Mechanisms fo Clopidogrel Resistance in Older Adults
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 37
- 试验地点
- 4
- 主要终点
- PK/PD correlation - clopidogrel active metabolite concentration (pharmacokinetics PK in ) / platelet response phenotype(pharmacodynamics, PD)
研究概览
简要总结
A clopidogrel resistance rate of 40-50% has been found in the population over 70 years of age, whereas biological resistance, associated with an increased risk of cardiovascular events, is observed in about 20-30% of younger patients. One hypothesis is that the active metabolite is less available in resistant patients. Indeed, 85% of the absorbed clopidogrel undergoes inactivation by esterases. Then the remaining fraction undergoes two steps of metabolisation to the active thiol metabolite by CYP450, essentially the isoform 2C19. In older adults, increased esterase activity and/or decreased CYP450 2C19 activity may lead to a decreased concentration of the active metabolite. Multiple chronic conditions and polypharmacy encountered in older individuals are associated with basal platelet hyperactivity, and may also contribute to a poor response to clopidogrel. No data on the relationship between platelet response and circulating metabolite levels, or on the determinants of response to clopidogrel, are currently available in the geriatric population. Therefore, we propose to analyse the relationship between age and platelet and extra-platelet mechanisms potentially involved in the variability of response to clopidogrel.
详细描述
This study is a prospective observational multi-centre study. The main objective is assessing the pharmacokinetics (PK) and pharmacodynamics (PD) correlation of clopidogrel action in older adults, i.e. correlation between clopidogrel active metabolite concentration (PK) and platelet response phenotype (PD). The primary outcome is the correlation between the concentration of active metabolite of clopidogrel (PK) over the percentage of maximum aggregation at 10 μM ADP (PD) as a function of age. Inclusion criteria are: age 50-100 years old, hospitalization in one of the 4 participating centres, treatment with clopidogrel 75 milligrammes per day, for at least 10 days. The statistical analysis is a multiple linear regression model with the introduction of an interaction term. The first variable of interest (explanatory) is the concentration of the metabolite. A linear regression model will be used to estimate the proportion of variance explained. The analyses will be conducted with SAS version 9.4 (SAS Institute Inc., Cary, N.C., USA). Results will be published in an international scientific review.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 50 Years 至 100 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Consecutive patients per 10-year age range, (20 patients per age range from 50 to 100 years included) :
- •in consultation or hospitalization in one of the participating centres,
- •treatment with clopidogrel 75 mg/d for at least 10 days for primary or secondary prevention of cardiovascular events.
- •who have received the information and have not expressed their opposition to participate in the study and who have given their written consent for the performance of genetic examinations and the realization of a biocollection
- •affiliated to French social security system
排除标准
- •treatment with another antithrombotic agent,
- •myeloproliferative syndrome,
- •platelet count < 100 G/L,
- •acute inflammatory situation: severe sepsis, documented acute infection, chronic systemic inflammatory disease or active cancer,
- •under dialysis,
- •no participation in another clinical study,
- •deprived of liberty
研究组 & 干预措施
Age Group 50 to 59
Inclusion criteria :
- age 50-100 years old,
- in consultation or hospitalization in one of the participating centres,
- treatment with clopidogrel 75 milligrammes per day, for at least 10 days, for primary or secondary prevention of cardiovascular events.
Non-inclusion criteria :
- treatment with another antithrombotic drug,
- myeloproliferative syndrome,
- platelet count < 100 gigas/liter,
- acute inflammatory situation: severe sepsis, documented acute infection, chronic systemic inflammatory disease or active cancer,
- dialysis.
干预措施: additional blood sample (Biological)
Age Group 60 to 69
Inclusion criteria :
- age 50-100 years old,
- in consultation or hospitalization in one of the participating centres,
- treatment with clopidogrel 75 milligrammes per day, for at least 10 days, for primary or secondary prevention of cardiovascular events.
Non-inclusion criteria :
- treatment with another antithrombotic drug,
- myeloproliferative syndrome,
- platelet count < 100 gigas/liter,
- acute inflammatory situation: severe sepsis, documented acute infection, chronic systemic inflammatory disease or active cancer,
- dialysis.
干预措施: additional blood sample (Biological)
Age Group 70 to 79
Inclusion criteria :
- age 50-100 years old,
- in consultation or hospitalization in one of the participating centres,
- treatment with clopidogrel 75 milligrammes per day, for at least 10 days, for primary or secondary prevention of cardiovascular events.
Non-inclusion criteria :
- treatment with another antithrombotic drug,
- myeloproliferative syndrome,
- platelet count < 100 gigas/liter,
- acute inflammatory situation: severe sepsis, documented acute infection, chronic systemic inflammatory disease or active cancer,
- dialysis.
干预措施: additional blood sample (Biological)
Age Group 80 to 89
Inclusion criteria :
- age 50-100 years old,
- in consultation or hospitalization in one of the participating centres,
- treatment with clopidogrel 75 milligrammes per day, for at least 10 days, for primary or secondary prevention of cardiovascular events.
Non-inclusion criteria :
- treatment with another antithrombotic drug,
- myeloproliferative syndrome,
- platelet count < 100 gigas/liter,
- acute inflammatory situation: severe sepsis, documented acute infection, chronic systemic inflammatory disease or active cancer,
- dialysis.
干预措施: additional blood sample (Biological)
Age Group 90 to 100
Inclusion criteria :
- age 50-100 years old,
- in consultation or hospitalization in one of the participating centres,
- treatment with clopidogrel 75 milligrammes per day, for at least 10 days, for primary or secondary prevention of cardiovascular events.
Non-inclusion criteria :
- treatment with another antithrombotic drug,
- myeloproliferative syndrome,
- platelet count < 100 gigas/liter,
- acute inflammatory situation: severe sepsis, documented acute infection, chronic systemic inflammatory disease or active cancer,
- dialysis.
干预措施: additional blood sample (Biological)
结局指标
主要结局
PK/PD correlation - clopidogrel active metabolite concentration (pharmacokinetics PK in ) / platelet response phenotype(pharmacodynamics, PD)
时间窗: Day 0
Correlation PK (concentration of active metabolite of clopidogrel) / PD (%maximum aggregation at 10 μM ADP) as a function of age
次要结局
- Correlation between the area under the curve of aggregationat 10 μM ADP and the concentration of the active metabolite of clopidogrel(Day 0)
- Determination of factors influencing PK/PD response(Day 0)
- Correlation of prodrug/active metabolite concentrations(Day 0)
- Correlation between the Platelet Reactivity Index of VASPphosphorylation and the concentration of the active metabolite of clopidogrel(Day 0)