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Un-fractionated Heparin Versus Bivalirudin During Percutaneous Coronary Interventions (PCI) (ISAR-REACT-3)

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ClinicalTrials.gov Identifier: NCT00262054
Recruitment Status : Completed
First Posted : December 6, 2005
Last Update Posted : March 15, 2010
Information provided by:
Deutsches Herzzentrum Muenchen

Brief Summary:
The purpose of this study is to determine whether bivalirudin given during PCI is associated with better outcomes compared to un-fractionated heparin.

Condition or disease Intervention/treatment Phase
Coronary Disease Angina Pectoris Drug: Bivalirudin Drug: Un-fractionated heparin Phase 4

Detailed Description:
Thrombin plays a major role in acute coronary artery occlusions during percutaneous coronary interventions. Unfractionated heparin has been traditionally used during invasive coronary procedures to reduce the risk of thrombotic occlusion. Bivalirudin, a direct antithrombin inhibitor, has several advantages over unfractionated heparin: it acts independently of antithrombin and inhibits both free and clot-bound thrombin; it is not neutralized by circulating inhibitors; exhibits consistent dose-response characteristics, and does not cause thrombocytopenia. Previous studies have shown that use of bivalirudin among patients undergoing percutaneous coronary interventions is associated with better outcomes (death, myocardial infarction, urgent repeat revascularization or in-hospital major bleeding) as compared with unfractionated heparin and adjunctive use of glycoprotein IIb/IIIa platelet receptor inhibitors. However, previous studies have included patients treated with plain balloon angioplasty or stenting after inadequate pre-treatment with thienopyridines (ticlopidine or clopidogrel). Recent guidelines recommend that all patients undergoing percutaneous coronary interventions must receive a loading dose of 300 -600 mg of clopidogrel. A 600 mg loading dose of clopidogrel eliminates the need for glycoprotein IIb/IIIa platelet receptor inhibitors in adjunct to heparin. According to existing evidence antithrombotic regimens based on either bivalirudin or pre-treatment with 600 mg of clopidogrel in addition to UFH intraprocedurally, are effective strategies to reduce ischemic and hemorrhagic complications in patients with coronary artery disease undergoing PCI. At present, it is not known whether bivalirudin is superior to UHF in patients who have been optimally pre-treated with a loading dose of clopidogrel.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 4570 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Prospective, Randomized, Double-Blind, Active-Controlled, Multicenter Trial of Bivalirudin and Un-fractionated Heparin in Patients Undergoing Percutaneous Coronary Interventions. ISAR-REACT-3
Study Start Date : November 2005
Actual Primary Completion Date : February 2008
Actual Study Completion Date : May 2008

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Blood Thinners

Arm Intervention/treatment
Experimental: A
bivalirudin is to be administered as an intravenous bolus of 0.75 mg/kg prior to the start of the intervention, followed by infusion of 1.75 mg/kg per hour for the duration of the procedure.
Drug: Bivalirudin
bivalirudin to be administered as an intravenous bolus of 0.75 mg/kg prior to the start of the intervention, followed by infusion of 1.75 mg/kg per hour for the duration of the procedure.
Other Name: ReoPro

Active Comparator: B
UFH given as an intravenous bolus of 140 units/kg. Double blinding will be maintained by using a double-dummy technique consisting of identical UFH and bivalirudin syringes and bivalirudin or placebo infusion bags.
Drug: Un-fractionated heparin
UFH is given as an intravenous bolus of 140 units/kg followed by infusion of placebo 1.75 mg/kg per hour for the duration of the procedure.

Primary Outcome Measures :
  1. Composite rate of death, myocardial infarction (MI),urgent target vessel revascularization (TVR) within 30 days or in-hospital major bleeding [ Time Frame: 30 days ]

Secondary Outcome Measures :
  1. Composite rate of death, MI or urgent TVR within 30 days [ Time Frame: 30 days ]
  2. Composite rate of death, MI or TVR at 1 year [ Time Frame: 1 year ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients older than 18 years of age to undergo PCI
  • Clopidogrel loading at least 2 hrs prior to PCI according to the PCI guidelines
  • Informed, written consent

Exclusion Criteria:

  • Recent ST-elevation myocardial infarction within the last 48 hours
  • Cardiogenic shock
  • ACS and positive biomarkers (Troponin T > 0.03 µg/L)
  • Malignancies or other comorbid conditions (for example severe liver, renal and pancreatic disease) with life expectancy less than one year or that may result in protocol non-compliance
  • Active bleeding; bleeding diathesis
  • History of gastrointestinal or genitourinary bleeding within the last 6 weeks
  • Presence of diseases which have a high probability of vascular lesions and subsequent bleeding such as active gastric ulcer or active ulcerous colitis
  • Recent trauma or major surgery in the last month
  • Ophthalmic surgery or brain surgery in the last month
  • Retinopathies or vitreous body bleeding in the last month
  • History of intracranial bleeding or structural abnormalities (for example aneurysm of cerebral arteries)
  • Suspected aortic dissection; pericarditis and subacute bacterial endocarditis
  • Patient's refusal to blood transfusion
  • Oral anticoagulation therapy with coumarin derivative within the last 7 days
  • Treatment with UFH within 6 hours or low-molecular weight heparin within 8 hours before randomization
  • Treatment with bivalirudin within 24 hours before randomization
  • Severe uncontrolled hypertension >180/110 mmHg unresponsive to therapy
  • Planned staged PCI procedure within 30 days from index procedure or prior PCI within the last 30 days
  • Relevant hematologic deviations:hemoglobin < 100 g/L; platelet count < 100 x 109 /L
  • Glomerular filtration rate (GFR) < 30 ml/min or serum creatinine > 30 mg/L or dependence on renal dialysis
  • Known allergy to the study medications: aspirin, clopidogrel, UFH, bivalirudin; stainless steel; true anaphylaxis after prior exposure to contrast media
  • Known heparin-induced thrombocytopenia (Typ II)
  • Previous enrollment in this trial
  • Pregnancy (present, suspected or planned) or positive pregnancy test
  • Spinal, peridural and epidural anesthesia
  • Patient's inability to fully cooperate with the study protocol

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00262054

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Bad Krozingen, Germany, 79189
Segeberger Kliniken
Bad Segeberg, Germany, 23795
Deutsches Herzzentrum Muenchen
Munich, Germany, 80636
First Medizinische Klinik, Klinikum rechts der Isar
Munich, Germany, 81675
Sponsors and Collaborators
Deutsches Herzzentrum Muenchen
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Study Chair: Albert Schomig, MD Deutsches Herzzentrum Muenchen
Principal Investigator: Adnan Kastrati, MD Deutsches Herzzentrum Muenchen
Study Director: Franz-Josef Neumann, MD Herz-Zentrum Bad Krozingen
Publications of Results:
Other Publications:

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Responsible Party: Prof. A. Schömig, Deutsches Herzzentrum Munich
ClinicalTrials.gov Identifier: NCT00262054    
Other Study ID Numbers: GE IDE No. A01005
KKF 1.1-05
First Posted: December 6, 2005    Key Record Dates
Last Update Posted: March 15, 2010
Last Verified: August 2008
Keywords provided by Deutsches Herzzentrum Muenchen:
coronary disease
Additional relevant MeSH terms:
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Coronary Disease
Coronary Artery Disease
Angina Pectoris
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Arterial Occlusive Diseases
Chest Pain
Neurologic Manifestations
Calcium heparin
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors