recommended that ACT be monitored 5 minutes after the first administration, and if ACT is \<225 s (Hemotec method), intravenous injection of 0.30 mg/kg of bivalirudin should be administered.

Heparin

Heparin 100U/kg

Group Type: ACTIVE_COMPARATOR

Heparin

Intervention Type: DRUG

Heparin is dosed at 100 U/kg. ACT is monitored 5 min after the first administration, and if the ACT \<225 s (Hemotec method), an intravenous injection of heparin should be administered by need.

Interventions

Bivalirudin

Bivaliruding 0.75 mg/kg intravenous bolus loading dose, and immediately followed by intravenous infusion of 1.75 mg/kg/h until 4 hours after PCI. A prolonged infusion of 0.2 mg/kg/h for ≤20h could be considered at the operator's discretion. It is recommended that ACT be monitored 5 minutes after the first administration, and if ACT is \<225 s (Hemotec method), intravenous injection of 0.30 mg/kg of bivalirudin should be administered.

Intervention Type: DRUG

Heparin

Heparin is dosed at 100 U/kg. ACT is monitored 5 min after the first administration, and if the ACT \<225 s (Hemotec method), an intravenous injection of heparin should be administered by need.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Age ≥ 18 years.
• Acute STEMI (including patients within 12 h of symptom onset, or 24-48 h with recurrent or ongoing chest pain chest pain, persistent ST-segment elevation or new left bundle branch block.
• Staged intervention of non-infarction related artery within 5 days after PPCI during Hospitalization.
• Signed informed consent.

Exclusion Criteria

• Cardiogenic shock.
• Received thrombolytic therapy or used any anticoagulant drugs within 48 hours before randomized.
• Active bleeding, recent bleeding events or bleeding tendency.
• History of surgery in the last 1 month.
• Suspicious symptoms of aortic dissection, pericarditis and endocarditis.
• Blood pressure > 180/110 mmHg.
• Hemoglobin < 100 g/L, Platelet count <100×10(9)/L, Transaminase 3 times upper limit of normality or Creatinine clearance <30ml/min.
• History of Heparin-Induced Thrombocytopenia.
• Allergic to any research drug or device.
• Pregnancy or lactation.
• Any condition that makes the patient unsuitable for PCI or may interfere with the study.
• Patient disagrees or fails to sign the written informed consent.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

First Affiliated Hospital Xi'an Jiaotong University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Yihui Xiao

Role: PRINCIPAL_INVESTIGATOR

First Affiliated Hospital Xi'an Jiaotong University

Locations

First Affiliated Hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Site Status: RECRUITING

Countries

China

Central Contacts

Yihui Xiao

Role: CONTACT

sbw_514@163.com

+86-18220824850

Facility Contacts

Yihui Xiao

Role: primary

sbw_514@163.com

+86-18220824850

Other Identifiers

XJTU1AF2020LSK-017

Identifier Type: -

Identifier Source: org_study_id