Body Weight Adjusted Clopidogrel Treatment in Patients With Coronary Artery Disease
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 入组人数
- 80
- 试验地点
- 2
- 主要终点
- Platelet reactivity
研究概览
简要总结
Extreme body weights (BW) or body mass index (BMI) affect the pharmacokinetics of antithrombotic drugs and consequently may affect cardiovascular risk during treatment. The goal of this clinical trial is to establish if clopidogrel treatment can be optimized in patients with a low or high BW compared to patients with a normal BW by adjusting the dosage of clopidogrel and evaluating platelet reactivity.
Participants are stratified into three groups based on their BW (Low BW: BW <60kg; normal BW: 60-100kg; High BW: >100 kg)
Clopidogrel dosage will then be adjusted to the BW, as follows:
- Low BW: >10 days clopidogrel 50mg 1dd1, followed by >10 days clopidogrel 25mg 1dd1.
- Normal BW: Clopidogrel 75mg 1dd1.
- High BW: >10 days clopidogrel 150mg 1dd1 followed by >10 days prasugrel 10mg 1dd1.
The primary endpoint of the study is P2Y12 Reaction Units (PRU) and platelet inhibition measured using the VerifyNow measured before starting new treatment regimen (at the end of 10 days of treatment).
详细描述
Patients with a high BMI/BW have a higher cardiovascular risk and patients with a low BMI/BW seem to have a higher bleeding risk. A high BMI/BW affects the efficacy of clopidogrel. It is not yet known if this clopidogrel efficacy is altered in patients with a low BMI/BW and whether BW-adjusted treatment can optimise this efficacy. We hypothesize that a personalised treatment will eventually lead to a more optimal effect of clopidogrel, optimizing the balance between bleeding and thrombotic risk. This could benefit therapy compliance.
Primary Objective:
To determine if clopidogrel treatment can be optimized in patients with a low or high BW compared to patients with a normal BW by adjusting the dosage of clopidogrel and evaluating platelet reactivity measured using the VerifyNow.
Secondary Objective(s):
To determine if the CYP2C19 genotype has additional effect on the platelet reactivity in the different treatment groups.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients, male or female, ≥18 years of age
- •Patients treated for CCS with clopidogrel 75mg QD (aspirin 100mg QD).
- •Patients must be treated with clopidogrel 75mg for at least one month
- •Patients must give consent by means of a signed informed consent
排除标准
- •Contra-indication for aspirin
- •Contra-indication for clopidogrel or prasugrel
- •Occurrence of an ischemic event after PCI or ACS (stroke, myocardial infarction, or coronary revascularization)
- •Presence of unstable angina complaints.
- •Presence of two CYP2C19 Loss-of-function (LOF) alleles (*2 or *3)
- •Scheduled for cardiac valve surgery
- •Indication for chronic oral anticoagulants
- •Expected life span of less than one year
- •Pregnancy
- •Suboptimal stent placement as determined by the cardiologist.
- •Patients at increased risk of bleeding with two of the following characteristics: liver cirrhosis with portal hypertension, enhanced bleeding tendency, active malignancy in the past 12 months, thrombocytopenia, major surgery in the past month, spontaneous intracerebral haemorrhage, traumatic intracerebral haemorrhage in the past 12 months, major bleeding requiring hospitalisation or blood transfusion in the past month, ischaemic CVA in the past 5 months.
- •Known with established stent thrombosis
研究组 & 干预措施
Group 1: body weight <60kg
Treatment with clopidogrel 50mg once daily for a minimum of 10 days (max. 14 days), followed by a minimum of 10 days treatment with clopidogrel 25mg once daily (max 14 days).
干预措施: Clopidogrel (Drug)
Group 3: body weight >100kg
Treatment with clopidogrel 150mg once daily for a minimum of 10 days (max. 14 days), followed by a minimum of 10 days treatment with prasugrel 10mg once daily (max 14 days).
干预措施: Clopidogrel (Drug)
结局指标
主要结局
Platelet reactivity
时间窗: Baseline and 10 days after dose alteration
Change in P2Y12 Reaction Units (PRU) measured using the VerifyNow
High on-treatment platelet reactivity (HTPR)
时间窗: 20 days
umber of participants with high on-treatment platelet reactivity (HTPR) defined by a PRU \>208
次要结局
- Myocardial infarction(30 days)
- Bleeding complications(30 days)
- Stroke(30 days)
- Stent thrombosis(30 days)
- All-cause death(30 days)
研究者
Jurriën M. ten Berg, MD, PhD
Prof. dr.
St. Antonius Hospital