A Mechanistic Study in Patients With Non-Dialysis Chronic Kidney Disease to Investigate Altered Platelet Response to Antiplatelet Therapy (CKD-Platelet Study)
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 76
- 试验地点
- 2
- 主要终点
- ADP Induced Platelet Aggregation
研究概览
简要总结
This study evaluates how aspirin, clopidogrel and ticagrelor work in people with chronic kidney disease (CKD) compared to people with normal kidneys. In the first part of the study, half of CKD participants will be randomly assigned to ticagrelor and aspirin, while the other half will be assigned to clopidogrel and aspirin in a blinded fashion. The treatment duration will be two weeks. After recruiting CKD participants the investigator will recruit controls with normal kidney function that will receive only ticagrelor and aspirin for two weeks.
详细描述
It is known that people with chronic kidney disease (CKD) are at higher risk to have heart and blood vessel problems like heart attack and stroke compared to people that do not have kidney problems. Aspirin, clopidogrel and ticagrelor prevent blood clots building up in the vessels. If a blood clot is present in one vessel, it could stop oxygen carrying blood to get to a specific organ, and that could cause problems like heart attack or stroke. There is very little knowledge about the way this group of medicines works in people with chronic kidney disease as well as it works in individuals with normal kidney function.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
盲法说明
CKD participants will be randomly assigned into one of the 2 study groups: ticagrelor (90 mg) one pill in the morning and one pill in the evening, or, clopidogrel (75 mg) one pill in the morning + placebo one pill in the evening. Placebo looks like the study drug but has no medicine in it. Neither participant nor the study personnel will know about allocation. The study drugs will look the same, except aspirin pill which will be dispensed to everyone in an open label manner.
There is no masking for control with normal kidney function. Participants will be asked to take open label ticagrelor, 90 mg twice daily (one pill in the morning and one pill in the evening) and aspirin 81 mg/day.
入排标准
- 年龄范围
- 18 Years 至 91 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Males and females, aged 18-91 years
- •Ability to understand and sign informed consent after the nature of the study has been fully explained
- •CKD participants: Non-dialysis CKD patients: Presence of CKD with an estimated GFR of <30 mL/min/1.73 m2 for a period of ≥3 months, as defined by the National Kidney Foundation (NKF) and determined with the CKD-EPI creatinine-based formula
- •Controls with normal kidney function: participants with an estimated GFR >90 mL/min/1.73 m2 as determined by the CKD-EPI creatinine-based formula and a urine albumin-to-creatinine ratio <30 mg/g as defined by the National Kidney Foundation
排除标准
- •No healthcare power of attorney to sign informed consent
- •Unwillingness or inability to participate in the protocol or comply with any of its components.
- •Subjects unable or unwilling to stop taking:
- •Aspirin and other antithrombotic agents, like cilostazol, ranolazine, aggrenox, prasugrel, warfarin, xarelto, pradaxa, eliquis.
- •Glycoprotein IIb/IIIa antagonist (abciximab-ReoPro, eptifibatide-Integrilin, tirofiban-Aggrastal)
- •NSAIDs and PPIs
- •Fish oil, Vitamin E and herbal supplements
- •Acute kidney injury superimposed on CKD
- •Kidney transplant or any other solid organ transplant recipient
- •End-stage kidney disease on maintenance dialysis (peritoneal or hemodialysis)
- •Nephrotic syndrome defined as nephrotic range proteinuria, hypoalbuminemia, hyperlipidemia and generalized edema
- •Recent hospitalization or surgery <3 months
- •Acute coronary or cerebrovascular event in the last 12 months
- •Blood dyscrasias, active bleeding, or bleeding diathesis
- •Gastrointestinal bleeding in the last 6 months
- •Recent treatment (<30 days) with a glycoprotein IIb/IIIa antagonist (Integrelin).
- •Hematocrit <25%, white blood cell count >20,000/μL, or platelet count <50,000/μL
- •Any active malignancy or liver disease.
- •Pregnancy
- •Positive urine pregnancy test in a woman of childbearing potential prior to study entry. A female of childbearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:
- •Has not undergone a hysterectomy or bilateral oophorectomy; or
- •Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).
- •Patients must not be nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.
研究组 & 干预措施
CKD-Ticagrelor
Ticagrelor 90 mg twice daily (double blind, random assignment) + aspirin 81 mg/d
干预措施: Ticagrelor 90mg (Drug)
CKD-Ticagrelor
Ticagrelor 90 mg twice daily (double blind, random assignment) + aspirin 81 mg/d
干预措施: Aspirin 81 mg (Drug)
CKD-Clopidogrel
Clopidogrel 75 mg/day in the morning and a matching placebo in the evening to conceal frequency (double blind, random assignment) + aspirin 81 mg/d
干预措施: Clopidogrel 75mg (Drug)
CKD-Clopidogrel
Clopidogrel 75 mg/day in the morning and a matching placebo in the evening to conceal frequency (double blind, random assignment) + aspirin 81 mg/d
干预措施: Aspirin 81 mg (Drug)
Control-ticagrelor
Open label ticagrelor, 90 mg twice daily + aspirin 81 mg/d
干预措施: Ticagrelor 90mg (Drug)
Control-ticagrelor
Open label ticagrelor, 90 mg twice daily + aspirin 81 mg/d
干预措施: Aspirin 81 mg (Drug)
结局指标
主要结局
ADP Induced Platelet Aggregation
时间窗: 2 weeks
We will use summary statistics to describe the distribution of the data. Post-treatment ADP-induced WBPA value in ohms (Ω) will be the primary outcome variable. We will use an analysis of covariance (ANCOVA) model to compare the treatment effects of ticagrelor vs. clopidogrel in CKD patients because this approach has higher statistical power than other methods to analyze drug effects. T
次要结局
- Platelet Surface P-selectin Expression(2 weeks)