Peripheral Endothelial Function Assessment of Patients on Ticagrelor vs. Clopidogrel Who Have Undergone PCI
Primary Purpose
Myocardial Ischemia, Coronary Artery Disease, Endothelial Dysfunction
Status
Completed
Phase
Phase 4
Locations
Ireland
Study Type
Interventional
Intervention
Ticagrelor
Clopidogrel
Sponsored by
About this trial
This is an interventional basic science trial for Myocardial Ischemia focused on measuring Ticagrelor, Clopidogrel, Coronary Artery Disease, Percutaneous Coronary Intervention, Acute Coronary Syndrome
Eligibility Criteria
Inclusion Criteria:
- Subjects must be able and willing to give written informed consent and to comply with the requirements of this study protocol
- Subjects must be male or female, aged 18 years or above at baseline
- Diagnosed with coronary artery disease and undergone PCI
- Female subjects of child bearing potential must be willing to ensure that they or their partner use effective contraception during the study and for 12 months (as per guidelines on patients undergoing PCI who are on antiplatelet therapy).
- Female subjects' urine pregnancy test performed at the baseline visit must be negative (which is required by local hospital policy in order to undergo PCI).
Exclusion Criteria:
- Allergy/hypersensitivity to study medications or their ingredients
Contraindications to either clopidogrel or ticagrelor:
- Ticagrelor contraindications - active bleeding, history of intracranial haemorrhage, moderate to severe hepatic impairment, dialysis, uric acid nephropathy, co-administration of a strong CYP3A4 inhibitor (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir), history of sick sinus syndrome or high degree AV block without pacemaker protection
- Clopidogrel contraindications - severe hepatic impairment, active bleeding
- On treatment with oral anticoagulant (vitamin K antagonist, dabigatran, rivaroxaban, apixaban)
- Unable to follow up in research centre (for example, due to logistic difficulties)
- Female subjects who are pregnant or breast-feeding, or considering becoming pregnant during the study.
- Subjects who have participated in another study and received any other investigational agent within the previous 12 months
- Subjects unable to provide written informed consent within 24 hours of PCI (for example, intubated patients)
- Subjects who have a history of drug or alcohol use that, in the opinion of the investigator, would interfere with adherence to study requirements.
- Use of both left and right radial access for PCI
Sites / Locations
- University Hospital Limerick
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Ticagrelor
Clopidogrel
Arm Description
Patients in this group will be prescribed ticagrelor 90 mg BD for 4 weeks.
Patients in this group will be prescribed clopidogrel 75 mg OD for 4 weeks
Outcomes
Primary Outcome Measures
The number of patients with endothelial dysfunction (Reactive Hyperemia index of < 1.67 using the non-invasive Endo-PAT 2000 device) on ticagrelor versus clopidogrel.
Secondary Outcome Measures
Full Information
NCT ID
NCT02469740
First Posted
June 9, 2015
Last Updated
March 10, 2016
Sponsor
University Hospital of Limerick
1. Study Identification
Unique Protocol Identification Number
NCT02469740
Brief Title
Peripheral Endothelial Function Assessment of Patients on Ticagrelor vs. Clopidogrel Who Have Undergone PCI
Official Title
Peripheral Endothelial Function Assessment of Patients on Ticagrelor vs. Clopidogrel Who Have Undergone Percutaneous Coronary Intervention - a Randomised, Crossover Study.
Study Type
Interventional
2. Study Status
Record Verification Date
March 2016
Overall Recruitment Status
Completed
Study Start Date
July 2015 (undefined)
Primary Completion Date
January 2016 (Actual)
Study Completion Date
January 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Hospital of Limerick
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Usage of antiplatelet agents and cardiac procedures such as coronary angioplasty has dramatically improved the morbidity and mortality associated with coronary artery disease. In patients with a coronary stent, dual antiplatelet therapy is recommended. Aspirin is the main antiplatelet agent used. For many years, clopidogrel was the second antiplatelet of choice. Recent studies have revealed new antiplatelet drugs that can substitute clopidogrel, one of which is ticagrelor. The degree to which ticagrelor reduced the overall mortality compared to clopidogrel in the PLATO trial suggested that ticagrelor possibly has a pleiotropic effect and that the reduction in mortality is not simply due to its antiplatelet effects. The ticagrelor molecule resembles adenosine. Adenosine has been shown to be cardioprotective.
The aim of this project is to study the effects of ticagrelor on the arterial system using a noninvasive method. The study will employ the measurement of peripheral endothelial function of patients who undergo percutaneous coronary intervention who are on ticagrelor vs. clopidogrel using a cross over trial design.
Detailed Description
Cardiovascular disease remains the most common cause of death in Ireland. Usage of antiplatelet agents and cardiac procedures such as coronary angioplasty has dramatically improved the morbidity and mortality associated with coronary artery disease. In patients with a coronary stent, dual antiplatelet therapy is recommended. Aspirin is the main antiplatelet agent used. For many years, clopidogrel was the second antiplatelet of choice. Recent studies have revealed new antiplatelet drugs that can substitute clopidogrel, one of which is ticagrelor. Ticagrelor received approval from regulatory authorities such as the Food and Drug Administration and the European Medicines Agency based on the PLATO trial which demonstrated a reduction in overall mortality and thrombotic cardiovascular events when compared to clopidogrel. Ticagrelor is approved in Europe and specifically in Ireland for use in patients with ACS and in patients undergoing coronary angioplasty. The degree to which ticagrelor reduced the overall mortality compared to clopidogrel in the PLATO trial suggested that ticagrelor possibly has a pleiotropic effect and that the reduction in mortality is not simply due to its antiplatelet effects. The ticagrelor molecule resembles adenosine. It has been shown that ticagrelor increases adenosine concentration, by interfering with its red blood cells' uptake and by inducing the release of ATP which is then converted to adenosine. Adenosine has been shown to be cardioprotective.
Peripheral Arterial Tonometry (EndoPAT 2000 system (Itamar Medical, Caesarea, Israel) is a method for evaluating endothelial dysfunction. The device has received a CE mark (approved for use in Europe). It uses a non-invasive assessment called fingertip pulse amplitude tonometry.
The reactive hyperaemia response as detected by the reactive hyperaemia index (RHI) has been shown to be related to multiple traditional and metabolic risk factors. It has also been found to positively correlate with flow mediated dilatation (FMD) and coronary vasoreactivity as assessed by intracoronary acetylcholine. A significant advantage of the endoPAT device is the reproducibility of results when compared to FMD in assessment of peripheral endothelial function. Smaller studies have shown positive effects of ticagrelor on endothelial function assessment compared with clopidogrel or prasugrel but no randomised study has been done to date.
The aim of this project is to study the effects of ticagrelor on the arterial system using a noninvasive method. The study will employ the measurement of peripheral endothelial function of patients who undergo percutaneous coronary intervention who are on ticagrelor vs. clopidogrel using a cross over trial design.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myocardial Ischemia, Coronary Artery Disease, Endothelial Dysfunction
Keywords
Ticagrelor, Clopidogrel, Coronary Artery Disease, Percutaneous Coronary Intervention, Acute Coronary Syndrome
7. Study Design
Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
61 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Ticagrelor
Arm Type
Experimental
Arm Description
Patients in this group will be prescribed ticagrelor 90 mg BD for 4 weeks.
Arm Title
Clopidogrel
Arm Type
Active Comparator
Arm Description
Patients in this group will be prescribed clopidogrel 75 mg OD for 4 weeks
Intervention Type
Drug
Intervention Name(s)
Ticagrelor
Other Intervention Name(s)
Brilique
Intervention Description
Patients that are randomly selected to receive ticagrelor during the first phase of the study will receive the dose of 90 mg BD orally. This will be continued for 4 weeks before the endothelial function test will be performed. If the patients are assigned in the 2nd phase of the study, they will receive 90 mg BD orally for 5 weeks (4 weeks plus a 1 week washout period).
Intervention Type
Drug
Intervention Name(s)
Clopidogrel
Other Intervention Name(s)
Plavix, Clodel
Intervention Description
Patients that are randomly selected to receive ticagrelor during the first phase of the study will receive the dose of 75 mg OD orally. This will be continued for 4 weeks before the endothelial function test will be performed. If the patients are assigned in the 2nd phase of the study, they will receive 75 mg OD orally for 5 weeks (4 weeks plus a 1 week washout period).
Primary Outcome Measure Information:
Title
The number of patients with endothelial dysfunction (Reactive Hyperemia index of < 1.67 using the non-invasive Endo-PAT 2000 device) on ticagrelor versus clopidogrel.
Time Frame
9 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subjects must be able and willing to give written informed consent and to comply with the requirements of this study protocol
Subjects must be male or female, aged 18 years or above at baseline
Diagnosed with coronary artery disease and undergone PCI
Female subjects of child bearing potential must be willing to ensure that they or their partner use effective contraception during the study and for 12 months (as per guidelines on patients undergoing PCI who are on antiplatelet therapy).
Female subjects' urine pregnancy test performed at the baseline visit must be negative (which is required by local hospital policy in order to undergo PCI).
Exclusion Criteria:
Allergy/hypersensitivity to study medications or their ingredients
Contraindications to either clopidogrel or ticagrelor:
Ticagrelor contraindications - active bleeding, history of intracranial haemorrhage, moderate to severe hepatic impairment, dialysis, uric acid nephropathy, co-administration of a strong CYP3A4 inhibitor (e.g. ketoconazole, clarithromycin, nefazodone, ritonavir and atazanavir), history of sick sinus syndrome or high degree AV block without pacemaker protection
Clopidogrel contraindications - severe hepatic impairment, active bleeding
On treatment with oral anticoagulant (vitamin K antagonist, dabigatran, rivaroxaban, apixaban)
Unable to follow up in research centre (for example, due to logistic difficulties)
Female subjects who are pregnant or breast-feeding, or considering becoming pregnant during the study.
Subjects who have participated in another study and received any other investigational agent within the previous 12 months
Subjects unable to provide written informed consent within 24 hours of PCI (for example, intubated patients)
Subjects who have a history of drug or alcohol use that, in the opinion of the investigator, would interfere with adherence to study requirements.
Use of both left and right radial access for PCI
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas J Kiernan
Organizational Affiliation
University Hospital of Limerick
Official's Role
Study Chair
Facility Information:
Facility Name
University Hospital Limerick
City
Dooradoyle
State/Province
Limerick
Country
Ireland
12. IPD Sharing Statement
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Peripheral Endothelial Function Assessment of Patients on Ticagrelor vs. Clopidogrel Who Have Undergone PCI
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