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Completed

NCT Number: NCT03664180

Comparison of Anticoagulation Prolongation vs. no Anticoagulation in STEMI Patients After Primary PCI

The RIGHT study is a large randomized study dedicated to post-PPCI anticoagulation in STEMI patients. The investigators propose to evaluate the clinical efficacy and safety of anticoagulation prolonged for at least 48 hours after the procedure vs. no prolongation of anticoagulation after procedure in patients with STEMI treated with bivalirudin during PPCI (primary hypothesis). When allocated to anticoagulation prolongation by randomization, the subject will be assigned to UFH, enoxaparin or bivalirudin (same regimen allocated by centre) for at least 48 hours after PPCI. The results from this study are expected to provide guidance on the risk/benefit of post-procedural anticoagulation in patients with STEMI.

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Key information

Conditions

STEMI - ST Elevation Myocardial Infarction Cardiovascular Diseases Heart Diseases Infarction Ischemia Myocardial Infarction Myocardial Ischemia Necrosis Pathologic Processes Pathological Conditions, Signs and Symptoms ST Elevation Myocardial Infarction Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

Beijing Anzhen Hospital, Capital Medical University

Beijing, 100029, China

About this study

A minor change of time of randomization after prolongation of bivalirudin infusion at PCI dose up to 4 hours on protocol at September 19,2018. Reasons: a minor change concerning the timing of randomization considering the current local practice in some centers that use the 4 hour infusion of bivalirudin just after PCI. It remains in agreement with the current international guidelines and with the drug label in China. There is no change in drugs used and doses of these drugs once the randomization occurs.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age ≥18 years old
  • STEMI with PPCI of culprit lesion
  • Bivalirudin therapy during PPCI
  • Signed informed consent form

Exclusion criteria

  • Patients with a formal indication for anticoagulation after PPCI (e.g. atrial fibrillation, left-ventricular thrombus, intra-aortic balloon pump, pulmonary embolism, mechanical heart valve)
  • Patients with any indication for chronic anticoagulation
  • Patient with previous lytic treatment
  • Patient with previous coronary artery bypass graft surgery
  • Cardiogenic shock, malignant ventricular arrhythmia, or mechanical complications
  • Any anticoagulation other than bivalirudin started after the procedure before randomization
  • Estimated body weight of >120 kg or <45kg
  • BP ≥180/110mmHg at randomization
  • Any bleeding diathesis or severe hematologic disease or history of intracerebral mass, aneurysm, arteriovenous malformation, recent (<6months) ischemic stroke or TIA, recent (<6months) intracranial hemorrhage or, gastrointestinal or genitourinary bleeding within the past 2 weeks
  • History of heparin-induced thrombocytopenia
  • Suspected acute aortic dissection (AAD)
  • Major surgery within 1 month
  • A planned elective surgical procedure that would necessitate an interruption in treatment with P2Y12 inhibitors in the next 6 months after enrollment
  • Known PLT≤100×109 or HGB≤10g/L
  • Known transaminase >3-fold ULN, or CCr<30ml/min
  • Known allergy to any study drug
  • Pregnancy or lactation
  • Noncardiac coexisting conditions that could limit life expectancy to less than 1 year
  • Current participation in an investigational drug or device trial

Treatment and study plan

Bivalirudin

Drug

IV infusion of 0.2 mg/kg/h (low-rate infusion) for at least 48h after the procedure or until discharge from CCU if it occurs later

Enoxaparin

Drug

40mg/d s.c.for at least 48h after the procedure or until discharge from CCU if it occurs later

Unfractionated heparin

Drug

IV infusion of 10 U/kg/h (maximum 1000 U) initially, adjusted to maintain ACT between 150 and 220 seconds for at least 48h after the procedure or until discharge from CCU if it occurs later

Bivalirudin placebo

Drug

Matching placebo IV infusion for at least 48h after the procedure or until discharge from CCU if it occurs later

Enoxaparin placebo syringe

Drug

Placebo syringe will be only prepared by a designated unblended medical professional on site. Placebo syringe will be presented in identical containers as a clear, colorless, sterile liquid of saline.Subcutaneous injection once a day for at least 48 hours after the procedure or until discharge from CCU if it occurs later.

Unfractionated heparin placebo

Drug

Matching placebo IV infusion for at least 48h after the procedure or until discharge from CCU if it occurs later.

Primary outcomes

  1. Primary efficacy endpoint - number of event of a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis (definite) or urgent revascularization (any vessel)

    Time frame: 30 days

    The number of event of a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis (definite) or urgent revascularization (any vessel) within 30 days after randomization

  2. Primary safety endpoint - The number of event of major bleeding

    Time frame: 30 days

    The number of event of major bleeding (BARC 3 to 5) within 30 days after randomization

Secondary outcomes

  1. Secondary ischemic endpoints - The number of event of a composite of all-cause death, non-fatal myocardial infarction, or non-fatal stroke

    Time frame: 30 days

    The number of event of a composite of all-cause death, non-fatal myocardial infarction, or non-fatal stroke within 30 days after randomization

  2. Secondary ischemic endpoints - The number of event of a composite of all-cause death or non-fatal myocardial infarction

    Time frame: 30 days

    The number of event of a composite of all-cause death or non-fatal myocardial infarction within 30 days after randomization

  3. Secondary ischemic endpoints - The number of cardiovascular death events

    Time frame: 30 days

    The number of cardiovascular death event within 30 days after randomization

  4. Secondary ischemic endpoints - The number of stent thrombosis (ARC definite) events

    Time frame: 30 days

    The number of stent thrombosis (ARC definite) event within 30 days after randomization

  5. Secondary safety endpoints - The number of bleeding events (TIMI, STEEPLE and GUSTO definition)

    Time frame: 30 days

    The number of bleeding events (TIMI, STEEPLE and GUSTO definition) within 30 days after randomization

    To demonstrate that post-procedure anticoagulation with UFH, enoxaparin or bivalirudin as compared to their placebo is associated to lower rate of the composite endpoint of major bleeding according to TIMI, STEEPLE and GUSTO definitions within the first 30 days after randomization.

  6. Secondary safety endpoints - The number of thrombocytopenia events

    Time frame: 30 days

    The number of thrombocytopenia events within 30 days after randomization

    To demonstrate superiority of a strategy of post-procedure anticoagulation with UFH, enoxaparin or bivalirudin as compared to their placebo by the time from randomization to the first occurrence of any event of the Thrombocytopenia endpoint over 30 days of follow-up.

Sponsors and collaborators

Lead sponsor

Beijing Anzhen Hospital

Other

Collaborators

  • Chinese Academy of Medical Sciences, Fuwai Hospital
  • Groupe Hospitalier Pitie-Salpetriere

Registry information

Official study title

Randomized Comparison of Anticoagulation After Primary Percutaneous Coronary Intervention Using Enoxaparin, ACT Guided Unfractionated Heparin or Bivalirudin Prolongation vs. no Anticoagulation To Improve Clinical Outcome

Acronym: RIGHT

Important dates

Study start
2019
Primary completion
2022
Study completion
2022
First posted
Sep 10, 2018
Registry last updated
May 3, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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