Acute Coronary Syndrome (ACS)
Conditions
Keywords
Dual antiplatelet therapy (DAPT), Platelet function, Clopidogrel, Ticagrelor, Switch
Brief summary
This is a prospective, randomized, open-label clinical trial which will enroll 80 acute coronary syndrome (ACS) patients after Percutaneous Transluminal Coronary Intervention (PCI) in China. Patients on maintenance dosing (MD) of aspirin (100 mg/d) and ticagrelor (90 mg twice daily) will be divided into two groups switching from ongoing ticagrelor to clopidogrel 600 mg loading dose (LD)/ 75 mg MD according to their bleeding risk. Then each group will randomly switch at different times(24 hours/ 12 hours after the last MD of ticagrelor). Pharmacodynamic assessments are performed at baseline, and at 4h, 8h, 24h, 48h, 72h hours with platelet aggregation rate by Light Transmittance Aggregometry method (LTA). All patients are followed-up for 30 days.
Detailed description
The primary endpoint of the study was platelet inhibition measured by Light Transmittance Aggregometry method(LTA). Secondary clinical endpoints included a 30-day major adverse cardiovascular endpoint (MACE) defined as a composite of cardiovascular death, recurrent myocardial infarction, target vessel revascularisation or stroke and individual components of the MACE. Safety endpoints of 30-day TIMI major and minor bleed were also evaluated.
Interventions
DRUGSwitch ticagrelor to clopidogrel
Switch ticagrelor to clopidogrel with 600 mg loading dose (LD)/75 mg maintenance dose（MD）12/24 hours after the last MD of ticagrelor
Sponsors
The First Affiliated Hospital with Nanjing Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥ 18 years. * ACS patients. * Patients who are treated with ticagrelor and do not tolerate it. * Volunteer to participate and sign informed consent. * Approved by national regulatory authorities ethics committees.
Exclusion criteria
* Patients who are contraindicated, intolerant or resistant to clopidogrel. * History of hematological disease or bleeding tendency; platelet count \< 100 × 10\^9 cells/L, or \> 600 × 10\^9 cells/L, hemoglobin \< 100 g/L. * Abnormal liver or kidney function (ALT \> 3 ULN; estimated CrCl \< 30 ml/min calculated by Cockcroft-Gault equation); diagnosed severe pulmonary disease. * Patients in need of drugs which affect the efficacy of clopidogrel such as miconazole, ketoconazole, andfluconazole. * Malignancies or other comorbid conditions with life expectancy less than 1 year. * Pregnant or lactating woman.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of platelet aggregation between different time points | baseline,4 hours,8 hours,24 hours,48 hours,72 hours | Regional differences between blood samples from each subjects of different groups by LTA.The results of LTA are reported in platelet aggregation rate(%).Platelet aggregation was induced by0.5mg/ml arachidonic acid (AA). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of clinical endpoint event | 30 days | Secondary clinical endpoints included a 30-day major adverse cardiovascular endpoint (MACE) defined as a composite of cardiovascular death, recurrent myocardial infarction, target vessel revascularisation or stroke and individual components of the MACE. Safety endpoints of 30-day TIMI major and minor bleed were also evaluated. |
Countries
China
Contacts
Primary ContactChunjian Li, Dr, PhD
Backup ContactQian Gu
Outcome results
None listed