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Diabetes MellitusPhase 4ANDAMANNCT02520921

Aspirin Twice a Day in Patients With Diabetes and Acute Coronary Syndrome

A Phase 4 study testing Novel strategy Aspirin and Conventional strategy Aspirin in people with Diabetes Mellitus and Acute Coronary Syndrome, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on a composite end-point of ischemic events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Novel strategy Aspirin and Conventional strategy Aspirin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,484 participants
Where
1 siteFrance
Study dates
13 Jun 2016to 18 Jul 2024
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diabetes mellitus defined as (≥ 1 item)
  • Treated diabetes mellitus
  • 2 fasting glucose levels ≥ 7 mmol/l after admission
  • glucose level ≥ 11 mmol/l after admission (any moment)
  • HbA1C ≥ 6.5% OR
  • Factor of aspirin lack of efficacy defined as (≥ 1 item)
Show all 21Show fewer
  • Obesity defined as BMI≥27kg/m2
  • Waist circumference ≥ 88cm for women or ≥102cm for men
  • Index event occurring under chronic low dose of aspirin (<300mg)
  • AND
  • Acute coronary syndrome defined as:
  • Acute coronary syndrome with ST-segment elevation (STEMI) is defined as chest pain (≥ 30min) with persistent ST-segment elevation in at least two contiguous leads (≥1mm) or a new left bundle-branch block and the intention to perform primary PCI or thrombolysis.
  • Acute coronary syndrome without ST-segment elevation (NSTEMI) is defined as universal myocardial definition:
  • Detection of cardiac biomarker values elevation [preferably cardiac troponin (cTn)] with at least one value above the 99th percentile upper reference limit (URL) and with at least one of the following:
  • Symptoms of ischemia
  • New or presumed new significant ST-segment-T wave (ST-T) changes except ST elevation
  • Development of pathological Q waves in the ECG
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
  • Identification of an intracoronary thrombus by angiography
  • included after the angiography showing stenosis ≥50% and before discharge
  • signed informed consent and ≥18 years old

Who cannot join

  • Allergy or contraindication to aspirin (Hypersensitivity to aspirin or any of the excipients, history of asthma induced by the administration of salicylates, ongoing peptic ulcer, constitutional or acquired haemorrhagic disease including gastrointestinal bleeding, history of hemorrhagic stroke and thrombocytopenia, pregnancy after 24 weeks of gestation, risk of bleeding, severe renal failure, severe hepatic impairment, uncontrolled severe heart failure
  • Concomitant anticoagulation therapy that cannot be stopped
  • Fibrinolytic therapy less than 24 hours.
  • Unstable patients according to investigator: use of amine or mechanical device (IABP, ECMO or similar) or mechanical ventilation during index hospitalization
  • Index event is an acute complication of coronary revascularization (PCI or CABG)
  • Known serious hematological disorder
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  • Proven gastric or duodenal ulcer in the past 3 months
  • Previous hemorrhagic stroke, previous cranial bleeding, intracranial neoplasia, arterio-venous malformation
  • Any condition that may put the patient at risk or influence study result in the investigators' opinion (active cancer ….) or that increase the risk for non-compliance or being lost to follow-up
  • Concomitant treatment with methotrexate or with chronic non-steroidal anti-inflammatory drug
  • Pregnancy or lactation or woman of childbearing age without contraception
  • Participant in an another investigational drug study within 30 days
  • Patients under curatorship
  • No social security

Trial locations and contacts

1 site in 1 country.

France1 site
  • Department of Cardiology - Lariboisiere Hospital

    Paris, 75010

Other trials in France

About this study

Official title: Aspirin With a Novel Twice-a-day Administration in Diabetic Patients With Acute Coronary Syndrome to Minimize Recurrence of Acute Ischemic Events or New Urgent Revascularization

To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on a composite end-point of ischemic events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome. It is expected that aspirin taken twice a day will reduce the occurrence of new ischemic event after acute coronary syndrome in diabetic patients or in patients with a known risk factor.

Read the detailed description

Patients who show high persistent platelet reactivity under aspirin are increasingly becoming an issue of clinical concern. Several studies have suggested that giving aspirin more frequently is very effective for reducing aspirin high persistent platelet reactivity, especially in diabetic patientsor in patients with a known risk factor. The aim of the study is to evaluate low dose of aspirin twice a day (compared to once a day) for the reduction of ischemic events in diabetic patients or in patients with a known risk factor, with acute coronary syndrome.

Experimental Design:

A multicenter, randomised, parallel group comparing aspirin given twice a day compared to once per day in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.

Primary objective:

To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on a composite end-point of ischemic events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.

Secondary objectives:

  • To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on net clinical benefit combining the ischemic and bleeding events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.
  • To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day on cardiac events in diabetic patients, or in patients with a known risk factor for non-optimal aspirin response (obesity, abdominal obesity or coronary event occurring with long-term aspirin),with acute coronary syndrome.
  • To compare treatment with Aspirin Protect® twice a day (100 mg in the morning and 100 mg in the evening) versus Aspirin Protect® 100 mg once per day in each of individual component of the main criterion.
  • To confirm the safety of the innovative strategy (aspirin twice a day) concerning major bleeding events.

Study enrollment:

Multicentric national study involving 42 centers in France The duration is expected to be 24 months of recruitment. Patients will be randomized during the index hospitalization for acute coronary syndrome and before discharge between a conventional strategy of enteric coated aspirin 100mg per day with the standard of care or a innovative strategy of enteric coated aspirin 100mg morning and evening. Patients will be followed at one month, six months, one year and 18 months

Statistical analysis:

The study will include 2574 patients. We hypothesized that at 18 months, there will be an event rate of 22% for "death, MI, stroke, urgent revascularization, or acute arterial thrombotic event in the group treated with aspirin and we expect a decrease of the primary event of 20% (relative variation) using aspirin twice a day corresponding to an event rate of 17.6%.

A sample size of 1287 patients /group will allow an 80% power to detect this difference using a log-rank test at a two-sided 5% significance level. The study will include 2574 diabetic patients, or patients with a known risk factor for non-optimal aspirin response.

The primary analysis is based on the Intention To Treat population and the primary endpoint. The primary analysis on the primary endpoint will be carried out using a log-rank test for survival analysis. The 95% confidence interval of the hazard ratio will be presented. In addition the survival status during 18 months follow-up will be described by showing Kaplan-Meier curves.

Primary outcome according to pre-specified subgroups:

  • Age: patients < 75 years or patient ≥75 years
  • Gender: male or female
  • Insulin vs no insulin treatment
  • Type of acute coronary syndrome : STEMI vs NSTEMI
  • Type of ADP inhibitor cotreatment
  • Treatment strategy medical vs invasive (angioplasty or CABG surgery)
  • Peripheral artery disease Yes/No
  • GRACE score > or ≤140
  • Left ventricular ejection fraction > or ≤ 40%
  • Prior stroke Yes/No
  • previous treatment with aspirin Yes/No
  • initial HbA1C level > or ≤8%
  • duration of diabetes > or ≤10 years
  • Weight <60; 60-90; >90kg
  • PPI use Yes/No
Being tested
Novel strategy Aspirin, Conventional strategy Aspirin
Keywords
Diabetes mellitus, Acute coronary syndrome, Coronary artery disease, Aspirin, Secondary prevention, Obesity
Medical subject headings
Diabetes Mellitus, Acute Coronary Syndrome, Coronary Artery Disease, Obesity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Novel strategy AspirinDrug

    Aspirin twice a day : enteric coated enteric coated aspirin given twice a day, 100 mg in the morning and 100 mg in the evening (i.e. 200mg/day)

  • Conventional strategy AspirinDrug

    Aspirin once day: enteric coated aspirin 100 mg in the morning (i.e. 100mg/day)

Study groups in NCT02520921
Study groupRoleWhat they receive
Arm 1 : Novel strategyActive comparatorenteric coated aspirin 100 mg in the morning and 100 mg in the evening
Receives: Drug: Novel strategy Aspirin
Arm 2 : Conventional strategyActive comparatorenteric coated aspirin 100 mg in the morning
Receives: Drug: Conventional strategy Aspirin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. first main vascular event occurring within the 18 months after randomization among the following: Death (any), Myocardial infarction, Stroke, Urgent coronary revascularization and/or stent thrombosis, Acute arterial thrombotic event

    Measured: at18 months

Secondary outcomes (4)
  1. Major bleeding (type 3 to 5 following BARC classification

    Measured: at18 months

  2. Net clinical benefit: Death (any), Myocardial infarction, Stroke, Urgent coronary revascularization and/or stent thrombosis, Acute arterial thrombotic event, Major bleeding

    Measured: at18 months

  3. Cardiac endpoint: Cardiovascular death / Myocardial infarction

    Measured: at18 months

  4. Death, myocardial infarction, stroke, urgent revascularization, stent thrombosis, acute arterial thrombotic event and major bleeding analyzed specifically and separately

    Measured: at18 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Aug 2015 (estimated)
  2. Study start13 Jun 2016
  3. Primary completion18 Jul 2024
  4. Study completion18 Jul 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
2,484 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02520921
Sponsor's protocol ID
P141005
Other IDs
2015-000947-18, 2015
Acronym
ANDAMAN
Status last verified
Nov 2025
First submitted
12 Jun 2015
Last updated
20 Nov 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Dillinger JG, Pezel T, Batias L, Angoulvant D, Goralski M, Ferrari E, Cayla G, Silvain J, Gilard M, Lemesle G, Souteyrand G, Lim P, Roubille F, Georges JL, Bal Dit Sollier C, Petroni T, Morel O, Delarche N, Elbaz M, Puymirat E, Toupin S, Montalescot G, Drouet L, Vicaut E, Henry P; ANDAMAN Investigators of the ACTION Study Group. Aspirin dosing after acute coronary syndrome with suspected aspirin resistance: the ANDAMAN trial. Eur Heart J. 2026 Feb 11;47(6):719-730. doi: 10.1093/eurheartj/ehaf680.

    PubMed 40884757
  • Dillinger JG, Pezel T, Batias L, Angoulvant D, Goralski M, Ferrari E, Cayla G, Silvain J, Gilard M, Lemesle G, Souteyrand G, Lim P, Roubille F, Georges JL, Bal Dit Sollier C, Petroni T, Morel O, Delarche N, Elbaz M, Puymirat E, Toupin S, Montalescot G, Drouet L, Vicaut E, Henry P; ANDAMAN Investigators of the ACTION Study Group. Twice-a-day administration of aspirin in patients with diabetes mellitus or aspirin resistance after acute coronary syndrome: Rationale and design of the randomized ANDAMAN trial. Am Heart J. 2025 Oct;288:101-110. doi: 10.1016/j.ahj.2025.04.016. Epub 2025 Apr 21.

    PubMed 40268181

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Novel strategy Aspirin and Conventional strategy Aspirin in people with Diabetes Mellitus and Acute Coronary Syndrome, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 21 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

first main vascular event occurring within the 18 months after randomization among the following: Death (any), Myocardial infarction, Stroke, Urgent coronary revascularization and/or stent thrombosis, Acute arterial thrombotic event (time frame: at18 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02520921, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Nov 2025.

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