Therapy With High Clopidogrel Dose or Prasugrel Standard Dose Reduces the Platelet Reactivity in Patients With Genotype Variation RESET GENE Trial
- Registration Number
- NCT01465828
- Lead Sponsor
- Gennaro Sardella
- Brief Summary
Dual antiplatelet therapy with aspirin and Clopidogrel for at least one year is essential in patients following an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) with drug eluting stent(s. Interindividual variability in platelet response to clopidogrel has been reported, with several mechanisms being implicated for high post-clopidogrel treatment PR. High on-treatment platelet reactivity (HTPR) is associated with an increased risk of adverse events after PCI. Studies in patients on chronic clopidogrel treatment are scarce, mainly in diabetic patients where HTPR is frequently present and independently predictive of adverse events. Optimization of platelet inhibition in patients with HTPR by increasing clopidogrel or alternatively, by more potent P2Y12 inhibitors is a controversial issue, mostly studied in post PCI patients, while no data exist, to the best of the investigators knowledge, in stable patients on chronic clopidogrel treatment. Therefore all HTPR patients, that will accept to participate, will be enrolled will randomize (Day 0) in a 1:1 ratio to either clopidogrel 150 mg a day, or prasugrel 10 mg a day, until Day 14 post randomization. A 14 ± 2 day visit will be performed for PR measurement and safety evaluation, with the blood sample being will be obtained 16-18 hours after the last study-drug dose, will follow by crossover directly to the alternate therapy for an additional 14 days without an intervening washout period. At Day 28 ± 2 patients will return for the clinical and laboratory assessment as did on Day 14 visit.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 30
- patients underwent to PCI
- lopidogrel resistance after Platelet reactivity blood test
- history of bleeding diathesis
- chronic oral anticoagulation treatment
- contraindications to antiplatelet therapy
- PCI or coronary artery bypass grafting (CABG) <3 months
- hemodynamic instability
- platelet count <100,000/μl
- hematocrit <30%
- creatinine clearance <25 ml/min
- Patients with a history of stroke
- contraindication for prasugrel administration
- patients weighing <60 kg
- >75 years of age.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description high clopidogrel dose Clopidogrel Patients will be randomized to this arm to receive before high clopidogrel dose and after crossover they will receive standard dose of prasugrel high clopidogrel dose prasugrel Patients will be randomized to this arm to receive before high clopidogrel dose and after crossover they will receive standard dose of prasugrel
- Primary Outcome Measures
Name Time Method antiplatelet effect of standard dose of prasugrel versus high dose clopidogrel in stable patients with HTPR 14-28 days The primary aim will be to investigate the antiplatelet effect of standard dose of prasugrel versus high dose clopidogrel in stable patients with HTPR while receiving chronic clopidogrel treatment at the end of the 2 study periods (switching, crossover and post-crossover)
- Secondary Outcome Measures
Name Time Method Bleeding (major, minor, or minimal according to the TIMI study criteria) 14-28 days Bleeding (major, minor, or minimal according to the TIMI study criteria)
Major Adverse Cardiac Cerebrovascular Events 14-28 days cardiovascular death, myocardial infarction, and stroke
Trial Locations
- Locations (1)
Dept.of Cardiovascular Sciences,Policlinico Umberto I
🇮🇹Rome, Italy