Percutaneous Coronary Intervention Clinical Trial
Official title:
Reassessment of Long-Term Dual Anti-Platelet Therapy Using InDividualized Strategies - Using a Novel Combined Demographic and Pharmacogenomic Strategy: The RAPID EXTEND Pilot Study
In patients with heart attacks, the current standard of care is to restore blood flow through
percutaneous coronary intervention (PCI). This is done using stents (metal meshes) that opens
up blockages. Following PCI, standard preventative drug treatment includes the use of dual
antiplatelet therapy (DAPT) using both aspirin and a platelet P2Y12 receptor inhibitor
(Ticagrelor 90 mg twice a day or Clopidogrel 75 mg once a day) for one year to prevent
clotting that can result in additional heart attacks, sudden clotting of stents or death.
New studies have shown that there is a benefit to continuing DAPT beyond this one year mark.
Longer-term DAPT has been shown to reduce ischemic events (heart attack, stroke) but increase
the risk of bleeding. Present guidelines state that the decision to continue DAPT beyond the
one year mark should be made on an individualized basis.
The present study is a "pilot study" that seeks to compare Long-Term use of Ticagrelor (LTT)
versus a Personalized Approach (PA). We will be recruiting patients who have been stable
(free of ischemic or bleeding outcomes) on DAPT for 1 year after initial presentation with a
heart attack.
The PA group will use a modified DAPT score based on patient demographics to decide whether
treatment is warranted. Patient will also undergo bedside genetic testing to identify
potential at-risk genes. Those identified as carriers will be treated with ticagrelor while
non-carriers will be treated with clopidogrel.
The present study will determine whether a personalized approach will decrease bleeding
versus an approach of universal ticagrelor use.
The hypothesis is that patients receiving a personalized strategy will have a decreased risk
of bleeding.
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