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Can Very Low Dose Rivaroxaban in Addition to Dual Antiplatelet Therapy (DAPT) Improve Thrombotic Status in Acute Coronray Syndrome (ACS) ACS (VaLiDate-R)

Primary Purpose

Acute Coronary Syndrome

Status
Unknown status
Phase
Phase 4
Locations
United Kingdom
Study Type
Interventional
Intervention
Clopidogrel 75Mg Tablet
Rivaroxaban 2.5Mg Tablet
Ticagrelor 90Mg Tablet
Sponsored by
East and North Hertfordshire NHS Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Coronary Syndrome

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male and female patients aged 18 years or over
  2. Have a diagnosis of acute coronary syndrome requiring treatment with dual antiplatelet therapy
  3. Be willing and able to understand the Participant Information Sheet and provide informed consent
  4. Agree to comply with the drawing of blood samples for the assessments
  5. Not meet any of the exclusion criteria below

Exclusion Criteria:

  1. Male and female participants aged < 18 years of age.
  2. Patient unwilling or unable to give informed consent
  3. Patients who might be pregnant or are breast-feeding
  4. Active clinically significant bleeding
  5. Patient who, in the opinion of the investigator, has condition considered to be a significant risk for major bleeding (such as current or recent gastrointestinal ulceration, presence of malignant neoplasm at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, known or suspected oesophageal varices, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities)
  6. Hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C
  7. Patient with any contraindications to use of antiplatelet agents or anticoagulants
  8. Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 of Summary of Product Characteristics (SmPC) of Rivaroxaban
  9. Concomitant treatment with any other anticoagulants e.g. unfractionated heparin (UFH), low molecular weight heparins (enoxaparin, dalteparin, etc.), heparin derivatives (fondaparinux, etc.), oral anticoagulants (warfarin, dabigatran etexilate, apixaban etc.) except under specific circumstances of switching anticoagulant therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter
  10. Concomitant treatment of ACS with antiplatelet therapy in patients with a prior stroke or a transient ischaemic attack (TIA)
  11. Patient with ongoing active alcohol or substance abuse or demonstrates signs or clinical features of active substance abuse.
  12. Patient with any major bleeding diathesis or blood dyscrasia at baseline (platelets<70 x 109/l, Hb<80 g/l, INR>1.4, APTT> x 2UNL, leucocyte count< 3.5x 109/l, neutrophil count<1x 109/l)
  13. Patient currently enrolled in an investigational drug trial

Sites / Locations

  • East and North Hertfordshire NHS TrustRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Active Comparator

Arm Label

Clopidogrel with Rivaroxaban

Clopidogrel

Ticagrelor

Arm Description

Clopidogrel 75mg o.d. and Rivaroxaban 2.5mg b.i.d.

Clopidogrel 75mg o.d.

Ticagrelor 90mg b.i.d.

Outcomes

Primary Outcome Measures

The change in Lysis Time (LT) in the three treatment groups assessed using the GTT from admission to follow-up at 30 days
To investigate, in patients with recent acute coronary syndrome and who have impaired endogenous fibrinolysis, whether the addition of low dose rivaroxaban to DAPT can improve endogenous thrombotic and fibrinolytic status

Secondary Outcome Measures

Frequency of further angioplasty
Clinical events including re-intervention
Frequency of further heart attack, stroke or death
Incidence of further major adverse cardiac events

Full Information

First Posted
December 12, 2018
Last Updated
February 11, 2020
Sponsor
East and North Hertfordshire NHS Trust
Collaborators
University of Hertfordshire
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1. Study Identification

Unique Protocol Identification Number
NCT03775746
Brief Title
Can Very Low Dose Rivaroxaban in Addition to Dual Antiplatelet Therapy (DAPT) Improve Thrombotic Status in Acute Coronray Syndrome (ACS) ACS
Acronym
VaLiDate-R
Official Title
Can Very Low Dose Rivaroxaban in Addition to Dual Antiplatelet Therapy (DAPT) Improve Thrombotic Status in Acute Coronray Syndrome (ACS) ACS
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Unknown status
Study Start Date
January 8, 2019 (Actual)
Primary Completion Date
December 2021 (Anticipated)
Study Completion Date
December 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
East and North Hertfordshire NHS Trust
Collaborators
University of Hertfordshire

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A prospective, randomised, open label study of 3 clinically licensed treatments for ACS to assess the effects of these treatments on blood tests of endogenous fibrinolysis. 50 patients will be randomised to each of the 3 treatment arms in 1:1:1 ratio. Patients will receive the randomised treatment for 1 month after their index admission with ACS.
Detailed Description
Heart attacks are caused by a blood clot occurring in a blood vessel (artery) which supplies blood to the heart. Such a clot can build up and block the blood flow, depriving part of the heart muscle of oxygen and blood, causing transient or permanent damage to the heart muscle. The standard treatment for a heart attack is two blood thinning medications combined, every day, to reduce the risk of further blood clots forming and to prevent another heart attack. The highest risk of another heart attack is in the next 30 days after the first heart attack. However, despite two blood thinners combined, some patients still go on to have another clot (heart attack or stroke or death) and this can be life threatening. Earlier research has shown that through a blood test, it is possible to identify patients who remain at increased risk of further clots and who may benefit from further blood thinners to reduce the risk of further heart attack, stroke and death in the next 30 days. The aim of this study is to test which of 3 blood thinning treatment options (all already in widespread clinical use) is best for patients to reduce further blood clots, in particular the addition of low dose rivaroxaban.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Coronary Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
150 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Clopidogrel with Rivaroxaban
Arm Type
Experimental
Arm Description
Clopidogrel 75mg o.d. and Rivaroxaban 2.5mg b.i.d.
Arm Title
Clopidogrel
Arm Type
Active Comparator
Arm Description
Clopidogrel 75mg o.d.
Arm Title
Ticagrelor
Arm Type
Active Comparator
Arm Description
Ticagrelor 90mg b.i.d.
Intervention Type
Drug
Intervention Name(s)
Clopidogrel 75Mg Tablet
Other Intervention Name(s)
EU/1/08/465/001
Intervention Description
Prevention of atherothrombotic events in percutaneous coronary intervention (adjunct with aspirin) in patients not already on clopidogrel
Intervention Type
Drug
Intervention Name(s)
Rivaroxaban 2.5Mg Tablet
Other Intervention Name(s)
EU/1/08/472/025-035, EU/1/08/472/041, EU/1/08/472/046-047
Intervention Description
Prophylaxis of atherothrombotic events following an acute coronary syndrome with elevated cardiac biomarkers (in combination with aspirin alone or aspirin and clopidogrel)
Intervention Type
Drug
Intervention Name(s)
Ticagrelor 90Mg Tablet
Other Intervention Name(s)
EU/1/10/655/007-011
Intervention Description
Prevention of atherothrombotic events in patients with acute coronary syndrome [in combination with aspirin]
Primary Outcome Measure Information:
Title
The change in Lysis Time (LT) in the three treatment groups assessed using the GTT from admission to follow-up at 30 days
Description
To investigate, in patients with recent acute coronary syndrome and who have impaired endogenous fibrinolysis, whether the addition of low dose rivaroxaban to DAPT can improve endogenous thrombotic and fibrinolytic status
Time Frame
30 days
Secondary Outcome Measure Information:
Title
Frequency of further angioplasty
Description
Clinical events including re-intervention
Time Frame
6 months
Title
Frequency of further heart attack, stroke or death
Description
Incidence of further major adverse cardiac events
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patients aged 18 years or over Have a diagnosis of acute coronary syndrome requiring treatment with dual antiplatelet therapy Be willing and able to understand the Participant Information Sheet and provide informed consent Agree to comply with the drawing of blood samples for the assessments Not meet any of the exclusion criteria below Exclusion Criteria: Male and female participants aged < 18 years of age. Patient unwilling or unable to give informed consent Patients who might be pregnant or are breast-feeding Active clinically significant bleeding Patient who, in the opinion of the investigator, has condition considered to be a significant risk for major bleeding (such as current or recent gastrointestinal ulceration, presence of malignant neoplasm at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, known or suspected oesophageal varices, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities) Hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C Patient with any contraindications to use of antiplatelet agents or anticoagulants Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 of Summary of Product Characteristics (SmPC) of Rivaroxaban Concomitant treatment with any other anticoagulants e.g. unfractionated heparin (UFH), low molecular weight heparins (enoxaparin, dalteparin, etc.), heparin derivatives (fondaparinux, etc.), oral anticoagulants (warfarin, dabigatran etexilate, apixaban etc.) except under specific circumstances of switching anticoagulant therapy or when UFH is given at doses necessary to maintain an open central venous or arterial catheter Concomitant treatment of ACS with antiplatelet therapy in patients with a prior stroke or a transient ischaemic attack (TIA) Patient with ongoing active alcohol or substance abuse or demonstrates signs or clinical features of active substance abuse. Patient with any major bleeding diathesis or blood dyscrasia at baseline (platelets<70 x 109/l, Hb<80 g/l, INR>1.4, APTT> x 2UNL, leucocyte count< 3.5x 109/l, neutrophil count<1x 109/l) Patient currently enrolled in an investigational drug trial
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Diana A Gorog, MD, PhD, FRCP
Phone
01438 284 753
Email
d.gorog@nhs.net
First Name & Middle Initial & Last Name or Official Title & Degree
Ying X Gue, MBChB, MRCP
Phone
01438 284 753
Email
y.gue@nhs.net
Facility Information:
Facility Name
East and North Hertfordshire NHS Trust
City
Stevenage
State/Province
Hertfordshire
ZIP/Postal Code
SG1 4AB
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Diana A Gorog
Phone
+44(0)1707 247512
Email
d.gorog@nhs.net
First Name & Middle Initial & Last Name & Degree
Ying Gue
Phone
+44(0)1438 284753
Email
y.gue@nhs.net

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31872349
Citation
Gue YX, Kanji R, Wellsted DM, Srinivasan M, Wyatt S, Gorog DA. Rationale and design of "Can Very Low Dose Rivaroxaban (VLDR) in addition to dual antiplatelet therapy improve thrombotic status in acute coronary syndrome (VaLiDate-R)" study : A randomised trial modulating endogenous fibrinolysis in patients with acute coronary syndrome. J Thromb Thrombolysis. 2020 Feb;49(2):192-198. doi: 10.1007/s11239-019-02014-5.
Results Reference
derived

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Can Very Low Dose Rivaroxaban in Addition to Dual Antiplatelet Therapy (DAPT) Improve Thrombotic Status in Acute Coronray Syndrome (ACS) ACS

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