The Effect of Dual Eradication Therapy vs PPI on Gastrointestinal Bleeding in ACS Patients

NCT ID: NCT04728516

Last Updated: 2025-09-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

2600 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-12

Study Completion Date

2026-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Patients with acute coronary syndrome (ACS) after Percutaneous Coronary Intervention (PCI) require routine treatment with dual antiplatelet (DAPT) treatment, but with the high risk of bleeding, gastrointestinal bleeding is the most common type of major bleeding. Helicobacter pylori (Hp) infection is a high-risk factor for gastrointestinal bleeding, with an incidence of about 50%. Foreign authoritative DAPT guidelines do not give individual guidance to Hp-infected patients. It is recommended that those with high bleeding risk should be combined with proton pump inhibitors (PPI), but long-term compliance with PPI is not ideal. Authoritative experts in China have agreed to recommend Hp detection and eradication therapy for DAPT patients, but loss of evidence. Vonoprazan is a novel potassium ion competitive acid blocker, based on Vonoprazan's dual Hp eradication therapy is simple and effective. Our team will conduct a multi-center, open-label, randomized controlled clinical trial using a non-inferior design to compare the combination of Vonoprazan + amoxicillin combined with pantoprazole (PPI) for 6 months after PCI on the bleeding events of the digestive tract.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

This study plans to enroll 2600 patients, 1300 patients in each group, in the project participating hospitals who received coronary stenting and are expected to undergo DAPT ≥6 months after operation. Hp13C-urea breath test and serum Hp antibody scores Type detection, patients with positive Hp infection.

Antiplatelet drugs (DAPT) use aspirin 100 mg qd, plus clopidogrel 75 mg qd or aspirin 100mg qd plus ticagrelor 90 mg bid. The specific medication is evaluated and decided by the interventional doctor.

After the subjects in each center signed a written informed consent form, they randomly divided each test case into a test group or a control group at a 1:1 ratio:

1. Test group:

In the project participating hospitals who received coronary stenting and are expected to undergo DAPT ≥6 months after operation. Hp13C-urea breath test and serum Hp antibody scores Type detection, patients with positive Hp infection. Antiplatelet drugs (DAPT) use aspirin 100 mg qd, plus clopidogrel 75 mg qd or aspirin 100 mg qd, plus ticagrelor 90 mg bid. The specific medication is evaluated and decided by the interventional doctor.

H. pylori eradication using a dual eradication regimen, a course of 14 days, followed up to 6 months after randomization; the treatment regimen is as follows: routine use of Vonoprazan 20mg bid + amoxicillin 1g tid, a duration of 14 days(Considering the high drug resistance rate of Hp strains in China, we increase the course of eradication treatment to 14 days) .

i. Introduce the subject to the possible adverse reactions to the dual eradication at the informed stage, and inform the subject that when the adverse reaction occurs, the researcher should be contacted as soon as possible to deal with it as soon as possible to reduce unnecessary shedding. For patients who are unable to tolerate the combination therapy and fall off, record the reason for the incomplete treatment and the corresponding time point, and continue the safety visit.

ii. More than 1 month after completion of the dual eradication (scheduled at the 12th week of follow-up, visit 3), use the 13C-urea breath test to retest Hp infection. For subjects who failed H. pylori eradication, in the Department of Gastroenterology Remedial treatment under the guidance of a doctor.
2. Control group:

In the project participating hospitals who received coronary stenting and are expected to undergo DAPT ≥ 6 months after operation. Hp13C-urea breath test and serum Hp antibody scores Type detection, patients with positive Hp infection. Antiplatelet drugs (DAPT) use aspirin 100 mg qd, plus clopidogrel 75 mg qd or aspirin 100 mg qd plus ticagrelor 90 mg bid. The specific medication is evaluated and decided by the interventional doctor. Taking pantoprazole 40 mg daily, followed up to 6 months after randomization.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Acute Coronary Syndrome Helicobacter Pylori Infection

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Vonoprazan-based dual eradication therapy

H. pylori eradication using a dual eradication regimen, a course of 14 days, followed up to 6 months after randomization; the treatment regimen is as follows: routine use of Vonoprazan 20mg bid + amoxicillin 1g tid, a course of 14 days .

Group Type EXPERIMENTAL

Vonoprazan-based dual eradication therapy for two weeks

Intervention Type DRUG

Patients with ACS after PCI, associated with positive Hp need a long-term DAPT treatment. We conducted a study on the prevention of gastrointestinal bleeding between vonoprazan-based dual eradication therapy for two weeks and pantoprazole for six months of a rountine therapy.

amoxicillin

Intervention Type DRUG

amoxicillin

Pantoprazole

To take pantoprazole 40 mg daily, followed up to 6 months after randomization.

Group Type ACTIVE_COMPARATOR

Pantoprazole

Intervention Type DRUG

Pantoprazole

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Vonoprazan-based dual eradication therapy for two weeks

Patients with ACS after PCI, associated with positive Hp need a long-term DAPT treatment. We conducted a study on the prevention of gastrointestinal bleeding between vonoprazan-based dual eradication therapy for two weeks and pantoprazole for six months of a rountine therapy.

Intervention Type DRUG

amoxicillin

amoxicillin

Intervention Type DRUG

Pantoprazole

Pantoprazole

Intervention Type DRUG

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

1. Patients with ACS and PCI treatment and postoperative DAPT ≥ 6 months;
2. Hp infection is positive;
3. Age ≥18 years old;
4. The patient himself or his authorized client signs the subject's consent.

Exclusion Criteria

1. Previous history of gastrointestinal ulcer bleeding;
2. Long-term use of PPI and H2 receptor inhibitors in the past;
3. Complicated with gastroesophageal varices, or after gastrectomy;
4. Those who are taking anti-coagulation drugs such as vitamin K antagonists (warfarin) ,factor X or factor II inhibitors;
5. Recently received fibrinolytic therapy (using fibrin-specific drugs within 24 hours before randomization, or using non-fibrin-specific drugs within 48 hours before randomization);
6. Recently accepted (within 30 days before randomization) or planned to undergo coronary artery bypass grafting (CABG);
7. Combining active bleeding or coagulation dysfunction (indicator);
8. In patients with liver and kidney disease, serum creatinine is greater than 150 μmol/L, GFR \<60ml/min/1.73m2, alanine aminotransferase and aspartate aminotransferase increase ≥3 times from the normal value;
9. Complicated with hemorrhagic stroke, intracranial tumor, arteriovenous malformation or aneurysm;
10. Anemia (adult male hemoglobin less than 120 g/L or red blood cells less than 4×10\^12/L,adult female hemoglobin less than 105 g/L or red blood cells less than 3.5×10\^12/L);
11. Systemic glucocorticoid application;
12. Have taken antibiotics and other drugs that affect the flora in the stomach within the past month;
13. A history of allergy to aspirin, clopidogrel, ticagrelor, pantoprazole, penicillin and other test drugs;
14. Pregnancy or breastfeeding women and subjects of childbearing age who do not want to take contraceptive measures;
15. With malignant tumors and other diseases, the expected survival time is less than 1 year;
16. Patients who participated in clinical trials of other drugs or are participating in clinical studies of other new drugs within 30 days before enrollment;
17. Complicated with mental illness or severe neurosis;
18. Can't express subjective discomfort symptoms;
19. The investigator decides that it is not suitable to participate in this research.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Qilu Hospital of Shandong University

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Yu-guo Chen, MD, PhD

Role: STUDY_CHAIR

Qilu Hospital of Shandong University

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Bozhou People's Hospital

Bozhou, Anhui, China

Site Status RECRUITING

Chuzhou First People's Hospital

Chuzhou, Anhui, China

Site Status RECRUITING

The First Affiliated Hospital of Anhui Medical University

Hefei, Anhui, China

Site Status NOT_YET_RECRUITING

Aviation General Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

China-Japan Friendship Hospital

Beijing, Beijing Municipality, China

Site Status RECRUITING

The First People'S Hospital of Zunyi

Zunyi, Guizhou, China

Site Status RECRUITING

The First Affiliated Hospital of Zhengzhou University

Zhengzhou, Henan, China

Site Status RECRUITING

The First Affiliated Hospital of Dalian Medical University

Dalian, Liaoning, China

Site Status RECRUITING

Qinghai Red Cross Hospital

Xining, Qinghai, China

Site Status RECRUITING

Qilu Hospital of Shandong University Dezhou Hospital

Dezhou, Shandong, China

Site Status RECRUITING

Pingyuan First People'S Hospital

Dezhou, Shandong, China

Site Status RECRUITING

NINGJIN People's Hospital

Dezhou, Shandong, China

Site Status RECRUITING

Dongying People's Hospital

Dongying, Shandong, China

Site Status RECRUITING

THE Second People's Hospital of Dongying

Dongying, Shandong, China

Site Status RECRUITING

Heze Municipal Hospital

Heze, Shandong, China

Site Status RECRUITING

The 960th Hospital of the Joint Logistic Support Force

Jinan, Shandong, China

Site Status WITHDRAWN

Shandong Second Provincial General Hospital

Jinan, Shandong, China

Site Status WITHDRAWN

Affiliated Hospital of Shandong University of Traditional Chinese Medicine

Jinan, Shandong, China

Site Status RECRUITING

Qilu Hospital of Shandong University

Jinan, Shandong, China

Site Status NOT_YET_RECRUITING

Shandong Provincial Third Hospital

Jinan, Shandong, China

Site Status RECRUITING

The fourth People's Hospital of jinan

Jinan, Shandong, China

Site Status RECRUITING

Shandong Public Health Clinical Center

Jinan, Shandong, China

Site Status RECRUITING

JINA CITY People's Hospital

Jinan, Shandong, China

Site Status RECRUITING

Central Hospital Affiliated to Shandong First medical University

Jinan, Shandong, China

Site Status WITHDRAWN

The First People's Hospital of Jining City

Jining, Shandong, China

Site Status NOT_YET_RECRUITING

Liaocheng People's Hospital

Liaocheng, Shandong, China

Site Status NOT_YET_RECRUITING

Linyi City People's Hospital

Linyi, Shandong, China

Site Status NOT_YET_RECRUITING

Linshu County People'S Hospital

Linyi, Shandong, China

Site Status RECRUITING

Qilu Hospital of Shandong University (Qingdao)

Qingdao, Shandong, China

Site Status NOT_YET_RECRUITING

The Affiliated Hospital of Qingdao University

Qingdao, Shandong, China

Site Status RECRUITING

Affiliated Hospital of Shandong Second Medical University

Weifang, Shandong, China

Site Status RECRUITING

Weifang Hospital of Traditional Chinese Medicine

Weifang, Shandong, China

Site Status RECRUITING

Weihai Central Hospital

Weihai, Shandong, China

Site Status WITHDRAWN

Weihai Municipal Hospital

Weihai, Shandong, China

Site Status NOT_YET_RECRUITING

Haiyang People's Hospital

Yantai, Shandong, China

Site Status RECRUITING

Shandong Healthcare Group Zaozhuang Central Hospital

Zaozhuang, Shandong, China

Site Status WITHDRAWN

Zaozhuang Municipal Hospital

Zaozhuang, Shandong, China

Site Status RECRUITING

Zibo Central Hospital

Zibo, Shandong, China

Site Status WITHDRAWN

The Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Shanghai, Shanghai Municipality, China

Site Status NOT_YET_RECRUITING

Hospital of Chengdu University of Traditional Chinese Medicine

Chengdu, Sichuan, China

Site Status WITHDRAWN

Tianjin Chest Hospital

Tianjin, Tianjin Municipality, China

Site Status WITHDRAWN

Ru Shan People's Hospital

Rushan, Yantai, China

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

China

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Yuan Bian, MD, PhD

Role: CONTACT

+8618560083065

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Duoxue Chen

Role: primary

Tongtong Shen

Role: primary

xianhe lin

Role: primary

Yanfu Wang

Role: primary

Mingjing Shao

Role: primary

Xiaochuan Bai

Role: primary

Junhui Xing

Role: primary

Junjie Wang

Role: primary

Jiuping Zhao

Role: primary

Hongwei Dong

Role: primary

Xia Li

Role: primary

Tao Zhang

Role: primary

Xiaotian Wang

Role: primary

Tianjin Gu

Role: primary

Ke Liang

Role: primary

Zhen Wang

Role: primary

YUGUO CHEN

Role: primary

Guo Zhou

Role: primary

Qiang Liu

Role: primary

Xiaojuan Zhang

Role: primary

Zengtang Zhang

Role: primary

shuyin sun

Role: primary

yuzeng xue

Role: primary

yanjin wei

Role: primary

Xiaozhou Wang

Role: primary

beian you

Role: primary

Peng Li

Role: primary

Luchang Yin

Role: primary

Qinwei Zhu

Role: primary

xinfu zhou

Role: primary

Xuguang Liu

Role: primary

Jun Yang

Role: primary

changqian wang

Role: primary

Lei Dong

Role: primary

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

2020SDUCRCA006

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.