Cardiac allograft vasculopathy is a common complication affecting heart transplant patients. This condition causes narrowing of the heart arteries leading to graft dysfunction. The research team is investigating whether early antiplatelet therapy post heart transplant can prevent the development of CAV. This study will determine the feasibility of a large multicenter randomized placebo-controlled trial to answer this question.
Heart transplant patients who fulfill selection criteria will undergo baseline clinical evaluation and data collection. Participants will be randomized to either placebo, aspirin or clopidogrel to be taken daily for the duration of the study. Patients will undergo invasive coronary studies (angiography, optical coherence tomography and intracoronary flow) and platelet function testing at 2 and 12 months post heart transplant. In addition, angiography will be performed at 24 months post heart transplant and thereafter according to institutional protocol. The primary analysis will determine the feasibility of conducting a large multicenter randomized placebo controlled trial by assessing recruitment rates, event rates, treatment crossovers and loss to follow-up. Secondary analyses will include assessing the effect of antiplatelet treatment on angiographic CAV, coronary intimal disease on optical coherence tomography, coronary macrovascular and microvascular function by intracoronary flow measures, and platelet function.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
135
patients randomized to placebo study group will be dispensed placebo capsules to be taken daily for the duration of the treatment
patients randomized to aspirin study group will be dispensed aspirin capsules to be taken daily for the duration of the treatment
patients randomized to clopidogrel study group will be dispensed clopidogrel capsules to be taken daily for the duration of the treatment
St.Pauls Hospital
Vancouver, British Columbia, Canada
RECRUITINGUniversity of Ottawa Heart Institute
Ottawa, Ontario, Canada
RECRUITINGToronto General Hospital UHN
Toronto, Ontario, Canada
RECRUITINGFeasibility: Recruitment rate
Average recruitment rate of 4.5 patients per month at 3 study sites
Time frame: 3 years
Feasibility: CAV event rate
2-year CAV event rate of \>8%
Time frame: 3 years
Feasibility: Treatment cross over rate
Crossover from aspirin to placebo \<2%, clopidogrel to placebo \<2%, placebo to aspirin \<4%, placebo to clopidogrel \<1%
Time frame: 3 years
Feasibility: Loss to follow up rate
Loss-to-follow-up \<1%
Time frame: 3 years
Feasibility: Compliance to treatment
Compliance to treatment \>80%
Time frame: 3 years
Cardiac allograft vasculopathy
Angiographic CAV disease severity according to ISHLT CAV 0-3 grading
Time frame: 1 and 2 years post transplant
Coronary intimal disease
Coronary intimal volume measured on OCT
Time frame: 2 months, 1 year post transplant
Coronary endothelial function
Coronary flow reserve measured by intracoronary flow assessment
Time frame: 2 months and 1 year post transplant
Coronary macrovascular function
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Fractional flow reserve measured by intracoronary flow assessment
Time frame: 2 months and 1 year post transplant
Coronary microvascular function
Index of microcirculatory resistance measured by intracoronary flow assessment
Time frame: 2 months and 1 year post transplant
Platelet Function
Assessment of response to antiplatelet therapy using Enzyme-Linked Immunosorbent Assays (ELISA) for thromboxane B2 and Vasodilator Stimulated Phosphoprotein (VASP).
Time frame: Baseline, 2 months and 1 year post transplant