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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04088513
Other study ID # SAST
Secondary ID 2018001
Status Recruiting
Phase Phase 4
First received
Last updated
Start date January 22, 2020
Est. completion date December 31, 2024

Study information

Verified date March 2022
Source First Affiliated Hospital, Sun Yat-Sen University
Contact Jinsheng Zeng, MD,PhD
Phone 13322800657
Email zengjs@pub.guangzhou.gd.cn
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Aspirin was reported to induce hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency on some occasions, while still widely uesd for stroke prevention. The SAST trial is designed to evaluate the safety and efficacy of aspirin in patients this enzyme disorder.The primary purpose of the trial is to evaluate the hemolytic effects of a 3-month regimen of aspirin 100mg/d versus a 3-month regimen of clopidogrel 75mg/d.


Description:

This SAST trial is a prospective, multicenter, randomized, double-blind trial.440 acute ischemic stroke (AIS) patients with G6PD deficiency will be randomized to receive a 3-month regimen of aspirin 100mg/d or clopidogrel 75mg/d. The primary end point is the proportion of protocol-defined hemolysis at 90 days. Protocol-defined hemolysis is defined as one or more of the following conditions: a) Hemoglobin level declined ≥2.5 g/dL from baseline, meanwhile ruling out bleeding events. b) Hemoglobin level declined ≥25% from baseline, meanwhile ruling out bleeding events. c) Clinically relevant hemolytic events, could manifested as fatigue, back pain, anemia, dark urine and jaundice. The study consists of five visits including the day of randomization, day 4, day10±3days, day27±3days, day90±7days.


Recruitment information / eligibility

Status Recruiting
Enrollment 440
Est. completion date December 31, 2024
Est. primary completion date December 31, 2024
Accepts healthy volunteers No
Gender All
Age group 40 Years and older
Eligibility Inclusion Criteria: 1. Age=40 years(no upper limit) 2. Acute ischemic stroke within 14 days of symptoms onset; 3. Glucose-6-phosphate dehydrogenase deficiency screened in G6PD enzyme activity 4. Had not received aspirin 7 days prior to randomization 5. Informed consent signed Exclusion Criteria: 1. Diagnosis of hemorrhage or other pathology, such as vascular malformation, tumor, abscess or other non-ischemic brain disease, base on head CT or MRI 2. Concomitant infections at the time of randomization 3. mRS>2 prior to the presenting stroke 4. Hemoglobin<10 g/dL prior to randomization 5. Received intravenous thrombolytic therapy or neurointervention treatment before randomization 6. Clear indication for anticoagulation (presumed cardioembolism, eg, atrial fibrillation, prosthetic cardiac valves or suspected endocarditis) 7. Clear indication for dual antiplatelet therapy (eg, minor stroke in 24h (NIHSS =3) or endovascular therapy for the indexed event) 8. Anticipated concomitant antiplatelets other than aspirin or clopidogrel (eg, GPIIb/IIIa inhibitors, ticlopidine, prasugrel, dipyridamole, ozagrel, cilostazol, ticagrelor) and other antithrombotic agents with antiplatelet effects, including traditional/herbal medicine agents. 9. Anticipated concomitant therapy with long-term (>7 days) NSAIDs affecting platelet function 10. Contraindication to clopidogrel or aspirin (1)Known allergic reactions (2)Severe hepatic or renal dysfunction (Severe hepatic dysfunction is defined as serum ALT or AST >2 times the upper limit of the normal group;Severe renal dysfunction is defined as serum creatinine > 1.5 times the upper limit of the normal group) (3)Severe cardiac failure(NYHA class ? or ?) (4)Asthma (5)Any history of Hemostatic disorder or systemic bleeding (6)Any history of thrombocytopenia or neutropenia (7)Any history of drug-induced hematologic or hepatic insufficiency (8)Low white blood cell (<2×10^9/L) or platelet count (<100×10^9/L) 11. Any history of thalassemia, autoimmune hemolytic disease, aplastic anemia or other severe hematologic diseases 12. Anticipated concomitant therapy with other contraindicated drugs for G6PD deficiency 13. Severe dysphagia to unable swallow the drugs 14. Concomitant infections and need for antimicrobial therapy 15. Intracranial hemorrhage or gastrointestinal bleed within 3 months, or major surgery within 30 days 16. Stomach tumor or any other malignant tumor 17. Planed surgery or interventional treatment that may affect the study procedure 18. Severe non-cardiovascular comorbidity with life expectancy <3 m 19. Female who is pregnant or lactating 20. Currently receiving an investigational drug or device 21. Inability to understand and/or comply with study procedures due to psychosis, cognition impairment or emotion disturbance.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Aspirin
This group will receive a 100 mg/day aspirin plus clopidogrel placebo for 90 days.
Clopidogrel
This group will receive a 75 mg/day clopidogrel plus aspirin placebo for 90 days.

Locations

Country Name City State
China People's Hospital of Baise Baise Guangxi
China Fengcheng People's Hospital Fengcheng Jiangxi
China First Affiliated Hospital of Gannan Medical University Ganzhou Jiangxi
China Ganzhou Municipal Hospital Ganzhou Jiangxi
China Ganzhou People' Hospital Ganzhou Jiangxi
China The First Affiliated Hospital of Guangdong Pharmaceutical University Guangzhou Guangdong
China The First Affiliated Hospital of Jinan University Guangzhou Guangdong
China The First Affiliated Hospital of Sun Yat-Sen University Guangzhou Guangdong
China The Second Affiliated Hospital of Hainan Medical University Haikou Hainan
China Jieyang Municipal People's Hospital Jieyang Guangdong
China The Forth Affiliated Hospital of Guangxi Medical Hospital Liuzhou Guangxi
China Longyan First Hospital Longyan Fujian
China Meizhou City People's Hospital Meizhou Guangdong
China The Forth Affiliated Hospital of Nanchang University Nanchang Jiangxi
China The First Affiliated Hospital of Guangxi Medical Hospital Nanning Guangxi
China Sanming First Hospital Sanming Fujian
China Yue Bei People's Hospital Shaoguan Guangdong
China Beiliu People's Hospital Yulin Guangxi
China Yunfu People's Hospital Yunfu Guangdong

Sponsors (1)

Lead Sponsor Collaborator
First Affiliated Hospital, Sun Yat-Sen University

Country where clinical trial is conducted

China, 

Outcome

Type Measure Description Time frame Safety issue
Primary Proportion of protocol-defined hemolysis. Protocol-defined hemolysis is defined as one or more of the following conditions: a) Hemoglobin level declined =2.5 g/dL from baseline, meanwhile ruling out bleeding events. b) Hemoglobin level declined =25% from baseline, meanwhile ruling out bleeding events. c) Clinically relevant hemolytic events, could manifested as fatigue, back pain, anemia, dark urine and jaundice, adjudicated by the adjudication committee ultimately. 90±5 days.
Secondary Change in hemoglobin. 4 days,10±3 days,27±3 days and 90±5 days.
Secondary Change in reticulocyte. 4 days,10±3 days,27±3 days and 90±5 days.
Secondary Change in unconjugated bilirubin and total bilirubin. 4 days,10±3 days,27±3 days and 90±5 days.
Secondary Change in lactic dehydrogenase. 4 days,10±3 days,27±3 days and 90±5 days.
Secondary Proportion of major bleed (GUSTO de?nition). 90±5 days.
Secondary Overall mortality. 90±5 days.
Secondary Proportion of new clinical vascular events, de?ned as the composite of stroke, transient ischemic attack (TIA), myocardial infarction and vascular death. 90±5 days.
Secondary Proportion of functional independence defined as modified Rankin Scale score 0-2. Modified Rankin Scale score ranges from 0 to 6, and lower score means more functional independence. 90±5 days.
Secondary Proportion of functional independence defined as Barthel Index 95-100. Barthel Index ranges from 0 to 100, and higher score means more functional independence. 90±5 days.
Secondary Change in National Institutes of Health Stroke Scale National Institutes of Health Stroke Scale ranges from 0 to 42, and higher scores indicate more severe neurologic deficits. 90±5 days.
Secondary Health related quality of life, assessed by EuroQoL-5 Dimensions questionnaire EuroQoL-5 Dimensions questionnaire contains utility index score and visual analogue scale. Utility index score ranges from 0 to 1, and visual analogue scale ranges from 0 to 100. Higher scores indicate more healthy quality of life. 90±5 days.
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