Rationale and Design of the Aspirin Dosing-A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE) Trial Article

Full Text via DOI: 10.1001/jamacardio.2020.0116 PMID: 32186653 Web of Science: 000536928300016
Industry Collaboration

Cited authors

  • Marquis-Gravel, Guillaume; Roe, Matthew T.; Robertson, Holly R.; Harrington, Robert A.; Pencina, Michael J.; Berdan, Lisa G.; Hammill, Bradley G.; Faulkner, Madelaine; Munoz, Daniel; Fonarow, Gregg C.; Nallamothu, Brahmajee K.; Fintel, Dan J.; Ford, Daniel E.; Zhou, Li; Daugherty, Sarah E.; Nauman, Elizabeth; Kraschnewski, Jennifer; Ahmad, Faraz S.; Benziger, Catherine P.; Haynes, Kevin; Merritt, J. Greg; Metkus, Thomas; Kripalani, Sunil; Gupta, Kamal; Shah, Raj C.; McClay, James C.; Re, Richard N.; Geary, Carol; Lampert, Brent C.; Bradley, Steven M.; Jain, Sandeep K.; Seifein, Hani; Whittle, Jeff; Roger, Veronique L.; Effron, Mark B.; Alvarado, Giselle; Goldberg, Ythan H.; VanWormer, Jeffrey L.; Girotra, Saket; Farrehi, Peter; McTigue, Kathleen M.; Rothman, Russell; Hernandez, Adrian F.; Jones, W. Schuyler

Abstract

  • Importance Determining the right dosage of aspirin for the secondary prevention treatment of atherosclerotic cardiovascular disease (ASCVD) remains an unanswered and critical question. Objective To report the rationale and design for a randomized clinical trial to determine the optimal dosage of aspirin to be used for secondary prevention of ASCVD, using an innovative research method. Design, Setting, and Participants This pragmatic, open-label, patient-centered, randomized clinical trial is being conducted in 15 & x202f;000 patients within the National Patient-Centered Clinical Research Network (PCORnet), a distributed research network of partners including clinical research networks, health plan research networks, and patient-powered research networks across the United States. Patients with established ASCVD treated in routine clinical practice within the network are eligible. Patient recruitment began in April 2016. Enrollment was completed in June 2019. Final follow-up is expected to be completed by June 2020. Interventions Participants are randomized on a web platform in a 1:1 fashion to either 81 mg or 325 mg of aspirin daily. Main Outcomes and Measures The primary efficacy end point is the composite of all-cause mortality, hospitalization for nonfatal myocardial infarction, or hospitalization for a nonfatal stroke. The primary safety end point is hospitalization for major bleeding associated with a blood-product transfusion. End points are captured through regular queries of the health systems' common data model within the structure of PCORnet's distributed data environment. Conclusions and Relevance As a pragmatic study and the first interventional trial conducted within the PCORnet electronic data infrastructure, this trial is testing several unique and innovative operational approaches that have the potential to disrupt and transform the conduct of future patient-centered randomized clinical trials by evaluating treatments integrated in clinical practice while at the same time determining the optimal dosage of aspirin for secondary prevention of ASCVD.

Authors

Publication date

  • 2020

Published in

International Standard Serial Number (ISSN)

  • 2380-6583

Start page

  • 598

End page

  • 607

Volume

  • 5

Issue

  • 5