Optimal AntiPlatelet therapy for prevention of gastrointestinal injury evaluated by Ankon magnetically controlled capsule endoscopy: Rationale and design of the OPT-PEACE trial

Li, Yi; Wang, Xiaozeng; Bao, Dan; Liao, Zhuan; Li, Jing; Han, Xiao; Wang, Heyang; Xu, Kai; Li, Zhaoshen; Stone, Gregg W.; Han, Yaling

Abstract Background Gastrointestinal injury is a common complication in patients treated with antiplatelet agents after percutaneous coronary intervention (PCI). However, the effects of different antiplatelet regimens on the incidence and severity of gastrointestinal injury have not been well studied, principally due to the lack of a low-risk sensitive and accurate detection system. Trial design. OPT-PEACE is a multicenter, randomized, double-blind, placebo-controlled trial. Gastrointestinal injury will be evaluated with the ANKON magnetically controlled capsule endoscopy system (AMCE), a minimally invasive approach for detecting mucosal lesions in the stomach, duodenum and small intestine. Patients without AMCE-detected gastrointestinal erosions, ulceration or bleeding after drug-eluting stent implantation are enrolled and treated with open-label aspirin (100mg/day) plus clopidogrel (75mg/day) for 6months. Thereafter, 480 event-free patients will undergo repeat AMCE and are randomly assigned in a 1:1:1 ratio to receive aspirin plus clopidogrel, aspirin plus placebo or clopidogrel plus placebo for an additional 6months. A final AMCE is performed at 12months. The primary endpoint is the incidence of gastric or intestinal mucosal lesions (erosions, ulceration or bleeding) within 12months after enrollment. Conclusions OPT-PEACE is the first study to investigate the incidence and severity of gastrointestinal injury in patients receiving different antiplatelet therapy regimens after stent implantation. This trial will inform clinical decision-making for personalized antiplatelet therapy post-PCI.