High Clopidogrel Dose Versus Prasugrel and Ticagrelor in High Reactive Stable Patients
Status:
Completed
Trial end date:
2013-12-01
Target enrollment:
Participant gender:
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) implantation. Interindividual variability in platelet
response to Clopidogrel has been reported, with several mechanisms (intrinsic high platelet
reactivity [PR], variability of the drug metabolism, and various drug interactions) being
implicated for high post-Clopidogrel treatment PR. The investigators aim to perform a
prospective, single-center, investigator-initiated, randomized, study to compare platelet
inhibition by Prasugrel 10 mg/day, Ticagrelor (90 mg twice daily) and high-dose 150 mg/day
Clopidogrel in patients with High on-treatment platelet reactivity (HTPR) with standard dose
of Clopidogrel. Patients with HTPR (defined as area under curve-AUC ≥ 450 or > 45 Unit) and
with loss-of-function allele CYP2C19*2 will be enrolled in the study and will be randomized
(Day 0) in a 1:1:1 ratio, to either Clopidogrel 150 mg a day or Prasugrel 10 mg a day or
Ticagrelor (90 mg twice daily) until Day-15 and-30 post randomization.