COMBO-Stent in Patients on Chronic Anticoagulant Therapy (COSTA) COSTA-Bleed and COSTA-Outcome Trials (COSTA)
Primary Purpose
Stable Angina, Unstable Angina, STEMI
Status
Withdrawn
Phase
Phase 4
Locations
Germany
Study Type
Interventional
Intervention
COMBO-Stent
Clopidogrel, Vitamin K Antagonist, Rivaroxaban, Dabigatran
Any drug eluting stent oder bare metal sent
ASA, Clopidogrel, Vitamin K Antagonist, Rivaroxaban, Dabigatran
Sponsored by
About this trial
This is an interventional treatment trial for Stable Angina focused on measuring Stent , COMBO Stent, anticoagulation
Eligibility Criteria
Inclusion Criteria:
- Age 18 and older;
- Willingness to comply with the study protocol; subject or a legally authorized representative must provide written informed consent prior to any study related procedure, in accordance with International Conference on harmonization of Good Clinical Practice (ICH-GCP) guidelines and per site requirements.
- Patients on anticoagulant therapy or treatment-naive pa-tients with an indication to chronic anticoagulant therapy. Indications to oral anticoagulation may include atrial fibrillation, prosthetic valve disease, peripheral by-pass surgery, lung embolism or deep vein thrombosis or any other indication according to the Investigator´s opinion.
- Single or multiple de novo lesion in a native coronary artery, all amenable to treatment with the COMBO stent;
Exclusion Criteria:
- Patients who, in the Investigator's opinion, should not be treated with (N)OAC. These may include, for instance: history of BARC 3-5 bleeding <12 months; patients with a haemorrhagic disorder or bleeding diathesis (e.g. von Willebrand disease, haemophilia A or B or other hereditary bleeding disorder, history of spontaneous intra-articular bleeding, history of prolonged bleeding after surgery/intervention); patients with recent major surgery; history of intraocular, spinal, retroperitoneal, intra-articular or recent gastrointestinal bleeding unless the causative factor has been permanently eliminated or repaired; (reduction in the haemoglobin level of at least 2g/dL, transfusion of at least two units of blood, or symptomatic bleeding in a critical area or organ) including life-threatening bleeding episode (symptomatic intracranial bleeding, bleeding with a decrease in the haemoglobin level of at least 5g/dL or bleeding requiring transfusion of at least 4 units of blood or inotropic agents or necessitating surgery); Anaemia (haemoglobin <10g/dL) or thrombocytopenia including heparin-induced thrombocytopenia (platelet count <100E9/L) at screening;
- Pregnant or nursing patients. Female patients of childbearing potential must have a negative pregnancy test done within 7 days prior to the index procedure per site standard test;
- Other medical illness with a life expectancy <2 years (e.g. known malignancy) or known history of substance abuse (alcohol, cocaine, heroin etc.) that may cause non-compliance with the protocol or confound the data in-terpretation or is associated with a limited life expectancy;
- Patient has received an organ transplant or is on a wait-ing list for an organ transplant;
- Known hypersensitivity or contraindication to antiplate-let or anticoagulant agents that does not allow guide-lines-compliant therapy and that cannot be adequately pre-medicated;
- Previously received murine therapeutic antibodies and exhibited sensitization through the production of Human Anti-Murine Antibodies (HAMA);
- Any significant medical condition which in the Investigator's opinion may interfere with the patient's optimal participation in the study;
- Current participation in another investigational drug or device study except for non-interventional registries;
- Patients not willing or able to comply with the protocol requirements or considered unreliable by the Investigator concerning the requirements for follow up during the study and/or compliance with study drug administration;
Angiographic exclusion criteria:
- Vessel diameter <2 und > 5mm;
- Target lesion with characteristics that make it unsuitable for stent delivery and deployment;
- Planned use of a stent or another coronary device in the same or another session (target vessel or non-target vessel), precluding a COMBO-only strategy.
Sites / Locations
- MVZ am Kuechwald GmbH
- Elisabeth Krankenhaus
- Universitaetsmedizin Mainz
- Theresienkrankenhaus und St. Hedwig GmbH
- Universitaetsmedizin Mannheim
- St. Franziskus, Kliniken Maria Hilf GmbH
- Evangelisches Krankenhuas Muehlheim a.d. Ruhr GmbH
- Diakonissen-Stiftungs-Krankenhaus
- Herzklinik Ulm GbR
- Schwarzwald-Baar-Klinikum
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
COMBO-Stent
Any Drug eluting or bare metal stent
Arm Description
Implantation of COMBO-Stent and medication with (N)OAC and clopidogrel for 3 months followed by (N)OAC alone
Implantation of any drug eluting oder bare metal stent combined with anticoagulant medication according to ESC guidelines
Outcomes
Primary Outcome Measures
Number of patients with bleedings
any BARC (bleeding academic research consortium) bleeding at 6 weeks - superiority.
Number of patients with safety events
Strategy oriented composite safety endpoint, including death (unless proven not to be connected to the other endpoints), any MI, stroke or systemic embolism, definite or probable stent thrombosis, BARC 3-4 bleeding at 15 months post PCI - non-inferiority with reflex to superiority testing. Hierarchical testing: Endpoint II is only tested if null hypothesis of no difference in bleeding incidence can be rejected at final analysis.
Secondary Outcome Measures
Full Information
NCT ID
NCT02723981
First Posted
March 16, 2016
Last Updated
February 17, 2017
Sponsor
IHF GmbH - Institut für Herzinfarktforschung
Collaborators
OrbusNeich
1. Study Identification
Unique Protocol Identification Number
NCT02723981
Brief Title
COMBO-Stent in Patients on Chronic Anticoagulant Therapy (COSTA) COSTA-Bleed and COSTA-Outcome Trials
Acronym
COSTA
Official Title
Prospective, Multi-centre, Randomized, Parallel Comparison to Evaluate the Safety and Efficacy of the Abluminal Sirolimus Coated Bio-engineered Stent (COMBO Stent) in Association With Short-term Single Antiplatelet Therapy in Patients With Coronary Artery Disease With an Indication for Chronic Oral Anticoagulant Therapy as Compared to a Guidelines-based Strategy
Study Type
Interventional
2. Study Status
Record Verification Date
February 2017
Overall Recruitment Status
Withdrawn
Why Stopped
Regulatory authority approval for the initial study design could not be obtained
Study Start Date
April 2016 (undefined)
Primary Completion Date
May 2018 (Anticipated)
Study Completion Date
December 2018 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
IHF GmbH - Institut für Herzinfarktforschung
Collaborators
OrbusNeich
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Prospective, multi-centre, randomized, open-label, parallel comparisons to evaluate
the incidence of bleedings (COSTA-Bleed) and
the incidence of ischemic and bleeding events (COSTA-Outcome) following a therapy with the abluminal sirolimus coated bio-engineered stent (COMBO stent) in association with short-term single antiplatelet therapy as compared to a guidelines-based strategy in patients with coronary artery disease with an indication for chronic oral anticoagulant therapy.
Detailed Description
The COSTA trials are investigator-initiated studies aimed at comparing the clinical outcome after percutaneous coronary intervention (PCI) using a COMBO-stent based strategy associated with short-term antiplatelet therapy with a guidelines-based therapy in patients with an indication for chronic oral anticoagulation. The study is organized as a national, multi-centre prospective, randomized trial. The duration of the follow-up is 15 months.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stable Angina, Unstable Angina, STEMI, NSTEMI, Coronary Disease
Keywords
Stent , COMBO Stent, anticoagulation
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
COMBO-Stent
Arm Type
Experimental
Arm Description
Implantation of COMBO-Stent and medication with (N)OAC and clopidogrel for 3 months followed by (N)OAC alone
Arm Title
Any Drug eluting or bare metal stent
Arm Type
Active Comparator
Arm Description
Implantation of any drug eluting oder bare metal stent combined with anticoagulant medication according to ESC guidelines
Intervention Type
Device
Intervention Name(s)
COMBO-Stent
Intervention Description
The OrbusNeich COMBO Bio-engineered Sirolimus Eluting Stent (COMBO Stent) consists of a 316L stainless steel alloy abluminally coated with a biocompatible, biodegradable poly-mer containing sirolimus. Covalently attached to the surface of the stent is a layer of murine, monoclonal, anti-human CD34 antibody. The antibody specifically targets circulatory CD34+ cells (endothelial progenitor cells) thus favoring endothelialization.
Intervention Type
Drug
Intervention Name(s)
Clopidogrel, Vitamin K Antagonist, Rivaroxaban, Dabigatran
Other Intervention Name(s)
Plavix, Marcumar, Xarelto, Pradaxa
Intervention Description
Anticoagulant medication after stent Implantation: (N)OAC and clopidogrel for 3 months followed by (N)OAC
Intervention Type
Device
Intervention Name(s)
Any drug eluting stent oder bare metal sent
Other Intervention Name(s)
Cypher, Taxus, CoStar, Janus, Endeavor, Xience, Promus, Multi Link, Coroflex, Veriflex, Integrity, Driver
Intervention Description
Implantation of traditional bare metal stents and/or drug eluting stents (any device approved on the market, implanted according to CE marking and IFU) and medication regimen in accordance with ESC Guidelines
Intervention Type
Drug
Intervention Name(s)
ASA, Clopidogrel, Vitamin K Antagonist, Rivaroxaban, Dabigatran
Other Intervention Name(s)
Anticoagulant medication according to ESC guidelines
Intervention Description
A combination of antiplatelet and anticoagulant therapy according to ESC guidelines (2014)
Primary Outcome Measure Information:
Title
Number of patients with bleedings
Description
any BARC (bleeding academic research consortium) bleeding at 6 weeks - superiority.
Time Frame
6 weeks
Title
Number of patients with safety events
Description
Strategy oriented composite safety endpoint, including death (unless proven not to be connected to the other endpoints), any MI, stroke or systemic embolism, definite or probable stent thrombosis, BARC 3-4 bleeding at 15 months post PCI - non-inferiority with reflex to superiority testing. Hierarchical testing: Endpoint II is only tested if null hypothesis of no difference in bleeding incidence can be rejected at final analysis.
Time Frame
15 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age 18 and older;
Willingness to comply with the study protocol; subject or a legally authorized representative must provide written informed consent prior to any study related procedure, in accordance with International Conference on harmonization of Good Clinical Practice (ICH-GCP) guidelines and per site requirements.
Patients on anticoagulant therapy or treatment-naive pa-tients with an indication to chronic anticoagulant therapy. Indications to oral anticoagulation may include atrial fibrillation, prosthetic valve disease, peripheral by-pass surgery, lung embolism or deep vein thrombosis or any other indication according to the Investigator´s opinion.
Single or multiple de novo lesion in a native coronary artery, all amenable to treatment with the COMBO stent;
Exclusion Criteria:
Patients who, in the Investigator's opinion, should not be treated with (N)OAC. These may include, for instance: history of BARC 3-5 bleeding <12 months; patients with a haemorrhagic disorder or bleeding diathesis (e.g. von Willebrand disease, haemophilia A or B or other hereditary bleeding disorder, history of spontaneous intra-articular bleeding, history of prolonged bleeding after surgery/intervention); patients with recent major surgery; history of intraocular, spinal, retroperitoneal, intra-articular or recent gastrointestinal bleeding unless the causative factor has been permanently eliminated or repaired; (reduction in the haemoglobin level of at least 2g/dL, transfusion of at least two units of blood, or symptomatic bleeding in a critical area or organ) including life-threatening bleeding episode (symptomatic intracranial bleeding, bleeding with a decrease in the haemoglobin level of at least 5g/dL or bleeding requiring transfusion of at least 4 units of blood or inotropic agents or necessitating surgery); Anaemia (haemoglobin <10g/dL) or thrombocytopenia including heparin-induced thrombocytopenia (platelet count <100E9/L) at screening;
Pregnant or nursing patients. Female patients of childbearing potential must have a negative pregnancy test done within 7 days prior to the index procedure per site standard test;
Other medical illness with a life expectancy <2 years (e.g. known malignancy) or known history of substance abuse (alcohol, cocaine, heroin etc.) that may cause non-compliance with the protocol or confound the data in-terpretation or is associated with a limited life expectancy;
Patient has received an organ transplant or is on a wait-ing list for an organ transplant;
Known hypersensitivity or contraindication to antiplate-let or anticoagulant agents that does not allow guide-lines-compliant therapy and that cannot be adequately pre-medicated;
Previously received murine therapeutic antibodies and exhibited sensitization through the production of Human Anti-Murine Antibodies (HAMA);
Any significant medical condition which in the Investigator's opinion may interfere with the patient's optimal participation in the study;
Current participation in another investigational drug or device study except for non-interventional registries;
Patients not willing or able to comply with the protocol requirements or considered unreliable by the Investigator concerning the requirements for follow up during the study and/or compliance with study drug administration;
Angiographic exclusion criteria:
Vessel diameter <2 und > 5mm;
Target lesion with characteristics that make it unsuitable for stent delivery and deployment;
Planned use of a stent or another coronary device in the same or another session (target vessel or non-target vessel), precluding a COMBO-only strategy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tommasso Gori
Organizational Affiliation
Universitaetsmedizin Mainz
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ibrahim Akin
Organizational Affiliation
Universitaetsmedizin Mannheim
Official's Role
Principal Investigator
Facility Information:
Facility Name
MVZ am Kuechwald GmbH
City
Chemnitz
Country
Germany
Facility Name
Elisabeth Krankenhaus
City
Essen
Country
Germany
Facility Name
Universitaetsmedizin Mainz
City
Mainz
Country
Germany
Facility Name
Theresienkrankenhaus und St. Hedwig GmbH
City
Mannheim
Country
Germany
Facility Name
Universitaetsmedizin Mannheim
City
Mannheim
Country
Germany
Facility Name
St. Franziskus, Kliniken Maria Hilf GmbH
City
Moenchengladbach
Country
Germany
Facility Name
Evangelisches Krankenhuas Muehlheim a.d. Ruhr GmbH
City
Muehlheim an der Ruhr
Country
Germany
Facility Name
Diakonissen-Stiftungs-Krankenhaus
City
Speyer
Country
Germany
Facility Name
Herzklinik Ulm GbR
City
Ulm
Country
Germany
Facility Name
Schwarzwald-Baar-Klinikum
City
Villingen-Schwenningen
Country
Germany
12. IPD Sharing Statement
Plan to Share IPD
No
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COMBO-Stent in Patients on Chronic Anticoagulant Therapy (COSTA) COSTA-Bleed and COSTA-Outcome Trials
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