Plavix, Prasugrel and Drug Eluting Stents Pilot Trial (PPD)
Primary Purpose
Coronary Artery Disease, Platelet Aggregation Inhibitors, PCI- Percutaneous Coronary Intervention
Status
Unknown status
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Loading Dose Arm
Maintenance Dose Arm
Sponsored by

About this trial
This is an interventional treatment trial for Coronary Artery Disease focused on measuring Coronary artery disease, clopidogrel, prasugrel, Verify Now, PRU measurements, Drug eluting stents (EDS), P2Y12, Platelet reactivity
Eligibility Criteria
Inclusion Criteria:
- Subject presenting for clinically indicated PCI with implantation of at least one drug-eluting stent.
- No planned use of Glycoprotein IIb/IIIa inhibitors during PCI procedure.
- Subject must be taking aspirin or enteric coated aspirin 81 mg-325 mg daily.
- Willing to participate and sign an informed consent.
Exclusion Criteria:
- Subject older than 75 years of age.
- Subject weight is 60 kg or less.
- Subject who have received intravenous eptifibatide or tirofiban within 48 hours prior to PCI or abciximab within 14 days before or during PCI.
- Subject taking warfarin or with clinical indication to resume warfarin post PCI for any indication.
- Subject currently requiring daily treatment with NSAID or COX2 inhibitors.
- Subject with a known platelet disorder.
- Subject with known active pathological bleeding or heightened risk of bleeding including but not limited to: gastrointestinal bleeding within 6 months, recent surgery or trauma.
- Subject with a history of a stroke or TIA
- Subject with pre-PCI hematocrit or platelet count outside the ranges validated for Verify Now P2Y12 test (33-52% and 119.000-502.000/μL, respectively).
- Subject with a history of hepatic impairment
- Subject with known NYHA Class III or greater for heart failure.
- Inability of subject to provide informed consent.
- Subject with known hypersensitivity or contraindication to clopidogrel, prasugrel or ASA, which would result in inability of patient to adhere to trial protocol.
- Presence of valvular heart disease left main coronary artery stenosis or urgent need for CABG.
Sites / Locations
- St. Francis HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Active Comparator
Arm Label
Maintenance Dose Arm
Loading Dose Arm
Arm Description
Open label clopidogrel 75 mg daily or prasugrel 10 mg daily
Clopidogrel 600 mg or Prasugrel 60 mg at time of PCI.
Outcomes
Primary Outcome Measures
Change in platelet reactivity after switching medication regimen of two thienopyridines- clopidogrel and prasugrel
Platelet reactivity will be measured using the Accumetrics Verify Now P2Y12 platelet assay
Secondary Outcome Measures
Occurrence of all bleeding events for subjects enrolled into the trial
All bleeding events will be observed, reported and adjudicated by the DSMB
Occurrence of all MACE events for subjects enrolled into the trial
All bleeding events will be observed, reported and adjudicated by the DSMB
Full Information
NCT ID
NCT01103843
First Posted
April 14, 2010
Last Updated
April 14, 2010
Sponsor
St. Francis Hospital, New York
1. Study Identification
Unique Protocol Identification Number
NCT01103843
Brief Title
Plavix, Prasugrel and Drug Eluting Stents Pilot Trial
Acronym
PPD
Official Title
PPD Trial Pilot Study: Plavix, Prasugrel and Drug Eluting Stents
Study Type
Interventional
2. Study Status
Record Verification Date
April 2010
Overall Recruitment Status
Unknown status
Study Start Date
April 2010 (undefined)
Primary Completion Date
April 2011 (Anticipated)
Study Completion Date
May 2011 (Anticipated)
3. Sponsor/Collaborators
Name of the Sponsor
St. Francis Hospital, New York
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to determine the level of inhibition of platelet activation of an approved thienopyridine(clopidogrel or prasugrel) and aspirin regimen in the setting of drug eluting coronary stent implantation.
In subjects with high residual levels of platelet reactivity after receiving either a maintenance or loading dose of either clopidogrel or prasugrel, a cross over of thienopyridine treatment to the alternate medication will occur.
The study tests the hypothesis that adequate platelet inhibition will occur in subjects who have high levels of platelet reactivity and are subsequently switched from clopidogrel to prasugrel(loading or maintenance dose) without increased episodes of bleeding or MACE events at discharge and 30 days post Percutaneous Coronary Intervention (PCI).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease, Platelet Aggregation Inhibitors, PCI- Percutaneous Coronary Intervention
Keywords
Coronary artery disease, clopidogrel, prasugrel, Verify Now, PRU measurements, Drug eluting stents (EDS), P2Y12, Platelet reactivity
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
1000 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Maintenance Dose Arm
Arm Type
Active Comparator
Arm Description
Open label clopidogrel 75 mg daily or prasugrel 10 mg daily
Arm Title
Loading Dose Arm
Arm Type
Active Comparator
Arm Description
Clopidogrel 600 mg or Prasugrel 60 mg at time of PCI.
Intervention Type
Drug
Intervention Name(s)
Loading Dose Arm
Other Intervention Name(s)
clopidogrel, prasugrel, Verify now P2Y12 platelet assay
Intervention Description
Subjects who are thienopyridine naive will be randomized 1:1 to either clopidogrel 600 mg or prasugrel 60 mg loading dose at the time of PCI. A Verify Now P2Y12 platelet assay will measure platelet reactivity. Cross over to loading dose and maintenance dose of alternate medication will occur based on level of platelet reactivity.
Intervention Type
Drug
Intervention Name(s)
Maintenance Dose Arm
Other Intervention Name(s)
thienoyridine, Verify now P2Y12, prasugrel, clopidogrel
Intervention Description
Verify Now P2Y12 platelet assay will measure platelet reactivity. Cross over to a loading dose and maintenance dose of alternate medication will occur based on level of platelet reactivity.
Primary Outcome Measure Information:
Title
Change in platelet reactivity after switching medication regimen of two thienopyridines- clopidogrel and prasugrel
Description
Platelet reactivity will be measured using the Accumetrics Verify Now P2Y12 platelet assay
Time Frame
4 hours post medicaton administration
Secondary Outcome Measure Information:
Title
Occurrence of all bleeding events for subjects enrolled into the trial
Description
All bleeding events will be observed, reported and adjudicated by the DSMB
Time Frame
24 hours post PCI or at time of discharge and 30 days post PCI
Title
Occurrence of all MACE events for subjects enrolled into the trial
Description
All bleeding events will be observed, reported and adjudicated by the DSMB
Time Frame
24 hours post PCI or at time of discharge and 30 days post PCI
10. Eligibility
Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subject presenting for clinically indicated PCI with implantation of at least one drug-eluting stent.
No planned use of Glycoprotein IIb/IIIa inhibitors during PCI procedure.
Subject must be taking aspirin or enteric coated aspirin 81 mg-325 mg daily.
Willing to participate and sign an informed consent.
Exclusion Criteria:
Subject older than 75 years of age.
Subject weight is 60 kg or less.
Subject who have received intravenous eptifibatide or tirofiban within 48 hours prior to PCI or abciximab within 14 days before or during PCI.
Subject taking warfarin or with clinical indication to resume warfarin post PCI for any indication.
Subject currently requiring daily treatment with NSAID or COX2 inhibitors.
Subject with a known platelet disorder.
Subject with known active pathological bleeding or heightened risk of bleeding including but not limited to: gastrointestinal bleeding within 6 months, recent surgery or trauma.
Subject with a history of a stroke or TIA
Subject with pre-PCI hematocrit or platelet count outside the ranges validated for Verify Now P2Y12 test (33-52% and 119.000-502.000/μL, respectively).
Subject with a history of hepatic impairment
Subject with known NYHA Class III or greater for heart failure.
Inability of subject to provide informed consent.
Subject with known hypersensitivity or contraindication to clopidogrel, prasugrel or ASA, which would result in inability of patient to adhere to trial protocol.
Presence of valvular heart disease left main coronary artery stenosis or urgent need for CABG.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Elizabeth S. Haag, RN, MPA CCRC
Phone
516 562-6790
Email
elizabeth.haag@chsli.org
First Name & Middle Initial & Last Name or Official Title & Degree
Lyn Santiago, RN,CCRC
Phone
516 562-6790
Email
lyn.santiago@chlsi.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Richard A Shlofmitz, MD
Organizational Affiliation
Saint Francis Memorial Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Francis Hospital
City
Roslyn
State/Province
New York
ZIP/Postal Code
11576
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elizabeth S Haag, RN, MPA,CCRP
Phone
516-562-6790
Email
elizabeth.haag@chsli.org
First Name & Middle Initial & Last Name & Degree
Lyn Santiago, RN,CCRC
Phone
516 562-6790
Email
lyn.santiago@chsli.org
First Name & Middle Initial & Last Name & Degree
Richard A Shlofmitz, MD
12. IPD Sharing Statement
Citations:
PubMed Identifier
17900275
Citation
Brandt JT, Close SL, Iturria SJ, Payne CD, Farid NA, Ernest CS 2nd, Lachno DR, Salazar D, Winters KJ. Common polymorphisms of CYP2C19 and CYP2C9 affect the pharmacokinetic and pharmacodynamic response to clopidogrel but not prasugrel. J Thromb Haemost. 2007 Dec;5(12):2429-36. doi: 10.1111/j.1538-7836.2007.02775.x. Epub 2007 Sep 26.
Results Reference
background
PubMed Identifier
18278186
Citation
Neubauer H, Lask S, Engelhardt A, Mugge A. How to optimise clopidogrel therapy? Reducing the low-response incidence by aggregometry-guided therapy modification. Thromb Haemost. 2008 Feb;99(2):357-62. doi: 10.1160/TH07-10-0624.
Results Reference
background
PubMed Identifier
12796140
Citation
Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation. 2003 Jun 17;107(23):2908-13. doi: 10.1161/01.CIR.0000072771.11429.83. Epub 2003 Jun 9.
Results Reference
background
PubMed Identifier
18941611
Citation
Ferguson AD, Dokainish H, Lakkis N. Aspirin and clopidogrel response variability: review of the published literature. Tex Heart Inst J. 2008;35(3):313-20.
Results Reference
background
PubMed Identifier
19106083
Citation
Simon T, Verstuyft C, Mary-Krause M, Quteineh L, Drouet E, Meneveau N, Steg PG, Ferrieres J, Danchin N, Becquemont L; French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) Investigators. Genetic determinants of response to clopidogrel and cardiovascular events. N Engl J Med. 2009 Jan 22;360(4):363-75. doi: 10.1056/NEJMoa0808227. Epub 2008 Dec 22.
Results Reference
background
PubMed Identifier
19948947
Citation
Farid NA, Kurihara A, Wrighton SA. Metabolism and disposition of the thienopyridine antiplatelet drugs ticlopidine, clopidogrel, and prasugrel in humans. J Clin Pharmacol. 2010 Feb;50(2):126-42. doi: 10.1177/0091270009343005. Epub 2009 Nov 30. Erratum In: J Clin Pharmacol. 2010 Apr;50(4):483.
Results Reference
background
PubMed Identifier
17982182
Citation
Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM; TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007 Nov 15;357(20):2001-15. doi: 10.1056/NEJMoa0706482. Epub 2007 Nov 4.
Results Reference
background
PubMed Identifier
18056526
Citation
Wiviott SD, Trenk D, Frelinger AL, O'Donoghue M, Neumann FJ, Michelson AD, Angiolillo DJ, Hod H, Montalescot G, Miller DL, Jakubowski JA, Cairns R, Murphy SA, McCabe CH, Antman EM, Braunwald E; PRINCIPLE-TIMI 44 Investigators. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 trial. Circulation. 2007 Dec 18;116(25):2923-32. doi: 10.1161/CIRCULATIONAHA.107.740324. Epub 2007 Dec 3.
Results Reference
background
PubMed Identifier
19637095
Citation
Li YG, Ni L, Brandt JT, Small DS, Payne CD, Ernest CS 2nd, Rohatagi S, Farid NA, Jakubowski JA, Winters KJ. Inhibition of platelet aggregation with prasugrel and clopidogrel: an integrated analysis in 846 subjects. Platelets. 2009 Aug;20(5):316-27. doi: 10.1080/09537100903046317.
Results Reference
background
PubMed Identifier
19414633
Citation
Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, Walker JR, Antman EM, Macias WL, Braunwald E, Sabatine MS. Cytochrome P450 genetic polymorphisms and the response to prasugrel: relationship to pharmacokinetic, pharmacodynamic, and clinical outcomes. Circulation. 2009 May 19;119(19):2553-60. doi: 10.1161/CIRCULATIONAHA.109.851949. Epub 2009 May 4.
Results Reference
background
PubMed Identifier
18569863
Citation
Payne CD, Li YG, Brandt JT, Jakubowski JA, Small DS, Farid NA, Salazar DE, Winters KJ. Switching directly to prasugrel from clopidogrel results in greater inhibition of platelet aggregation in aspirin-treated subjects. Platelets. 2008 Jun;19(4):275-81. doi: 10.1080/09537100801891640.
Results Reference
background
PubMed Identifier
19419580
Citation
Godino C, Mendolicchio L, Figini F, Latib A, Sharp AS, Cosgrave J, Calori G, Cera M, Chieffo A, Castelli A, Maseri A, Ruggeri ZM, Colombo A. Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy? Thromb J. 2009 May 6;7:4. doi: 10.1186/1477-9560-7-4.
Results Reference
background
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Plavix, Prasugrel and Drug Eluting Stents Pilot Trial
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