AzTrials
AzTrials

Dual Antiplatelet TherapyPhase 3DESC-HBRNCT05903976

De-escalating Antiplatelet Therapy to Assess Platelet Reactivity and Outcomes in High Bleeding Risk Patients With Recent ACS

A Phase 3 study testing P2Y12 inhibitor de-escalation in people with Dual Antiplatelet Therapy and Acute Coronary Syndrome, run by Azienda Ospedaliera Universitaria Policlinico "G. Martino" at 2 sites in Italy.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

High bleeding risk (HBR) patients, comprising up to 50% of those presenting with acute coronary syndrome (ACS), are a high-risk group that is increasing in size due to an aging population. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
P2Y12 inhibitor de-escalation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
2 sitesItaly
Study dates
12 Jun 2023to 30 Oct 2025
Phase
Phase 3
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

Participants fulfilling all the following inclusion criteria are eligible for the study:

  • Informed Consent signed and dated.
  • Patients deemed at HBR according to standard definitions (i.e. PRECISE-DAPT ≥25 or HBR-ARC with at least 1 major or 2 minor criteria).
  • Treated with PCI due to a recent ACS (i.e. unstable angina, non-ST segment elevated myocardial infarction or ST segment elevated myocardial infarction) 30 ±7 days earlier.
  • Treated with DAPT with full-dose potent P2Y12 inhibitors (e.g. prasugrel 10mg or ticagrelor 90mg bid) according to international guidelines recommendations.

The presence of anyone of the following exclusion criteria will lead to exclusion of the participant:

  • Age < 18 years
  • Known intolerance, hypersensitivity or contraindication (including active bleeding) to aspirin, clopidogrel, prasugrel, ticagrelor or to any of the excipients
  • Indication to oral anticoagulation
  • Indication to prolonged treatment with full-dose potent P2Y12 inhibitors (e.g. previous stent thrombosis, stenting of last remaining vessel, stent with indication for longer-term DAPT, perceived very high coronary ischemic risk)
  • Any planned major surgery or interventional procedure requiring treatment modification
  • Prior transient ischemic attack, ischemic or haemorrhagic stroke
  • Severe hepatic insufficiency (Child-Pugh class C)
  • Ongoing therapy with strong CYP3A inducers or strong CYP3A inhibitors (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir, atazanavir etc.)
  • Women who are pregnant, breast feeding or of childbearing potential (i.e. fertile, following menarche and who are not surgically sterile, including hysterectomy, bilateral salpingectomy, bilateral oophorectomy, or post-menopausal defined as no menses for 12 months without an alternative medical cause); Participation in another study with investigational drug within the 30 days, or 5 half-lives of the study drug whichever is longer, preceding and during the present study
  • Enrolment of the investigator, his/her family members, employees
  • Inability to follow the procedures of the study (language problems, mental disorders, dementia) or comorbidities associated with less than 12 months-life expectation (active malignancies drug or alcohol abuse, etc.) or other conditions that might result in protocol non-compliance.

Trial locations and contacts

2 sites in 1 country.

Francesco Costa, MD, PhD contact

+39090221 ext. 2341

francesco.costa@unime.it

Italy2 sites, 2 recruiting
  • Azienda Ospedaliera Universitaria Gaetano Martino

    Messina, 98125

    Francesco Costa, MD, PhD

    Francesco Costa, MD, PhD

    Recruiting
  • Ospedale degli Infermi

    Rivoli, 10098

    Greca Zanda, MD

    Giorgio Quadri, MD

    Not yet recruiting

Other trials in Italy

About this study

Official title: De-Escalation of Antiplatelet Therapy to Evaluate Platelet Reactivity and Clinical Outcomes After Coronary Stenting in Patients at High Bleeding Risk and Recent Acute Coronary Syndrome: DESC-HBR Trial

High bleeding risk (HBR) patients, comprising up to 50% of those presenting with acute coronary syndrome (ACS), are a high-risk group that is increasing in size due to an aging population. The optimal selection of the potency and duration of antiplatelet therapy to reduce the risk of recurrent ischemic and bleeding events in HBR patients is still a matter of debate. Multiple strategies to reduce bleeding during secondary prevention, such as reducing the duration of dual antiplatelet therapy, using single antiplatelet therapy with a P2Y12 inhibitor, or de-escalating to a lower potency or lower-dose P2Y12 inhibitor, have been proposed. De-escalation to a lower potency or lower-dose P2Y12 inhibitor is particularly attractive because it maintains efficient pharmacological inhibition of multiple platelet pathways while potentially reducing bleeding through less aggressive activity. Yet, there has been no study comparing the effects of different de-escalation strategies with the standard potent P2Y12 inhibitors in HBR patients. The aim of the DESC-HBR study is to assess the impact of de-escalating P2Y12 inhibitor to clopidogrel 75mg, prasugrel 5mg or ticagrelor 60mg bid in HBR patients, in comparison with full-dose potent P2Y12 inhibitors, on the proportion of patients with optimal platelet reactivity (OPR). Secondary objectives involve exploring the effect of de-escalation on clinical events and patients' quality of life.

Read the detailed description

The aim of the DESC-HBR trial is to compare the impact of de-escalating P2Y12 inhibitor to clopidogrel 75mg, prasugrel 5mg or ticagrelor 60mg bid, with full-dose potent P2Y12 inhibitors, on the proportion of patients with optimal platelet reactivity (OPR). The secondary objective is to explore the effect of de-escalating P2Y12 inhibitor therapy on clinical events and patients' quality of life. The primary outcome is the proportion of patients in the OPR range measured through the VerifyNow system at peak level after drug maintenance dose (MD) at 14±2 days. OPR is defined as a platelet reactive unit (PRU) between 85 and 208 reactivity units based on international consensus. A key secondary outcome will be major, minor and nuisance bleeding according to the bleeding academic research consortium (BARC) definition up to 5 months. Secondary pharmacodynamic outcomes include platelet reactivity with the VerifyNow and T-TAS system at different timepoints (baseline, 2h after first dose, through levels before MD and peak levels after MD at 14±2 days). Further pharmacodynamic assessment at 1 and 2 weeks after P2Y12 inhibitor discontinuation will be performed in the subset of patients discontinuing P2Y12 inhibitor at study conclusion or in case of P2Y12 discontinuation at anytime during the study.Other secondary endpoints will be explored including all-cause death, major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiac death, myocardial infarction (MI), target vessel revascularization (TVR) and stroke, net adverse clinical events (NACE), a composite of MACCE and BARC 2-5 bleeding, and each individual endpoint singularly appraised. Quality of life will be evaluated with health mobility and performance scales (i.e. EQ-5D-5L, SF-12), perceived stress scale (i.e. PPS).Cost-effectives analysis will be also carried out by inputting direct and indirect costs in relation to outcomes. Study visits are scheduled at baseline,14±2 days, 3 and 5 months after randomization.

Being tested
P2Y12 inhibitor de-escalation
Keywords
DAPT De-escalation, P2Y12 inhibitors
Medical subject headings
Acute Coronary Syndrome, Coronary Artery Disease

What participants receive

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

  • P2Y12 inhibitor de-escalationDrug

    Comparing, in patients at High Bleeding Risk (HBR) after a recent Acute Coronary Syndrome (ACS), continuation of full-dose potent P2Y12 inhibitor with a P2Y12i de-escalation strategy transitioning to clopidogrel 75mg, prasugrel 5mg or ticagrelor 60mg/bid.

Study groups in NCT05903976
Study groupRoleWhat they receive
CLOPIDOGREL 75 mg qdExperimental50 patients treated with clopidogrel 75mg
Receives: Drug: P2Y12 inhibitor de-escalation
PRASUGREL 5mg qdExperimental50 patients treated with prasugrel 5mg
Receives: Drug: P2Y12 inhibitor de-escalation
TICAGRELOR 60mg bidExperimental50 patients treated with ticagrelor 60mg bid
Receives: Drug: P2Y12 inhibitor de-escalation
Continue Potent P2Y12i Full-DoseActive comparator50 patients in the full-dose potent P2Y12 inhibitor (prasugrel 10 mg or ticagrelor 90 mg bid according to prior prescription)
Receives: Drug: P2Y12 inhibitor de-escalation

What is being measured

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

  1. Proportion of Patients Achieving Optimal Platelet Reactivity (OPR) at peak level following Drug Maintenance Dose (MD) Using the VerifyNow System

    The incidence of optimal platelet reactivity (OPR) measured by means of the VerifyNow system. OPR will be defined as a PRU between 85 and 208 reactivity units according to international expert consensus.

    Measured: 2 hours after drug MD at 14±2 days from study inclusion

Secondary outcomes (6)
  1. Incidence of Bleeding Events According to Multiple Bleeding Definitions

    The incidence of nuisance, minor or major bleeding according to the BARC definition (BARC 1-5).

    Measured: 5 Months after enrollment

  2. Platelet reactive units (PRU) at VerifyNow system

    Platelet reactive units (PRU) measurement at VerifyNow system

    Measured: baseline, 2 hours after the first treatment administration and before MD at 14±2 days from study inclusion

  3. Proportion of high platelet reactivity (HPR) and the proportion of low platelet reactivity (LPR) measured through the VerifyNow system

    The proportion of high platelet reactivity (HPR) defined as PRU > 208, and the proportion of low platelet reactivity (LPR), defined as PRU < 85, measured through the VerifyNow system before first randomized treatment administration (baseline), 2 hours after the first randomized treatment administration, before MD at 14±2 days from study inclusion and at 2 hours after drug MD administration at 14±2 days from study inclusion. PRU at 1 and 2 weeks after P2Y12 inhibitor discontinuation study in patients permanently ceasing treatment.

    Measured: baseline, 2 hours after the first treatment administration, before MD at 14±2 days from study inclusion and at 2 hours after drug MD administration at 14±2 days

  4. Platelet-derived thrombogenicity at Total Thrombus Formation (T-TAS)

    Platelet-derived thrombogenicity at Total Thrombus Formation (T-TAS) before first randomized treatment administration (baseline), 2 hours after the first randomized treatment administration, before and after MD at 14±2 days from study inclusion.

    Measured: baseline, 2 hours after the first treatment administration, before and after MD at 14±2 days from study inclusion.

  5. Adverse clinical event

    Adverse clinical events, assessed at each visit and up to 5 months after randomization. They include: death, cardiac death, non-fatal myocardial infarction, non-fatal stroke, urgent target vessel revascularization, definite/probable stent thrombosis and net adverse clinical events.

    Measured: 14±2 days, 3 and 5 months from study inclusion

  6. Cost-effectiveness

    Cost-effectives analysis will be carried out by inputting direct and indirect costs in relation to outcomes assessed.

    Measured: 5 Months after enrollment

Timeline

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

  1. First posted15 Jun 2023
  2. Study start12 Jun 2023
  3. Primary completion30 Jun 2025 (estimated)
  4. Study completion30 Oct 2025 (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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05903976
Sponsor's protocol ID
DESC-HBR
Acronym
DESC-HBR
Status last verified
Aug 2023
First submitted
26 May 2023
Last updated
23 Aug 2023
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Costa F, Vizzari G, Zecchino S, Galli M, Montalto C, Carciotto G, Quadri G, Vergallo R, Castriota F, Soraci E, Magliarditi A, Giudice SL, Iuvara G, Munafo A, Giannino F, Pallante F, Franzino M, Teresi L, Piccolo R, Varbella F, Musumeci G, Di Bella G, Ortega-Paz L, Angiolillo DJ, Micari A. De-escalation of antiplatelet therapy to evaluate platelet reactivity and clinical outcomes after coronary stenting in patients at high bleeding risk and recent acute coronary syndrome: Rationale and design of the DESC-HBR trial. Cardiovasc Revasc Med. 2026 Aug 4:S1553-8389(26)00334-9. doi: 10.1016/j.carrev.2026.07.022. Online ahead of print.

    PubMed 42567765

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing P2Y12 inhibitor de-escalation in people with Dual Antiplatelet Therapy and Acute Coronary Syndrome, run by Azienda Ospedaliera Universitaria Policlinico "G. Martino" at 2 sites in Italy.

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

Who may be eligible to take part?

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: status not confirmed, as of the sponsor's last update on 23 Aug 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Italy. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

Results are not available in the source record.

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

Contact Francesco Costa, MD, PhD (+39090221 ext. 2341, francesco.costa@unime.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of Patients Achieving Optimal Platelet Reactivity (OPR) at peak level following Drug Maintenance Dose (MD) Using the VerifyNow System (time frame: 2 hours after drug MD at 14±2 days from study inclusion). 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 NCT05903976, which also lists 1 linked publication.

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 23 Aug 2023.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in