Critical Limb Ischemia Clinical Trial
Official title:
Switch to Ticagrelor in Critical Limb Ischemia Anti-platelet Study
Critical Limb Ischemia (CLI) is defined as limb pain that occurs at rest, or impending limb loss that is caused by severe compromise of blood flow to the affected extremity. CLI is a major cause of death and disability (secondary to myocardial infarction, stroke and amputation). The mortality in patients with CLI approaches 13-25% and 50% at one and five years respectively. High on-treatment platelet reactivity (HPR) in patients treated with aspirin and clopidogrel is associated with increased risk of recurrent cardiovascular events after percutaneous coronary interventions and coronary syndromes. Preliminary studies suggest that the prevalence of HPR in patients with critical limb ischemia treated with aspirin and clopidogrel is as high a 78.5%. In patients with coronary artery disease ticagrelor overcomes non-responsiveness to clopidogrel. However, the antiplatelet effect of ticagrelor in patients with critical limb ischemia is unknown.
Study Aim: This pilot study aims to investigate platelet function after switching from
clopidogrel to ticagrelor in patients with critical limb ischemia.
Fifty patients with diagnosis of CLI (Rutherford class IV-VI) treated with clopidogrel 75 mg
and aspirin 81 mg daily will be tested for inhibition of platelet aggregation using the
VerifyNow P2Y12 and VASP assays before and 6±1 hours after their daily clopidogrel dose. All
patients will then be switched from clopidogrel to ticagrelor 90 mg twice daily for two weeks
and the VerifyNow and Vasodilator-Stimulated Phosphoprotein (VASP) platelet reactivity assays
repeated, samples will be collected before and 6±1 hours after the last ticagrelor dose. For
exploratory analysis, patients will be divided in two groups based on the P2Y12 reaction
units (PRU): Group 1. High on treatment platelet reactivity on clopidogrel (HPR), defined as
P2Y12 reaction units (PRU) ≥208 and Group 2. Appropriate platelet inhibition on clopidogrel
(API), defined as P2Y12 reaction units (PRU) <208. If subjects are withdrawn from the study
prior to completion due to the high co-morbidity rate of this population, additional subjects
will be enrolled to reach a total of 50 completed subjects for data analysis.
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