Clinical trial NCT06738992: Safety and Effectiveness of Early Aspirin Administration After Mitral Valve Repair
Official title: Safety and Effectiveness of Early Aspirin Administration After Mitral Valve Repair: a Prospective, Non-inferiority, Randomized Controlled Clinical Trial Protocol
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE4
Conditions: Mitral Valve Repair Surgery
Keywords: mitral valve repair surgery
Warfarin
Aspirin
Lead sponsor: Guangdong Provincial People's Hospital
Sponsor class: OTHER
First posted: 2024-12-18
Enrollment: 384
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: This study compares the efficacy and safety of two different antithrombotic drugs, warfarin and aspirin, in early application after mitral valve repair (MVRep). The objective is to verify whether the type of antithrombotic therapy affects clinical outcomes and the incidence of thromboembolic and bleeding complications within 3 months after MVRep, and to provide safe and effective antithrombotic treatment options for patients undergoing MVRep.

Detailed description: Patients were randomly assigned in a 1:1 ratio to two groups: the Warfarin Group and the Aspirin Group.

Warfarin Group: Anticoagulation therapy was initiated on the second day after surgery, starting at 4.5 mg once nightly, with adjustments made based on changes in the INR value.

Aspirin Group: Antiplatelet therapy was initiated on the second day after surgery with oral administration of Aspirin Enteric-coated Tablets (Bayer Aspirin) at a dose of 100 mg once daily.

For all patients, antithrombotic therapy was continued for at least 3 months post-surgery. Patients were scheduled for outpatient visits at 1, 4, 8, and 12 weeks following the surgical intervention.

Eligibility criteria: Inclusion Criteria:

* Individuals aged 18 years and above, but not exceeding 85 years;
* Patients who have successfully undergone mitral valve plasty with implantation of a mitral annuloplasty ring, with the option to undergo concurrent tricuspid valve plasty, atrial septal defect repair, or myxoma resection;
* Patients with preoperative electrocardiogram (ECG) showing sinus rhythm;
* Alternatively, patients with preoperative ECG showing atrial fibrillation (AF) rhythm, but who are male with a CHA2DS2-VASc-60 score of 0 or female with a score of 1; for patients with a CHA2DS2-VASc-60 score exceeding the aforementioned values but who have successfully converted to sinus rhythm following concurrent radiofrequency catheter ablation for AF;
* Patients who voluntarily participate in this study, have signed a written informed consent form, and are willing to comply with follow-up procedures.

Exclusion Criteria:

* Patients with contraindications to any of the following medications: heparin, warfarin, or aspirin;
* Patients who have undergone artificial valve replacement at other valve positions;
* Patients with a high risk of bleeding (including active bleeding, platelet count \<50×10\^9/L, hemoglobin \<8.0 g/dL, history of cerebral hemorrhage, active peptic ulcer, or history of gastrointestinal bleeding within the last 3 months);
* Patients with acute coronary syndrome within the last month;
* Patients with symptomatic stroke within the last 3 months;
* Patients with renal insufficiency and a creatinine clearance rate \<30 mL/min; Dialysis patients;
* Patients with moderate or severe hepatic impairment or liver disease with coagulation dysfunction: Child-Pugh score greater than B or bilirubin greater than or equal to 2 times the upper limit of normal (ULN) as defined by the center, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), or serum alkaline phosphatase (ALP) levels greater than or equal to 3 times the ULN as defined by the center;
* Patients with active malignant tumors;
* Patients who are planned to undergo surgical intervention or treatment (including endoscopy) during the trial period that requires discontinuation of anticoagulants;
* Pregnant or lactating women, or fertile individuals unwilling or unable to use effective contraceptives;
* Patients who have participated in any drug clinical trial within the last 6 months prior to screening;
* Patients who refuse to undergo follow-up;
* Patients deemed unsuitable for participation in this study by the investigator.

Primary outcomes:
measure: Clinical thromboembolic events
timeFrame: From enrollment to the end of treatment at 12 weeks
measure: Asymptomatic intracardiac thrombosis
timeFrame: From enrollment to the end of treatment at 12 weeks
measure: Death due to cardiovascular causes or thromboembolic events
timeFrame: From enrollment to the end of treatment at 12 weeks
measure: Major bleeding
timeFrame: From enrollment to the end of treatment at 12 weeks
Secondary outcomes:
measure: postoperative length of hospital stay
timeFrame: From enrollment to the end of treatment at 12 weeks
measure: International normalized ratio at the time of thromboembolic or bleeding events
timeFrame: From enrollment to the end of treatment at 12 weeks
measure: CHA2DS2-VASc scores
timeFrame: From enrollment to the end of treatment at 12 weeks
measure: HAS-BLED scores
timeFrame: From enrollment to the end of treatment at 12 weeks
Other outcomes:
Locations:
city: Guangzhou
country: China
facility: Guangdong Provincial People's Hospital
state: Guangdong
Study officials:
References: