Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized, Double-Blind, Double-Dummy, Parallel Group, Phase 3 Efficacy and Safety Study of CGT-2168 Compared With Clopidogrel to Reduce Upper Gastrointestinal Events Including Bleeding and Symptomatic Ulcer Disease
Brief Summary: The purpose of the COGENT-1 clinical trial is to determine whether CGT-2168 (clopidogrel and omeprazole) compared to clopidogrel is safe and effective in reducing the incidence of gastrointestinal bleeding and symptomatic ulcer disease, in the setting of concomitant aspirin therapy.

Antiplatelet therapy is an essential element of care for patients with atherothrombotic disease. Bleeding is a fundamental adverse effect of all antiplatelet drugs including aspirin, clopidogrel and dual antiplatelet regimens.

The gastrointestinal tract is the most common site of bleeding related to antiplatelet therapy, typically in connection with peptic ulcer disease. Recently published studies suggest the use of clopidogrel carries a gastrointestinal bleeding risk similar to that of aspirin or non-aspirin non-steroidal anti-inflammatory drugs. Patients taking any two of these drugs (clopidogrel, aspirin and/or non-aspirin NSAIDs) are exposed to an even higher risk of bleeding and ulcer disease.

Cogentus Pharmaceuticals is launching phase 3 trials of a novel combination product, CGT-2168, which has the potential to significantly reduce this problem and increase patient safety. CGT-2168 combines a standard dosage of clopidogrel and a gastroprotectant (omeprazole) in a once-daily pill that may reduce the likelihood of adverse gastrointestinal events.


Options:
A: Inclusion Criteria:

* Planned CABG and/or valve surgery
* Left ventricular dysfunction (EF≤ 45%)
* Age \> 18 years
* able to give written information consent

Exclusion Criteria:

* Existing permanent pace maker
* Atrial fibrillation
* Enrolment in other research protocols
* Inability to give written informed consent
* Heart transplant
* Pre operative cardiovascular instability
B: Inclusion Criteria:

* Patients in whom a requirement for clopidogrel therapy with concomitant aspirin is anticipated for at least the next 12 months. Specific conditions that may confer a need for long-term clopidogrel + aspirin therapy may include non-ST segment elevation acute coronary syndrome (unstable angina/non-Q-wave MI), ST segment elevation acute MI), or new placement of a coronary artery stent.
* For women of childbearing potential, negative pregnancy test prior to randomization and agreement to use effective method of birth control during the study.
* Able to provide written informed consent based on competent mental status.

Exclusion Criteria:

* Patients currently hospitalized for whom discharge is not anticipated within 48 hours of randomization.
* Requirement for current or chronic use of a proton pump inhibitor, H2 receptor blocker, sucralfate or misoprostol.
* Erosive esophagitis, esophageal or gastric variceal disease, or non-endoscopic gastric surgery. Patients with a history of GERD/erosive esophagitis or dyspepsia who do not currently require proton pump blockers will be eligible.
* Receipt of \> 21 days of clopidogrel or another thienopyridine prior to randomization.
* Oral anticoagulation that cannot be safely discontinued for duration of study.
* Recent fibrinolytic therapy.
* Scheduled percutaneous coronary intervention (PCI). Patients may be enrolled upon completion of PCI.
* Recent (\< 30 days prior to randomization) or scheduled coronary artery bypass graft (CABG) surgery.
* Cardiogenic shock at time of randomization, refractory ventricular arrhythmias, or congestive heart failure (NY Heart Association class IV).
* Active pathological bleeding or a history of hereditary or acquired hemostatic disorder.
* History of hemorrhagic stroke, intracranial neoplasm, arteriovenous malformation or aneurysm.
* Systemic corticosteroids except low-dose oral corticosteroids equivalent to prednisone \< or equal to 5 mg/day.
* Allergy or contraindication to clopidogrel or other thienopyridine drugs, omeprazole or other proton pump inhibitor drugs, aspirin or salicylate derivatives, or other study drug ingredients.
* Treatment within 30 days prior to randomization with any investigational drug or device including investigational coronary artery stents or currently enrolled in another interventional drug or device study.
* Women who are pregnant or breastfeeding.
* Life expectancy less than 12 months.
* Laboratory abnormality at screening that is clinically significant or outside protocol-allowed limits, or any other condition that precludes participation in the study in the opinion of the Investigator.
C: Inclusion Criteria:

* patients admitted for acute coronary syndrome or acute myocardial infarction requiring active treatment with aspirin clopidogrel and (enoxaparin or thrombolytics.)

Exclusion Criteria:

* known active peptic ulcer disease or gastrointestinal within 8 wk
* known iron deficiency anemia with Hb \< 10 gm/dl
* mechanical ventilation
* active cancer, liver cirrhosis, end-stage renal failure
* life expectancy \< 1 yr
* known allergic to aspirin, clopidogrel, enoxaparin famotidine or esomeprazole
* pregnancy, lactation, child-bearing potential in the absence of contraception,
* co-prescription of NSAID, corticosteroid, or warfarin
* non-oral feeding or impaired GI absorption e.g. vomiting
* already on proton pump inhibitor for \> 1 day or another clinical trial drug for ulcer disease
D: INCLUSION CRITERIA:

* Acute admission to the ICU
* Age ≥ 18 years
* One or more of the following risk factors:

  * Shock (continuous infusion with vasopressors or inotropes, systolic blood pressure \< 90 mmHg, mean arterial blood pressure \< 70 mmHg or lactate \> 4 mmol/l)
  * Acute or chronic intermittent or continuous renal replacement therapy
  * Invasive mechanical ventilation which is expected to last \> 24 hours
  * Coagulopathy (platelets \< 50 x 109/l or international normalized ratio (INR) \> 1.5 or prothrombin time (PT) \> 20 seconds) documented within the last 24 hours
  * Ongoing treatment with anticoagulant drugs (prophylaxis doses excluded)
  * History of coagulopathy (platelets \< 50 x 109/l or INR \> 1.5 or PT \> 20 seconds) within 6 months prior to hospital admission
  * History of chronic liver disease (portal hypertension, cirrhosis proven by biopsy, computed tomography (CT) scan or ultrasound, history of variceal bleeding or hepatic encephalopathy in the past medical history)

EXCLUSION CRITERIA:

* Contraindications to PPI
* Ongoing treatment with PPI and/or H2RA on a daily basis
* GI bleeding of any origin during current hospital admission
* Diagnosed with peptic ulcer during current hospital admission
* Organ transplant during current hospital admission
* Withdrawal from active therapy or brain death
* Fertile woman with positive urine human chorionic gonadotropin (hCG) or plasma-hCG
* Consent according to national regulations not obtainable

Answer: B