Ticagrelor vs High Dose Clopidogrel in Patients With ST Elevation Myocardial Infarction Post Fibrinolysis

ST Elevation Myocardial Infarction Clinical Trial

Official title:

Pharmacodynamic Assessment of Ticagrelor vs High Dose Clopidogrel in Patients With ST Elevation Myocardial Infarction Exhibiting High Platelet Reactivity Post Fibrinolysis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01950416
• Other study ID #: PATRASCARDIOLOGY-14
• Status: Completed
• Phase: Phase 4
• First received: September 21, 2013
• Last updated: August 19, 2015
• Start date: March 2013
• Est. completion date: December 2014

Study information

• Verified date: August 2015
• Source: University of Patras
• Contact: n/a
• Is FDA regulated: No
• Health authority: Greece: Ethics Committee
• Study type: Interventional

Clinical Trial Summary

This is a two-center, prospective, randomized, single-blind, investigator initiated, pharmacodynamic study of parallel design, carried out in 2 PCI-capable cardiology centers (Patras University Hospital and Konstantopoulio General Hospital of Athens).

Patients with ST elevation myocardial infarction, having undergone fibrinolysis in the previous 3 to 48 hours, who present high residual PR (defined as PRU ≥208 ) on admission, pre coronary angiography, will be randomized after written informed consent, in a 1:1 ratio to either:

Ticagrelor 180mg loading dose (LD), followed by a 90mg x2 maintenance dose (MD) starting 12±6 hours post LD, until discharge.

Or

Clopidogrel 600mg loading dose (LD), followed by a 150mg once daily maintenance dose (MD) starting 12±6 hours post LD, until discharge.

Platelet reactivity assessment will be performed at randomization (Hour 0) and at 2, 24 hours after randomization, as well as pre-discharge, using the VerifyNow assay, in platelet reactivity units (PRU).

Documentation of major adverse cardiac events (death, myocardial infarction, stroke, ischemia driven revascularization procedure with PCI or CABG) and bleeding (according to BARC criteria) will be performed until patient's discharge.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 56
• Est. completion date: December 2014
• Est. primary completion date: December 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 85 Years

Eligibility

Inclusion Criteria:

1. Age 18-85 years old

2. Patients with STEMI, having undergone fibrinolytic therapy in the previous 3 to 48 hours

3. Presenting HPR (=208 PRU) post 300mg clopidogrel loading dose ( assessment immediately before coronary angiography)

4. Informed consent obtained in writing

Exclusion Criteria:

• Pregnancy

• Breastfeeding

• Inability to give informed consent

• Cardiogenic shock

• Major periprocedural complications (death, stent thrombosis, vessel perforation, arrhythmias requiring cardioversion, temporary pacemaker insertion or intravenous antiarrhythmic agents, respiratory failure requiring intubation, vascular injury (arteriovenous shunt, retroperitoneal bleeding), major bleeding (need for bood transfusion or drop in haemoglobin post-PCI by = 5 gr/ dl or intracranial bleeding)

• Known hypersensitivity to ticagrelor or clopidogrel

• History of gastrointestinal bleeding, genitourinary bleeding or other site abnormal bleeding within the previous 3 months.

• Other bleeding diathesis, or considered by investigator to be at high risk for bleeding

• Any previous history of stroke, intracranial hemorrhage or disease (neoplasm, arteriovenous malformation, aneurysm).

• Thombocytopenia (<100.000 / µL) at randomization

• Anaemia (Hct <30%) at randomization

• Polycytaemia (Hct > 52%) at randomization

• Periprocedural IIb/IIIa inhibitors administration

• Per os anticoagulants

• Recent (< 6 weeks) major surgery or trauma, including GABG.

• Subjects receiving daily treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors that cannot be discontinued for the duration of the study.

• Concomitant oral or IV therapy with strong CY P3A inhibitors (ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, atazana vir, grapefruit juice N1 L/d), CYP3A substrates with narrow therapeutic indices (cyclosporine, quinidine), or strong CYP3A inducers (rifampin /rifampicin, phenytoin, carbamazepine).

• Increased risk of bradycardiac events.

• Dialysis required.

• Severe uncontrolled chronic obstructive pulmonary disease

• Known severe hepatic impairement

Study Design

Allocation: Randomized, Endpoint Classification: Pharmacodynamics Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Fibrinolysis
• Infarction
• Myocardial Infarction
• P2Y12 Inhibitor
• ST Elevation Myocardial Infarction

Intervention

Drug:
• Ticagrelor 180mg loading dose and 90mg bid maintenance dose

• Clopidogrel 600mg loading dose and 150mg maintenance dose

Locations

Country	Name	City	State
Greece	Konstantopoulio General Hospital of Athens	Athens	Attiki
Greece	Patras University Hospital	Patras

Sponsors (1)

Lead Sponsor	Collaborator
University of Patras

Country where clinical trial is conducted

Greece, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Platelet reactivity at 2 hours post randomization between the 2 treatment arms	Platelet reactivity at 2 hours post randomization between the 2 treatment arms	2 hours	No
Secondary	Platelet reactivity at 24 hours post randomization between the 2 treatment arms.		24 hours	No
Secondary	Platelet reactivity pre-discharge between the 2 treatment arms		5 days	No
Secondary	High on treatment platelet reactivity (HPR) rate (=208 PRU) at 2 hours post randomization		2 hours	No
Secondary	High on treatment platelet reactivity (HPR) rate (=208 PRU) at 24 hours post randomization		24 hours	No
Secondary	High on treatment platelet reactivity (HPR) rates (=208 PRU) pre discharge		5 days	No