Ticagrelor in Patients With ST Elevation Myocardial Infarction Treated With Pharmacological Thrombolysis

Phase 3

Completed

• Conditions: Thrombolysis in Myocardial Infarction Flow; Acute ST Segment Elevation Myocardial Infarction
• Interventions: Drug: Ticagrelor 180 mg; Drug: Clopidogrel

• Registration Number: NCT02298088
• Lead Sponsor: Hospital do Coracao

Brief Summary

Administration of Ticagrelor in patients with ST elevation myocardial infarction treated with pharmacological thrombolysis

Detailed Description

Phase III, Randomized, International, Multicenter, Open label, with Blinded Adjudication of Outcomes, Non-Inferiority Clinical Trial to Explore the Safety and Efficacy of Ticagrelor Compared with Clopidogrel in Patients with Acute Coronary Syndrome with ST Elevation Treated with Pharmacological Thrombolysis.

Study Timeline

• Study First Submitted: 2014-10-27
• Study First Submitted QC: 2014-11-19
• Study First Posted: 2014-11-21
• Study Start: 2015-08
• Primary Completion: 2017-12
• Study Completion: 2019-01
• Status Verified: 2019-02
• Last Update Submitted: 2019-02-12
• Last Update Posted: 2019-02-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 3799

Inclusion Criteria

• Patients of both sexes aged ≥ 18 years and < 75 years with ACS with ST segment elevation with onset during the previous 24 hours, documented by cardiac ischemic symptoms due to atherosclerosis of > 10 minutes duration at rest, treated with pharmacological thrombolysis
• Fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours

Patients with acute coronary syndrome with ST segment elevation will be included provided they present ST segment elevation at the J point in two contiguous leads in electrocardiogram with cut-points: > 0.1mV in all leads other than leads V2-V3, where the following cut points apply: > 0.2 mV in men > 40 years; > 0.25 mV in men < 40 years, or >0.15 mV in women and at least 1 of the following criteria:

• Angina-like chest pain or ischemic equivalent chest pain;
• Abnormalities above the reference value for markers of myocardial necrosis (troponin and CK-MB).

The patient must be able to give informed consent in accordance with ICH GCP guidelines and local legislation and/or regulations.

Exclusion Criteria

• Any contraindication against the use of clopidogrel (eg, hypersensitivity, moderate or severe liver disease, active bleeding or bleeding history, history of intracranial hemorrhage)

• Need for oral anticoagulation therapy,

• Concomitant oral or IV therapy with strong CYP3A inhibitors (ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir, grapefruit juice N1 L/d), CYP3A substrates with narrow therapeutic indices (cyclosporine, quinidine), or strong CYP3Ainducers (rifampin/rifampicin, phenytoin, carbamazepine)

• Increased risk of bradycardia events

• Dialysis required

• Known clinically important thrombocytopenia

• Known clinically important anemia

• Any other condition that may put the patient at risk or influence study results in the investigators' opinion (eg, cardiogenic shock, severe hemodynamic instability, active cancer)

• Participant in another investigational drug or device study within 30 d

• Pregnancy or lactation

• Any condition that increases the risk for noncompliance or being lost to follow-up

• Involvement in the planning or conduct of the study

• Previous enrollment or randomization in this study

• Contraindications to fibrinolytic therapy including: 15

  • Any prior intracranial hemorrhage
  • Known structural cerebral vascular lesion (eg, Arterial Venous Malformation - AVM)
  • Known malignant intracranial neoplasm (primary or metastatic)
  • Ischemic stroke within 3 months
  • Suspected aortic dissection
  • Active bleeding or bleeding diathesis (excluding menses)
  • Significant closed head trauma or facial trauma within 3 months

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Ticagrelor 180 mg	Ticagrelor 180 mg	Patients assigned to Ticagrelor will receive oral Ticagrelor, 180 mg as early as possible after the index event and not \>24 h post event followed by 90 mg twice daily for 12 months.
Clopidogrel	Clopidogrel	Patients will take the 300 mg clopidogrel as early as possible after the index event and not \> 24h post event, followed by 75mg/day for 12 months. For patients with \> 75 years the recommended load dose is 75 mg instead 300 mg.

Primary Outcome Measures

Name	Time	Method
Safety Outcome as a measure of Time to TIMI-defined first major bleeding	30 days	The primary safety endpoint is time to TIMI-defined and adjudicated first major bleeding event (including major life-threatening bleeding and other major bleeding).; Bleeding TIMI Definition; Major: Any intracranial hemorrhage (ICH)\*, OR Clinically significant overt signs of hemorrhage associated with a drop in hemoglobin (Hgb) of ≥ 5 g/dL (or, when Hgb is not available, an absolute drop in hematocrit (Hct) of ≥ 15%).; An independent blinded central adjudication committee will adjudicate all suspected primary end points.

Secondary Outcome Measures

Name	Time	Method
Efficacy Outcome as a measure of major cardiovascular events	12 months	Secondary efficacy combined endpoint: death from vascular causes, myocardial infarction, stroke, severe recurrent ischemia, recurrent ischemia, TIA, or other arterial thrombotic event.; We will also measure the individual outcomes all-cause mortality and need for rescue PCI, as well as individual components of the combined efficacy endpoint.
Safety Outcome as a measure of bleeding event	12 months	Secondary safety endpoints: Total bleeding (major and minor) according to PLATO, TIMI and BARC definitions, minor bleeding according to the TIMI definition and major bleeding as individual endpoint according to the PLATO definition. Others safety variables will include: dyspnea, arrhythmia, bradycardia and laboratory safety tests

Trial Locations

Locations (153)

Hospital Interzonal General de Agudos Dr, José Penna; 🇦🇷 Bahia Blanca, Argentina

Hospital Alvarez; 🇦🇷 Ciudad Autonoma de Buenos Aires, Argentina

Hospital Del Cruce Nestor Kishner; 🇦🇷 Florencio Varela, Argentina

Hospital Español de La Plata; 🇦🇷 La Plata, Argentina

Sanatorio Modelo de Quilmes; 🇦🇷 Quilmes, Argentina

Hospital Zenón Santillan; 🇦🇷 San Miguel de Tucuman, Argentina

Flinders Medical Centre; 🇦🇺 Adelaide, Australia

Royal Adelaide Hospital; 🇦🇺 Adelaide, Australia

Cairns Hospital; 🇦🇺 Cairns, Australia

The Alfred Hospital; 🇦🇺 Melbourne, Australia

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