Comparison of Anticoagulation Prolongation vs. no Anticoagulation in STEMI Patients After Primary PCI
Summary
The RIGHT study is a large randomized study dedicated to post-PPCI anticoagulation in STEMI patients. The investigators propose to evaluate the clinical efficacy and safety of anticoagulation prolonged for at least 48 hours after the procedure vs. no prolongation of anticoagulation after procedure in patients with STEMI treated with bivalirudin during PPCI (primary hypothesis). When allocated to anticoagulation prolongation by randomization, the subject will be assigned to UFH, enoxaparin or bivalirudin (same regimen allocated by centre) for at least 48 hours after PPCI. The results from this study are expected to provide guidance on the risk/benefit of post-procedural anticoagulation in patients with STEMI.
Timeline
- Start
- 2019-01-11
- Primary completion
- 2022-11-23
- Completion
- 2022-11-23
Outcome
Missed primary endpoint
paper The primary efficacy end point occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard ratio, 1.00 [95% CI, 0.63 to 1.57]). PMID 38406848 ↗
paper Routine PPA after primary percutaneous coronary intervention was safe but did not reduce 30-day ischemic events. PMID 38406848 ↗
Publications
- Background Yan Y, Wang X, Guo J, Li Y, Ai H, Gong W, Que B, Zhen L, Lu J, Ma C, Montalescot G, Nie S. Rationale and design of the RIGHT trial: A multicenter, randomized, double-blind, placebo-controlled trial of anticoagulation prolongation versus no anticoagulation after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Am Heart J. 2020 Sep;227:19-30. doi: 10.1016/j.ahj.2020.06.005. Epub 2020 Jun 20.
- Yan Y, Wang X, Fan Z, Guo J, Wang G, Yin D, Wang Z, Zhang F, Tian C, Gong W, Liu J, Lu J, Ma C, Vicaut E, Montalescot G, Nie S; RIGHT Investigators. Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention: 1-Year Results From the RIGHT Trial and Meta-analyses. JACC Asia. 2026 May 13:S2772-3747(26)00251-6. doi: 10.1016/j.jacasi.2026.04.003. Online ahead of print.
- Yan Y, Guo J, Wang X, Wang G, Fan Z, Yin D, Wang Z, Zhang F, Tian C, Gong W, Liu J, Lu J, Li Y, Ma C, Vicaut E, Montalescot G, Nie S; RIGHT Investigators. Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial. Circulation. 2024 Apr 16;149(16):1258-1267. doi: 10.1161/CIRCULATIONAHA.123.067079. Epub 2024 Feb 26.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Bivalirudin | Peptide | 0.2 mg/kg | Intravenous |
| Subject | Enoxaparin sodium | Other / unclassified | 40 mg | Subcutaneous |
| Subject | HEPARIN CALCIUM | Other / unclassified | 10 iu/kg | Intravenous |