Safety and Efficacy of Prolonged Use of Bivalirudin 4 Hours After ePCI (COBER Study)

NCT04120961 | Completed

• 1 other identifier: KY20190823-05
• Study Type: interventional
• Target: 330
• Locations: 1 country
• Sites: 1

Brief Summary

Since the development of percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD), unfractionated heparin (UFH) and low molecular weight heparin (LWMH) have been the preferred anticoagulants in peri-operative period. However, UFH has some defects, such as incomplete and unstable inhibition of thrombin, large individual differences, multiple monitoring of activated coagulation time (ACT), ineffective thrombin binding to fibrin, non-specific protein binding and induced thrombocytopenia (HIT). Compared with UFH, LWMH has lower non-specific protein binding rate, but it is not superior to UFH in efficacy, hemorrhage and HIT. Bivalirudin can bind specifically to thrombin catalytic site and anionic external binding site, directly inhibit thrombin activity, thereby inhibiting thrombin-catalyzed and induced reactions. At the same time, thrombin can also inactivate it by enzymatic hydrolysis of bivalirudin. Therefore, the inhibition of bivalirudin on thrombin is reversible and transient, and the risk of bleeding after drug withdrawal is relative small. It has been reported that bivalirudin can significantly reduce the risk of peri-operative bleeding during PCI period compared with UFH. Clopidogrel had not yet played a role in most patients after emergency PCI, and there was a "blank period" for 2-4 hours without effective antithrombotic concentration, which was also the peak period of acute stent thrombosis. Han and coworkers have shown that for acute myocardial infarction (AMI) patients undergoing emergency PCI, whether or not glycoprotein IIb/IIIa inhibitors were added, prolonged peri-operative use of bivalrudin was significantly better than UFH in terms of net clinical adverse event. However, for patients with elective PCI (ePCI), prolonged bivalirudin use was only used in some patients in REPLACE-2 and ISAR-REACT-3 studies, and the prolonged time of bivalrudin use after ePCI was not definite. Therefore, in the current study we aim to explore the efficacy and safety of prolonged bivalirudin use 4 hours after elective PCI in patients with CHD.

Conditions

Coronary Heart Disease

Keywords

bivalirudin; prolonged use; peri-operative myocardial injury; percutaneous coronary intervention

Outcome Measures

Primary Outcomes (1)

• The incidence rate of PMI in CHD patients 3 days after ePCI

  the incidence rate of PMI indicated by the changes of myocardial injury biomarkers (such as TNI and CK-MB) in CHD patients between prolonged use of bivalirudin and bivalirudin use during ePCI groups

  Clinical follow up at 3 days after ePCI

Secondary Outcomes (1)

• The incidence rate of MACEs and bleeding

  Clinical follow up at 7 days after ePCI

Study Arms (2)

prolonged continuous use of bivalirudine

EXPERIMENTAL

A total of 165 patients are assigned to group with prolonged continuous use of bivalirudin after randomization schedule.

Drug: prolonged continuous use of bivalirudin

bivalirudin use during ePCI

OTHER

A total of 165 patients are assigned to group with bivalirudin use during ePCI after randomization schedule.

Drug: bivalirudin use during ePCI

Interventions

prolonged continuous use of bivalirudin DRUG

prolonged continuous use of bivalirudin 4 hours after elective PCI (dose: 0.75 mg/kg bolus plus 1.75 mg/kg per hour)

Also known as: prolonged continuous use of bivalirudin 4 hours after elective PCI

prolonged continuous use of bivalirudine

bivalirudin use during ePCI DRUG

bivalirudin use during ePCI (0.75 mg/kg bolus plus 1.75 mg/kg per hour)

Also known as: bivalirudin use during ePCI period

bivalirudin use during ePCI

Eligibility Criteria

• Age: 18 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• De novo lesions
• elective PCI
• Only single coronary artery treated at this time

You may not qualify if:

• Those who meet the diagnostic criteria of acute myocardial infarction
• Patients with cardio-genic shock
• Patients with multiple organ failure
• Patients allergic to contrast
• Patients who can not tolerate dual antiplatelet therapy
• Patients who can't tolerate anticoagulation
• Recently infected patients
• Patients with hepatorenal dysfunction
• Thrombotic lesion of coronary artery
• Chronic total coronary occlusion lesion
• Patients with complex coronary bifurcation requiring two stent strategy
• Severe coronary calcified lesion
• Patients with percutaneous coronary angioplasty
• Patients with directional coronary atherectomy or rotational atherectomy
• Patients with drug coated balloon treatment

Sponsors & Collaborators

• Nanjing First Hospital, Nanjing Medical University: lead

Study Sites (1)

Nanjing First Hospital, Nanjing Medical University

Nanjing, Jiangsu, 210006, China

Location

Related Publications (5)

• Han Y, Guo J, Zheng Y, Zang H, Su X, Wang Y, Chen S, Jiang T, Yang P, Chen J, Jiang D, Jing Q, Liang Z, Liu H, Zhao X, Li J, Li Y, Xu B, Stone GW; BRIGHT Investigators. Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. JAMA. 2015 Apr 7;313(13):1336-46. doi: 10.1001/jama.2015.2323.

  PMID: 25775052 BACKGROUND

• Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Kereiakes DJ, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ; REPLACE-2 Investigators. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA. 2003 Feb 19;289(7):853-63. doi: 10.1001/jama.289.7.853.

  PMID: 12588269 BACKGROUND

• Schulz S, Mehilli J, Ndrepepa G, Neumann FJ, Birkmeier KA, Kufner S, Richardt G, Berger PB, Schomig A, Kastrati A; Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 3 Trial Investigators. Bivalirudin vs. unfractionated heparin during percutaneous coronary interventions in patients with stable and unstable angina pectoris: 1-year results of the ISAR-REACT 3 trial. Eur Heart J. 2010 Mar;31(5):582-7. doi: 10.1093/eurheartj/ehq008. Epub 2010 Feb 11.

  PMID: 20150324 BACKGROUND

• Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, Leslie K, Rao-Melacini P, Chrolavicius S, Yang H, Macdonald C, Avezum A, Lanthier L, Hu W, Yusuf S; POISE (PeriOperative ISchemic Evaluation) Investigators. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med. 2011 Apr 19;154(8):523-8. doi: 10.7326/0003-4819-154-8-201104190-00003.

  PMID: 21502650 BACKGROUND

• Wu Z, Meng P, Guo Y, You W, Wu X, Ye F. Prolonged infusion of bivalirudin after elective percutaneous coronary intervention protects against procedural myocardial injury (a COBER study)-a randomized trial. Sci Rep. 2023 Apr 24;13(1):6667. doi: 10.1038/s41598-023-34008-y.

  PMID: 37095298 DERIVED

MeSH Terms

Conditions

Coronary Disease

Condition Hierarchy (Ancestors)

Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases

Study Officials

• Zhiming Wu, MD

  Nanjing First Hospital, Nanjing Medical University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 29, 2019
• First Posted: October 9, 2019
• Study Start: September 20, 2019
• Primary Completion: August 1, 2022
• Study Completion: August 1, 2022
• Last Updated: August 9, 2022

Record last verified: 2022-08

Locations

CN (1)