Dual Antiplatelet Therapy Tailored on the Extent of Platelet Inhibition

NCT ID: NCT00774475

Last Updated: 2008-10-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

442 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-11-30

Study Completion Date

2011-01-31

Brief Summary

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The purpose of this study is to evaluate the efficacy (reduction of major ischemic events at 6 and 12 months of follow-up) of a tailored clopidogrel therapy in patients with UA/NSTEMI undergoing PCI with stent implantation and wiht a documented residual platelet reactivity assessed by a point of care system (VerifyNow P2Y12).

Detailed Description

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Several studies documented the presence of a high variability in the individual response to antiplatelet therapies in terms of extent of platelet function inhibition. This laboratory finding is the so-called aspirin or clopidogrel resistance which we prefer to define residual platelet reactivity (RPR) on antiplatelet therapy.

A growing body of evidence is demonstrating the clinical relevance of this laboratory parameter, i.e. patients with RPR are at higher risk of a subsequent adverse cardiovascular event.

In particular, it has been demonstrated that RPR measured by light transmittance aggregometry induced by ADP or by the point of care assay VerifyNow P2Y12 identifies patients which, after coronary revascularization with stent implantation, at higher risk of a potentially catastrophic event such as stent thrombosis.

No randomized trials are available in the literature on the efficacy and safety of an antiplatelet therapy tailored on the extent of platelet function inhibition.

Conditions

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Unstable Angina NSTEMI

Keywords

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Clopidogrel therapy platelet function inhibition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1: standard therapy

clopidogrel 75 mg/day

Group Type PLACEBO_COMPARATOR

comparison of different dosage of clopidogrel

Intervention Type DRUG

clopidogrel 75 mg/day versus clopidogrel 150 mg/day

2: doubled therapy

clopidogrel 150 mg/day

Group Type ACTIVE_COMPARATOR

doubled therapy

Intervention Type DRUG

clopidogrel 150 mg/day

Interventions

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comparison of different dosage of clopidogrel

clopidogrel 75 mg/day versus clopidogrel 150 mg/day

Intervention Type DRUG

doubled therapy

clopidogrel 150 mg/day

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Unstable or NSTEMI

Exclusion Criteria

Previous bleeding events which have required blood transfusion

* PT- INR \>1.5
* Platelet count ≤ 100000/ mm3
* Hb \< 10 g/dl
* Previous TIA/stroke (ischemic or hemorrhagic or unknown)
* Body weight \< 60 Kg
* Creatinine levels ≥ 4 mg/dl
* Cerebral neoplasia
* Recent major trauma/surgery/head injury (within 3 previous weeks)
* Gastrointestinal hemorrhage in the last month
* Aortic dissection
* Known haemorrhagic diathesis
* Oral anticoagulant therapy
* Pregnancy or 1 week after delivery
* Uncontrolled hypertension (systolic \>180 mmHg or diastolic \>110 mmHg)
* Severe liver disease
* Infective endocarditis
* Major psychiatric disorders
* Alcool or drug abuse
* Active peptic ulcer Noncompressible arterial puncture within 14 days Prolonged cardiopulmonary resuscitation
Minimum Eligible Age

20 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tuscany Region

UNKNOWN

Sponsor Role collaborator

University of Florence

OTHER

Sponsor Role lead

Responsible Party

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University of Florence

Principal Investigators

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Gian Franco Gensini, MD

Role: PRINCIPAL_INVESTIGATOR

University of Florence

Gianni Maria Santoro, MD

Role: STUDY_CHAIR

ASL 10 Florence, Italy

Niccolò Marchionni, MD

Role: STUDY_CHAIR

University of Florence

David Antoniucci, MD

Role: STUDY_CHAIR

Azienda Ospedaliero-Universitaria Careggi

Alfredo Zuppiroli, MD

Role: STUDY_CHAIR

ASL 10 Florence Italy

Maria Cristina Landini, MD

Role: STUDY_CHAIR

ASL 10 Florence Italy

Rosanna Abbate, MD

Role: STUDY_DIRECTOR

University of Florence

Locations

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University of Florence

Florence, , Italy

Site Status

Countries

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Italy

Central Contacts

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Gian Franco Gensini, MD

Role: CONTACT

Phone: 00390557949417

Email: [email protected]

Rossella Marcucci, MD

Role: CONTACT

Phone: 00390557949420

Email: [email protected]

References

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Gori AM, Marcucci R, Migliorini A, Valenti R, Moschi G, Paniccia R, Buonamici P, Gensini GF, Vergara R, Abbate R, Antoniucci D. Incidence and clinical impact of dual nonresponsiveness to aspirin and clopidogrel in patients with drug-eluting stents. J Am Coll Cardiol. 2008 Aug 26;52(9):734-9. doi: 10.1016/j.jacc.2008.05.032.

Reference Type BACKGROUND
PMID: 18718420 (View on PubMed)

Buonamici P, Marcucci R, Migliorini A, Gensini GF, Santini A, Paniccia R, Moschi G, Gori AM, Abbate R, Antoniucci D. Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis. J Am Coll Cardiol. 2007 Jun 19;49(24):2312-7. doi: 10.1016/j.jacc.2007.01.094. Epub 2007 Jun 4.

Reference Type BACKGROUND
PMID: 17572245 (View on PubMed)

Price MJ, Endemann S, Gollapudi RR, Valencia R, Stinis CT, Levisay JP, Ernst A, Sawhney NS, Schatz RA, Teirstein PS. Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation. Eur Heart J. 2008 Apr;29(8):992-1000. doi: 10.1093/eurheartj/ehn046. Epub 2008 Feb 10.

Reference Type BACKGROUND
PMID: 18263931 (View on PubMed)

Santoro GM, Carrabba N, Barchielli A, Balzi D, Marchionni N, Filice M, Valente S, Granelli M, Berni I, Buiatti E; AMI-Florence Working Group. Use and efficacy of abciximab in an unselected population with acute myocardial infarction treated with primary angioplasty: data from AMI-Florence registry. Atherosclerosis. 2007 Nov;195(1):116-21. doi: 10.1016/j.atherosclerosis.2006.08.053. Epub 2006 Sep 25.

Reference Type BACKGROUND
PMID: 16997308 (View on PubMed)

Balzi D, Barchielli A, Buiatti E, Franceschini C, Lavecchia R, Monami M, Santoro GM, Carrabba N, Margheri M, Olivotto I, Gensini GF, Marchionni N; AMI-Florence Working Group. Effect of comorbidity on coronary reperfusion strategy and long-term mortality after acute myocardial infarction. Am Heart J. 2006 May;151(5):1094-1100. doi: 10.1016/j.ahj.2005.06.037.

Reference Type BACKGROUND
PMID: 16644342 (View on PubMed)

Other Identifiers

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000

Identifier Type: -

Identifier Source: org_study_id