Comparison of Clopidogrel-based Antiplatelet Therapy Versus Warfarin As Secondary Prevention Strategy for AntiPhospholipid Syndrome-related STROKE

NCT ID: NCT05995600

Last Updated: 2024-10-16

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

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-20

Study Completion Date

2029-03-31

Brief Summary

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Antiphospholipid syndrome (APS) has a close association with ischemic stroke; however, the optimal treatment strategy for APS-related stroke has yet to be established. The clinical guidelines suggest using warfarin for APS-related stroke, but these suggestions are largely based on retrospective studies from the 1990s and expert opinion, rather than high-quality clinical trials. Moreover, the evidence on the role of antiplatelet drugs other than aspirin (e.g., clopidogrel) in APS-related stroke is particularly limited. Considering the relatively young age of patients with APS and the high clinical burden of using warfarin, it is necessary to verify whether warfarin is essential. Thus, the investigators aim to compare clopidogrel-based antiplatelet therapy and warfarin as a secondary preventive medication for patients with APS-related stroke. APS-STROKE is an exploratory, multicenter, prospective, randomized, open, blinded-endpoint clinical trial. Adult patients with definite APS who have a history of ischemic stroke will be included. Patients with high-risk APS (triple positivity or persistently high titers of anti-cardiolipin or anti-β2-glycoprotein I antibodies), systemic lupus erythematous, or indications for continued antiplatelet or anticoagulant therapy will be excluded. Eligible patients will be 1:1 randomized to receive clopidogrel-based antiplatelet therapy or warfarin. Patients assigned to the clopidogrel-based antiplatelet therapy group will be permitted to use additional antiplatelet drugs other than clopidogrel at the investigator's discretion. The primary outcome is a composite of any death, major adverse cardiovascular events, systemic thromboembolic events, and major bleeding during a follow-up period of at least 4 years. This study would provide valuable information for determining the optimal secondary prevention strategy for APS-related stroke.

Detailed Description

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Conditions

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Antiphospholipid Syndrome Ischemic Stroke Transient Ischemic Attack Cerebrovascular Disease Cardiovascular Diseases Major Bleed

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors
Prospective, Randomized, Open-label, Blinded Endpoint (PROBE) trial

Study Groups

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Clopidogrel-based antiplatelet therapy group

Clopidogrel 75 mg daily

Patients assigned to this group will be permitted to use additional antiplatelet drugs other than clopidogrel at the investigator's discretion.

Group Type EXPERIMENTAL

Antiplatelet Drug

Intervention Type DRUG

Clopidogrel ± other antiplatelet drug

Warfarin group

Warfarin (target prothrombin time-international normalized ratio 2.0-3.0)

Group Type ACTIVE_COMPARATOR

Warfarin

Intervention Type DRUG

Warfarin (target prothrombin time-international normalized ratio 2.0-3.0)

Interventions

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Antiplatelet Drug

Clopidogrel ± other antiplatelet drug

Intervention Type DRUG

Warfarin

Warfarin (target prothrombin time-international normalized ratio 2.0-3.0)

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age 19 years or older
* History of ischemic stroke (cerebral infarction, transient ischemic attack, or retinal arterial ischemic event)
* Patients who meet the laboratory diagnostic criteria for antiphospholipid syndrome (APS)
* Patients or guardians who agree to the study protocol and sign with informed consent

Exclusion Criteria

* Patients with high-risk antiphospholipid antibody profile (triple positivity; persistent high-titers exceeding 80 U/mL of anti-cardiolipin or anti-β2 glycoprotein I antibodies)
* Systemic lupus erythematous
* Patients unable to discontinue previously taken anticoagulants or antiplatelet agents (e.g., atrial fibrillation, valvular heart disease, or a history of percutaneous coronary intervention)
* Women who are pregnant, breastfeeding, or intending to become pregnant during the study period
* Deemed unsuitable for participation in the study for more than four years, as per the investigators' discretion
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Samjin Pharmaceutical Co., Ltd.

INDUSTRY

Sponsor Role collaborator

Seoul National University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Seung-Hoon Lee

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Seung-Hoon Lee, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Seoul National University Hospital

Locations

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Hallym University Sacred Heart Hospital

Anyang, , South Korea

Site Status RECRUITING

Busan Paik Hospital

Busan, , South Korea

Site Status RECRUITING

Pusan National University Hospital

Busan, , South Korea

Site Status RECRUITING

Chungbuk National University Hospital

Cheongju-si, , South Korea

Site Status RECRUITING

Hallym University Chuncheon Sacred Heart Hospital

Chuncheon, , South Korea

Site Status RECRUITING

Kangwon National University Hospital

Chuncheon, , South Korea

Site Status RECRUITING

Keimyung University Dongsan Medical Center

Daegu, , South Korea

Site Status RECRUITING

Yeungnam University Medical Center

Daegu, , South Korea

Site Status RECRUITING

Chungnam National University Hospital

Daejeon, , South Korea

Site Status RECRUITING

Hanyang University Guri Hospital

Guri-si, , South Korea

Site Status RECRUITING

Chonnam National University Hospital

Gwangju, , South Korea

Site Status RECRUITING

Chosun University Hospital

Gwangju, , South Korea

Site Status RECRUITING

Gachon University Gil Medical Center

Incheon, , South Korea

Site Status RECRUITING

Inha University Hospital

Incheon, , South Korea

Site Status RECRUITING

Jeju National University Hospital

Jeju City, , South Korea

Site Status RECRUITING

Jeonbuk National University Hospital

Jeonju, , South Korea

Site Status RECRUITING

Chungnam National University Sejong Hospital

Sejong, , South Korea

Site Status RECRUITING

Seoul National University Bundang Hospital

Seongnam, , South Korea

Site Status RECRUITING

Asan Medical Center

Seoul, , South Korea

Site Status RECRUITING

Chung-Ang University Hospital

Seoul, , South Korea

Site Status RECRUITING

Ewha Woman University Seoul Hospital

Seoul, , South Korea

Site Status RECRUITING

Ewha Womans University Mokdong Hospital

Seoul, , South Korea

Site Status RECRUITING

Hallym University Kangdong Sacred Heart Hospital

Seoul, , South Korea

Site Status RECRUITING

Hanyang University Seoul Hospital

Seoul, , South Korea

Site Status RECRUITING

Konkuk University Medical Center

Seoul, , South Korea

Site Status RECRUITING

Korea University Anam Hospital

Seoul, , South Korea

Site Status RECRUITING

Kyung Hee University Medical Center

Seoul, , South Korea

Site Status RECRUITING

Seoul Metropolitan Government-Seoul National University Boramae Medical Center

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Hospital

Seoul, , South Korea

Site Status RECRUITING

Severance Hospital

Seoul, , South Korea

Site Status RECRUITING

Uijeongbu Eulji Medical Center

Uijeongbu-si, , South Korea

Site Status RECRUITING

Yongin Severance Hospital

Yŏngin, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Wookjin Yang, MD, PhD

Role: CONTACT

+82-2-2072-2114

Seung-Hoon Lee, MD, PhD

Role: CONTACT

+82-2-2072-1014

References

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Other Identifiers

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H-2304-096-1425

Identifier Type: -

Identifier Source: org_study_id

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