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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
St. Francis Hospital, New York
About
Eligibility
Locations
Arms
Outcomes
Full info

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

21 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

First Posted
April 14, 2010
Last Updated
April 14, 2010
Sponsor
St. Francis Hospital, New York
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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

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Citation
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Plavix, Prasugrel and Drug Eluting Stents Pilot Trial

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