Angina, Unstable, Coronary Artery Disease
Conditions
Keywords
Argatroban, Direct thrombin inhibitor, Percutaneous coronary intervention, Activated clotting time, PCI, ACT
Brief summary
This is a phase II multi-centre study in 140 patients undergoing elective PCI to obtain the information on dose-response of argatroban in pharmacodynamic markers and to assess the anticoagulation, safety and efficacy of argatroban in reference to unfractionated heparin, in combination with dual antiplatelet therapy.
Detailed description
This is a phase II multi-centre study in Europe in patients with stable coronary artery disease or troponin negative unstable angina undergoing elective PCI, to obtain the information on the safety and effects on various pharmacodynamic markers, of three doses of argatroban in combination with clopidogrel and aspirin, and to assess the results of argatroban and unfractionated heparin, both used in combination with clopidogrel and aspirin, on clinical outcomes, adequacy of anticoagulation, various pharmacodynamic markers (approximately 35 patients per group).
Interventions
DRUGArgatroban
DRUGHeparin
Sponsors
Tanabe Pharma Corporation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or female (women of child bearing potential must have a negative pregnancy test prior to entry into the study) * Aged over 18 years * Diagnosis of stable coronary artery disease (CAD) or unstable angina (troponin negative, i.e. within the normal range for the study site) with low to moderate anatomic risk and a requirement for elective percutaneous coronary angioplasty or stent insertion with an approved device in one or more de novo-treated or re-stenotic lesions in native vessels * Signed written informed consent
Exclusion criteria
* Any condition which, in the investigator's opinion, contraindicates the use of argatroban, heparin or clopidogrel or endangers the patient if he/she participated in this study. * Known cirrhosis, hepatitis, clinically significant hepatic disorder, or history of hepatic disorder. Hepatic disorder is defined as having levels of liver function tests (bilirubin, Aspartate Aminotransferase (Serum Glutamate Oxaloacetate Transaminase)(AST (SGOT)), Alanine Aminotransferase (Serum Glutamate Pyruvate Transaminase)(ALT (SGPT)) greater than 3.0 times above the upper limit of the normal range of local laboratory. * Patients not currently taking aspirin * Renal insufficiency, defined as serum creatinine greater than 2.0 mg/dL (greater than 177mmol/L) * Platelets less than 125,000/ml * If already taking any form of heparin prior to study enrolment, Activated Partial Thromboplastin Time(aPTT) equal or greater than 35 sec or ACT greater than 160 sec * Use of low molecular heparin (LMWH) during 12 h prior to PCI * If taking oral anticoagulant medication prior to study enrolment, International Normalised Ratio(INR) greater than 1.2 * Q wave MI with cardiogenic shock or thrombolytic therapy within 72 h of study dosing * Use of Glycoprotein IIb / IIIa(GPIIb/IIIa) inhibitors within prior 3 weeks * Documented coagulation disorder or bleeding diathesis * Lumbar puncture within the past 2 weeks * History of previous cerebral aneurysm, haemorrhagic stroke, or thrombotic stroke within the past 6 months * Active, uncontrolled peptic ulcer disease or any gastrointestinal bleeding or genitourinary bleeding within 3 months prior to study enrolment * Major surgery, serious trauma, puncture of non-compressible vessel, or biopsy of parenchymal organ within prior 2 months * Planned staged procedure, planned rotational atherectomy, directional coronary atherectomy, brachytherapy, or thrombectomy catheters * Planned surgical intervention other than study procedure within next 7 days * Presence of greater than 50% stenosis of unprotected left main coronary artery * Severe peripheral vascular disease, precluding femoral access * History of vasculitis * Uncontrolled hypertension defined as greater than 180/120 mmHg * Pregnancy (exclusion by routine urine test) * Lactating woman * Woman of children bearing age who are or were not using accepted contraceptive methods * Participation in other clinical trials of investigational products within 3 months prior to study enrolment * Terminally ill patients with a life expectancy of \< 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Activated Clotting Time (ACT) Value After the First Dosing of Study Treatment. | 5 - 10 min after initial bolus | — |
| Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | 30 Days | Composite end point (a): all cause death, myocardial infarction and urgent revascularization at Day30 Composite end point (b): all cause death, myocardial infarction and urgent revascularization at Day30 as well as major bleeding events during hospital stay |
Countries
Belgium, Germany
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| ARG250 250μg/kg i.v. bolus of argatroban followed by infusion of 15μg/kg/min
additional 150μg/kg i.v. boluses (maximum 2 additional) could be given in order to reach the target ACT level of 250 sec | 36 |
| ARG300 300μg/kg i.v. bolus followed by infusion of 20μg/kg/min
additional 150μg/kg i.v. boluses (maximum 2 additional) could be given in order to reach the target ACT level of 250 sec | 38 |
| ARG350 350μg/kg i.v. bolus followed by infusion of 25μg/kg/min
additional 150μg/kg i.v. boluses (maximum 2 additional) could be given in order to reach the target ACT level of 250 sec | 32 |
| Heparin 70-100 IU/kg i.v. bolus
additional 2,000-5,000 IU boluses could be given in order to reach the target ACT level of 250 sec | 34 |
| Total | 140 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Protocol Violation | 0 | 0 | 1 | 1 |
Baseline characteristics
| Characteristic | ARG250 | ARG300 | ARG350 | Heparin | Total |
|---|---|---|---|---|---|
| Age, Continuous | 63.4 years STANDARD_DEVIATION 8.9 | 65.5 years STANDARD_DEVIATION 9.5 | 68.3 years STANDARD_DEVIATION 7.9 | 65.9 years STANDARD_DEVIATION 9.8 | 65.7 years STANDARD_DEVIATION 9.2 |
| Sex: Female, Male Female | 11 Participants | 8 Participants | 9 Participants | 5 Participants | 33 Participants |
| Sex: Female, Male Male | 25 Participants | 30 Participants | 23 Participants | 29 Participants | 107 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 22 / 36 | 25 / 38 | 23 / 32 | 27 / 34 |
| serious Total, serious adverse events | 4 / 36 | 5 / 38 | 7 / 32 | 4 / 34 |
Outcome results
Primary
Activated Clotting Time (ACT) Value After the First Dosing of Study Treatment.
Time frame: 5 - 10 min after initial bolus
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| ARG250 | Activated Clotting Time (ACT) Value After the First Dosing of Study Treatment. | 301.0 second |
| ARG300 | Activated Clotting Time (ACT) Value After the First Dosing of Study Treatment. | 330.0 second |
| ARG350 | Activated Clotting Time (ACT) Value After the First Dosing of Study Treatment. | 354.0 second |
| Heparin | Activated Clotting Time (ACT) Value After the First Dosing of Study Treatment. | 237.5 second |
Primary
Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay.
Composite end point (a): all cause death, myocardial infarction and urgent revascularization at Day30 Composite end point (b): all cause death, myocardial infarction and urgent revascularization at Day30 as well as major bleeding events during hospital stay
Time frame: 30 Days
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ARG250 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (a) | 1 participants |
| ARG250 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (b) | 1 participants |
| ARG250 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | All cause death | 0 participants |
| ARG250 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Myocardial infarction | 0 participants |
| ARG250 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Urgent revascularization | 1 participants |
| ARG250 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Major bleeding | 0 participants |
| ARG300 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Major bleeding | 0 participants |
| ARG300 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Myocardial infarction | 0 participants |
| ARG300 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (a) | 0 participants |
| ARG300 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | All cause death | 0 participants |
| ARG300 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (b) | 0 participants |
| ARG300 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Urgent revascularization | 0 participants |
| ARG350 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (b) | 1 participants |
| ARG350 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | All cause death | 0 participants |
| ARG350 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Myocardial infarction | 1 participants |
| ARG350 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Major bleeding | 0 participants |
| ARG350 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Urgent revascularization | 1 participants |
| ARG350 | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (a) | 1 participants |
| Heparin | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Urgent revascularization | 0 participants |
| Heparin | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Major bleeding | 1 participants |
| Heparin | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (b) | 2 participants |
| Heparin | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Myocardial infarction | 1 participants |
| Heparin | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | Composite end point (a) | 1 participants |
| Heparin | Composite and Each of Death, Myocardial Infarction, and Urgent Revascularisation at Day 30, and Major Bleeding Events During Hospital Stay. | All cause death | 0 participants |