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Myocardial InfarctionPhase 4Dan-DAPTNCT05262803

Reduced Antithrombotic Strategy for High Bleeding Risk Patients With Myocardial Infarction

A Phase 4 study testing CYP2C19*2/*3 and Shorter DAPT duration in people with Myocardial Infarction, run by Rikke Sorensen at 6 sites in Denmark.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Rationale: Heart attacks are a major cause of death and result from coronary blood clots that require acute coronary intervention and antithrombotic drugs to restore blood flow and prevent new heart attacks. Over time, more potent antithrombotic drugs have been introduced like prasugrel and ticagrelor. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Myocardial Infarction
What is being tested?
CYP2C19*2/*3 and Shorter DAPT duration
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,808 participants
Where
6 sitesDenmark
Study dates
17 Jun 2022to Dec 2028
Phase
Phase 4
Are there results?
Not yet: the study is under way

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

  • MI caused by atherothrombotic CAD (Type 1 MI) according to "The Fourth Universal Definition of MI", which has been treated with PCI with contemporary drug-eluting stents. This definition of type 1 MI requires the detection of a rise and/or fall of cardiac troponin values with at least one value >99th percentile and at least one of the following criteria assessed by the treating physician:
  • symptoms indicating acute myocardial ischemia
  • new ischemic changes on the electrocardiogram
  • development of pathological Q-waves
  • imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
  • visible coronary thrombus by angiography
  • PRECISE-DAPT score ≥25
  • Age ≥18 years

Who cannot join

  • Contraindications including allergies to ASA or P2Y12 inhibitors
  • Indication for oral anticoagulation
  • Previous stent thrombosis
  • Life expectancy <1 year
  • Resuscitated cardiac arrest with Glasgow Coma Scale <8 and/or need of intubation
  • Prior intracranial hemorrhage
Show all 10Show fewer
  • Active bleeding (BARC ≥2) at randomization
  • Women who are pregnant, have given birth recently (within the past 90 days), are lactating, or are fertile without contraception
  • Hypertensive crisis (systolic blood pressure >180 mmHg and/or diastolic blood pressure >120 mmHg)
  • Unable to understand and follow study-related instructions or to comply with study protocol

Trial locations and contacts

6 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Rikke Sorensen, MD, Ph.D. contact

35456851 ext. +45

rikke.soerensen@regionh.dk

6 sites in 1 country

Denmark6 sites, 6 recruiting
  • Aalborg University Hospital

    Aalborg, 9000

    Phillip Freeman, BSc, MBBS, MRCP, Ph.D.

    Recruiting
  • The Heart Centre, Copenhagen University Hospital, Rigshospitalet

    Copenhagen, 2100

    Rikke Sorensen, MD, Ph.D., 35456851 ext. +45, rikke.soerensen@regionh.dk

    Rikke Sorensen, MD, Ph.D.

    Recruiting
  • Herlev and Gentofte University Hospital - Gentofte

    Hellerup, 2900

    Mette G Charlot, MD, Ph.D.

    Recruiting
  • Odense University Hospital

    Odense, 5000

    Karsten T Veien, MD, DMSc

    Recruiting
  • Zealand University Hospital

    Roskilde, 4000

    Henning S Kelbaek, MD, DMSc

    Recruiting
  • Aarhus University Hospital

    Skejby, 8200

    Erik L Grove, Assoc.prof., MD, Ph.D.

    Erik L Grove, Assoc. prof., MD, Ph.D

    Recruiting

Other trials in Denmark

About this study

Official title: Reduced Antithrombotic Strategy for High Bleeding Risk Patients With Myocardial Infarction Treated With Percutaneous Coronary Intervention - The Dan-DAPT Trial

Rationale: Heart attacks are a major cause of death and result from coronary blood clots that require acute coronary intervention and antithrombotic drugs to restore blood flow and prevent new heart attacks. Over time, more potent antithrombotic drugs have been introduced like prasugrel and ticagrelor. These drugs have replaced the older drug, clopidogrel, as approximately 30% of patients are low-responders to clopidogrel for genetic reasons. However, the newer drugs introduce a significant risk of serious bleeding.

Aim: The aim of this trial is to assess a reduced antithrombotic strategy for high bleeding risk patients with heart attacks to reduce bleeding safely.

Read more

Hypothesis: Significantly reduced bleeding with a similar preventive effect are expected.

Design: The Dan-DAPT trial include high bleeding risk patients with heart attacks from Danish hospitals (Rigshospitalet, Aarhus, Odense, Aalborg, Roskilde, and Gentofte hospital) and randomize them to standard-of-care or shorter and individualized antithrombotic therapy based on responsiveness to clopidogrel after genetic testing.

Being tested
CYP2C19*2/*3, Shorter DAPT duration
Keywords
High bleeding risk, CYP2C19 genotyping, Dual antiplatelet therapy, Percutaneous coronary intervention
Medical subject headings
Myocardial Infarction

What participants receive

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

  • CYP2C19*2/*3Genetic

    • Non-carriers of CYP2C19*2/*3 loss-of-function alleles: DAPT with clopidogrel and ASA
    • Carriers of CYP2C19*2/*3 loss-of-function alleles: DAPT with prasugrel (or ticagrelor) and ASA
  • Shorter DAPT durationOther

    Duration of DAPT is shortened to 3 months

Study groups in NCT05262803
Study groupRoleWhat they receive
Standard-of-care DAPTNo interventionDual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and prasugrel or ticagrelor for 6 months followed by ASA monotherapy.
Genotype-guided DAPTExperimentalDAPT according to CYP2C19*2/*3-genotyping for 6 months followed by ASA monotherapy.
Receives: Genetic: CYP2C19*2/*3
Shorter genotype-guided DAPTExperimentalDAPT according to CYP2C19*2/*3-genotyping for 3 months followed by ASA monotherapy.
Receives: Genetic: CYP2C19*2/*3; Other: Shorter DAPT duration

What is being measured

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

  1. BARC type 2-5 bleedings

    A composite of type 2-5 non-access site bleeding according to the Bleeding Academic Research Consortium (BARC) scale, ranging from bleedings that require diagnosis, hospitalization, or treatment by a health care professional (BARC type 2) to fatal bleedings (BARC type 5)

    Measured: 1 year

  2. NACE (Net adverse clinical events)

    A composite of all-cause mortality, recurrent myocardial infarction, definite stent thrombosis, ischemic stroke, and BARC type 3-5 non-access site bleeding

    Measured: 1 year

Secondary outcomes (8)
  1. MACE (Major adverse cardiovascular events)

    A composite of all-cause mortality, recurrent myocardial infarction, definite stent thrombosis and ischemic stroke

    Measured: 3, 6, and 12 months

  2. Bleedings according to BARC and TIMI (Thrombolysis in Myocardial Infarction) defintions

    Measured: 3, 6, and 12 months

  3. All-cause mortality

    Measured: 3, 6, and 12 months

  4. Non-hemorrhagic cardiovascular death

    Measured: 3, 6, and 12 months

  5. Ischemic events

    Recurrent MI, definite/probable stent thrombosis, any (non-)target vessel revascularization, coronary artery bypass grafting, ischemic stroke

    Measured: 3, 6, and 12 months

  6. Discontinuation or switch to another antiplatelet drug

    Measured: 3, 6, and 12 months

  7. Pharmacoeconomic endpoint including direct and in-direct medical costs

    Direct medical costs (e.g. costs for genotyping, medicinal products, re-hospitalization) and indirect costs (e.g. absence from the workforce).

    Measured: 3, 6, and 12 months

  8. Self-reported quality of life scores

    Self-reported quality of life scores according to the EQ-5D-5L questionaries in electronic form

    Measured: 3, 6, and 12 months

Timeline

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

  1. First posted2 Mar 2022
  2. Study start17 Jun 2022
  3. Primary completionDec 2028 (estimated)
  4. Study completionDec 2028 (estimated)

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
Single blind
Who is masked
Outcomes assessor
Enrolment
2,808 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05262803
Sponsor's protocol ID
2022-500125-32-00
Acronym
Dan-DAPT
Status last verified
Mar 2024
First submitted
9 Feb 2022
Last updated
15 Mar 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine GN; ESC Scientific Document Group. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2018 Jan 1;53(1):34-78. doi: 10.1093/ejcts/ezx334. No abstract available.

    PubMed 29045581
  • Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Juni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289-1367. doi: 10.1093/eurheartj/ehaa575. No abstract available.

    PubMed 32860058
  • Costa F, van Klaveren D, James S, Heg D, Raber L, Feres F, Pilgrim T, Hong MK, Kim HS, Colombo A, Steg PG, Zanchin T, Palmerini T, Wallentin L, Bhatt DL, Stone GW, Windecker S, Steyerberg EW, Valgimigli M; PRECISE-DAPT Study Investigators. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017 Mar 11;389(10073):1025-1034. doi: 10.1016/S0140-6736(17)30397-5.

    PubMed 28290994
  • Claassens DMF, Vos GJA, Bergmeijer TO, Hermanides RS, van 't Hof AWJ, van der Harst P, Barbato E, Morisco C, Tjon Joe Gin RM, Asselbergs FW, Mosterd A, Herrman JR, Dewilde WJM, Janssen PWA, Kelder JC, Postma MJ, de Boer A, Boersma C, Deneer VHM, Ten Berg JM. A Genotype-Guided Strategy for Oral P2Y12 Inhibitors in Primary PCI. N Engl J Med. 2019 Oct 24;381(17):1621-1631. doi: 10.1056/NEJMoa1907096. Epub 2019 Sep 3.

    PubMed 31479209
  • Jacobsen MR, Engstrom T, Torp-Pedersen C, Gislason G, Glinge C, Butt JH, Fosbol EL, Holmvang L, Pedersen F, Kober L, Jabbari R, Sorensen R. Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction. Int J Cardiol. 2021 Nov 1;342:15-22. doi: 10.1016/j.ijcard.2021.07.047. Epub 2021 Jul 24.

    PubMed 34311012
  • Jacobsen MR, Jabbari R, Grove EL, Maeng M, Veien K, Hougaard M, Freeman P, Kelbaek H, Charlot MG, Engstrom T, Sorensen R. Genotype-guided de-escalation and abbreviation of dual antiplatelet therapy in patients with myocardial infarction and high bleeding risk: Design and rationale of the investigator-initiated, multicenter, randomized, controlled trial, DAN-DAPT. Am Heart J. 2025 Jul;285:74-81. doi: 10.1016/j.ahj.2025.02.020. Epub 2025 Feb 26.

    PubMed 40015616

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing CYP2C19*2/*3 and Shorter DAPT duration in people with Myocardial Infarction, run by Rikke Sorensen at 6 sites in Denmark.

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 8 inclusion and 10 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: looking for participants now, as of the sponsor's last update on 15 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Denmark. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Rikke Sorensen, MD, Ph.D. (35456851 ext. +45, rikke.soerensen@regionh.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

BARC type 2-5 bleedings (time frame: 1 year). The study lists 2 primary outcomes in all. 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 NCT05262803, which also lists 6 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 15 Mar 2024.

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