• Guillaume Marquis-Gravel, Matthew T Roe, Holly R Robertson, Robert A Harrington, Michael J Pencina, Lisa G Berdan, Bradley G Hammill, Madelaine Faulkner, Daniel Muñoz, Gregg C Fonarow, Brahmajee K Nallamothu, Dan J Fintel, Daniel E Ford, Li Zhou, Sarah E Daugherty, Elizabeth Nauman, Jennifer Kraschnewski, Faraz S Ahmad, Catherine P Benziger, Kevin Haynes, J Greg Merritt, Thomas Metkus, Sunil Kripalani, Kamal Gupta, Raj C Shah, James C McClay, Richard N Re, Carol Geary, Brent C Lampert, Steven M Bradley, Sandeep K Jain, Hani Seifein, Jeff Whittle, Véronique L Roger, Mark B Effron, Giselle Alvarado, Ythan H Goldberg, Jeffrey L VanWormer, Saket Girotra, Peter Farrehi, Kathleen M McTigue, Russell Rothman, Adrian F Hernandez, and W Schuyler Jones.
• Duke Clinical Research Institute, Durham, North Carolina.
• JAMA Cardiol. 2020 May 1; 5 (5): 598-607.

ImportanceDetermining the right dosage of aspirin for the secondary prevention treatment of atherosclerotic cardiovascular disease (ASCVD) remains an unanswered and critical question.ObjectiveTo 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 ParticipantsThis pragmatic, open-label, patient-centered, randomized clinical trial is being conducted in 15 000 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.InterventionsParticipants are randomized on a web platform in a 1:1 fashion to either 81 mg or 325 mg of aspirin daily.Main Outcomes And MeasuresThe 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 RelevanceAs 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.Trial RegistrationClinicalTrials.gov Identifier: NCT02697916.

16 keywords...

hide…