Reloading Prasugrel or Clopidogrel on High Platelet Reactivity Before Percutaneous Coronary Intervention

NCT ID: NCT01609647

Last Updated: 2014-12-23

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

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

76 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-09-30

Study Completion Date

2014-12-31

Brief Summary

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High platelet reactivity unit (PRU) after loading dose clopidogrel in patients undergoing percutaneous coronary intervention (PCI) is related to high risk of short and long term recurrent ischemic events including stent thrombosis.

The investigators hypothesize that additional loading of prasugrel in patients with high PRU after clopidogrel loading would be superior to additional loading of clopidogrel in reducing platelet reactivity and thereby result in lower risk of short term recurrent ischemic events.

Detailed Description

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Dual antiplatelet therapy with acetylsalicyclic acid (ASA) and additional clopidogrel is now standard regimen for the prevention of recurrent ischemic events in patients who undergo PCI.

But decreased effect of clopidogrel in a group of patients was reported and they are known to be associated with high risk of recurrent ischemic event. Decreased effect of clopidogrel is mainly resulted from decreased function to metabolite prodrug, clopidogrel to active form of drug.

Prasugrel, newer thienopyridine has been recently developed and showed advantages to clopidogrel. Prasugrel is known to have shorter onset time to achieve steady state level than clopidogrel and constant pharmacologic effect regardless of patient diversity.

High PRU after loading dose clopidogrel in patients undergoing PCI is known to be related to increased risk of short and long term recurrent ischemic events including stent thrombosis. Prasugrel has been reported to be effective in reducing platelet reactivity in patients showing resistance to clopidogrel and high PRU.

The investigators hypothesize that additional loading of prasugrel in patients with high PRU after clopidogrel loading would be superior to additional loading of clopidogrel in reducing platelet reactivity and thereby result in reduced risk of short term recurrent ischemic events.

The investigators plan to include 70 acute coronary syndrome patients who are planned to undergo PCI and show high platelet reactivity. Most patients with ACS administer loading dose of ASA and clopidogrel as soon as they are assumed to be ACS.

The investigators plan to perform platelet reactivity test by VeryfyNow (VN) before PCI and enroll patients with high PRU defined by 235 or more. They are to randomly administered additional 300mg of clopidogrel or 20mg of prasugrel.

Conditions

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Acute Coronary Syndrome

Keywords

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High plate reactivity unit after loading dose of clopidogrel

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Prasugrel

Reloading with prasugrel 20mg \& followed by administration of 5mg/day for 30 days

Group Type EXPERIMENTAL

Prasugrel

Intervention Type DRUG

Reloading with prasugrel 20mg and followed by daily administration of prasugrel 5mg for 30 days

Clopidogrel

Reloading with clopidogrel 300mg and followed by administration of clopidogrel 75 mg/day for 30 days

Group Type ACTIVE_COMPARATOR

Clopidogrel

Intervention Type DRUG

Reloading with clopidogrel 300mg and followed by daily administration of clopidogrel 75mg for 30 days

Interventions

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Prasugrel

Reloading with prasugrel 20mg and followed by daily administration of prasugrel 5mg for 30 days

Intervention Type DRUG

Clopidogrel

Reloading with clopidogrel 300mg and followed by daily administration of clopidogrel 75mg for 30 days

Intervention Type DRUG

Other Intervention Names

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Effient Plavix

Eligibility Criteria

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Inclusion Criteria

* Acute coronary syndrome
* Patients planned to undergo percutaneous transluminal coronary angioplasty
* Patients who agreed to the experimental plan which was permitted by IRB

Exclusion Criteria

* Low body weight (\<50kg)
* Urgent PCI for ACS
* Use of glycoprotein IIb/IIIa inhibitor in recent 24hrs or planned to
* History of transient ischemic attack
* History of upper gastrointestinal bleeding in recent 6 months
* Renal dysfunction defined as serum creatinine \> 2.5 mg/dl
* Severe hepatic dysfunction defined as serum transaminase \> 3 times normal limit
* Bleeding tendency
* Anticoagulation treatment including warfarin
* Thrombocytopenia defined by platelet \< 100,000/ml
* Anemia defined by hemoglobin \< 10 g/dl
* Contraindication for study drugs
Minimum Eligible Age

20 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dong-A University

OTHER

Sponsor Role lead

Responsible Party

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Moo Hyun Kim

MD. Director, Regional Clinical Trial Center. Professor, Dept. of Cardiology Dong-A University Hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Moo Hyun Kim, MD

Role: PRINCIPAL_INVESTIGATOR

Director, Regional Clinical Trial Center

Locations

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DongA University Hospital

Busan, , South Korea

Site Status

Countries

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South Korea

References

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Guo LZ, Kim MH, Shin ES, Ann SH, De Jin C, Cho YR, Park JS, Park K, Park TH, Lee MS, Serebruany VL. Thienopyridine reloading in clopidogrel-loaded patients undergoing percutaneous coronary interventions: The PRAISE study. Int J Cardiol. 2016 Nov 1;222:639-644. doi: 10.1016/j.ijcard.2016.08.027. Epub 2016 Aug 4.

Reference Type DERIVED
PMID: 27517654 (View on PubMed)

Lee DH, Kim MH, Park TH, Park JS, Park K, Zhang HZ, Seo JM, Lee MS. Comparison of prasugrel and clopidogrel reloading on high platelet reactivity in clopidogrel-loaded patients undergoing percutaneous coronary intervention (PRAISE-HPR): a study protocol for a prospective randomized controlled clinical trial. Trials. 2013 Feb 28;14:62. doi: 10.1186/1745-6215-14-62.

Reference Type DERIVED
PMID: 23448344 (View on PubMed)

Other Identifiers

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PRAISE-HPR

Identifier Type: -

Identifier Source: org_study_id