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Summary

for people ages 18 years and up (full criteria)
at San Francisco, California and other locations
study started
estimated completion:

Description

Summary

Clopidogrel is an anti-platelet medication approved by the U.S. Federal Drug Administration (FDA) for use in patients who undergo Percutaneous Coronary Intervention (PCI) with coronary stent implantation. Anti-platelet medications work to prevent blood clots from forming. Some studies have suggested that patients who have a certain genetic liver enzyme abnormality (known as cytochrome P450 2C19 [CYP2C19] 2 or 3 allele) may have a reduced ability to activate clopidogrel, and therefore may have a lowered response to clopidogrel. It is thought that perhaps people who have a coronary stent procedure may have this genetic liver enzyme abnormality. There is a research genetic test available to determine whether or not someone has this genetic liver enzyme abnormality. Ticagrelor, is a newer anti-platelet drug that is not dependent on the CYP2C19 liver enzyme for its activation and hence in poor clopidogrel metabolizers, alternative drugs like Ticagrelor have been recommended for use as an anti-platelet agent after PCI. The purpose of this study is to determine if genetic testing can identify the best anti-platelet therapy, for patients who undergo a coronary stent placement and do not activate clopidogrel very well.

Official Title

Tailored Antiplatelet Initiation to Lesson Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention (TAILOR-PCI)

Details

TAILOR-PCI is a multi-site, open label, prospective, randomized trial testing the hypothesis that after percutaneous coronary intervention (PCI), using a genotyping strategy ticagrelor 90 mg twice per day is superior to clopidogrel 75 mg per day in reducing a composite endpoint of major adverse cardiovascular events (MACE), i.e., non-fatal myocardial infarction, non-fatal stroke, severe recurrent ischemia, cardiovascular (CV) death, and stent thrombosis (primary endpoints) in CYP2C19 reduced function allele patients. Patients who undergo PCI will be randomized to a conventional therapy arm (i.e., to receive clopidogrel 75 mg once daily without prospective genotyping guidance) versus a prospective CYP2C19 genotype-based anti-platelet therapy approach (ticagrelor 90 mg bid in CYP2C19 2 or 3 reduced function allele patients, clopidogrel 75 mg once daily in non-2 or -3 CYP2C19 patients). Buccal swabs will be obtained for those subjects randomized to the prospective genotyping arm. All subjects will have a blood sample drawn for DNA analysis but genotyping using these DNA samples will be performed only after completion of the duration of anti-platelet therapy (i.e., after one year). The primary endpoints will be assessed prospectively and will be compared between the conventional arm and the prospective genotyping arm among those identified as reduced function CYP2C19 allele carriers according to the 1-year genotype results.

Keywords

Coronary Artery Disease Acute Coronary Syndrome Stenosis percutaneous coronary intervention angioplasty Myocardial Ischemia Coronary Disease Clopidogrel Ticlopidine Ticagrelor

Eligibility

For people ages 18 years and up

Inclusion

  • Patient >18 years of age
  • Patient presents with acute coronary syndrome (ACS) or stable coronary artery disease(CAD)
  • Patient is eligible for PCI
  • Patient is willing and able to provide informed written consent

5.3 Exclusion

  • Patient not able to receive 12 months of dual anti-platelet therapy
  • Failure of index PCI
  • Patient or physician refusal to enroll in the study
  • Patient with known CYP2C19 genotype prior to randomization
  • Planned revascularization of any vessel within 30 days post-index procedure and/or of the target vessel(s) within 12 months post-procedure
  • Anticipated discontinuation of clopidogrel or ticagrelor within the 12 month follow up period, example for elective surgery
  • Serum creatinine >2.5 mg/dL within 7 days of index procedure
  • Platelet count <80,000 or >700,000 cells/mm3, or white blood cell count <3,000 cells/mm3 if persistent (at least 2 abnormal values) within 7 days prior to index procedure.
  • History of intracranial hemorrhage
  • Known hypersensitivity to clopidogrel or ticagrelor or any of its components
  • Patient is participating in an investigational drug or device clinical trial that has not reached its primary endpoint
  • Patient previously enrolled in this study
  • Patient is pregnant, lactating, or planning to become pregnant within 12 months
  • Patient has received an organ transplant or is on a waiting list for an organ transplant
  • Patient is receiving or scheduled to receive chemotherapy within 30 days before or after the procedure
  • Patient is receiving immunosuppressive therapy or has known immunosuppressive or autoimmune disease (e.g., human immunodeficiency virus, systemic lupus erythematous,etc.)
  • Patient is receiving chronic oral anticoagulation therapy (i.e., vitamin K antagonist,direct thrombin inhibitor, Factor Xa inhibitor)
  • Concomitant use of simvastatin/lovastatin > 40 mg qd
  • Concomitant use of potent CYP3A4 inhibitors (atazanavir, clarithromycin, indinavir,itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir,telithromycin and voriconazole) or inducers (carbamazepine, dexamethasone,phenobarbital, phenytoin, rifampin, and rifapentine)
  • Non-cardiac condition limiting life expectancy to less than one year, per physician judgment (e.g. cancer)
  • Known history of severe hepatic impairment
  • Patient has a history of bleeding diathesis or coagulopathy or will refuse blood transfusions
  • Patient has an active pathological bleeding, such as active gastrointestinal (GI)bleeding
  • Inability to take aspirin at a dosage of 100 mg or less
  • Current substance abuse (e.g., alcohol, cocaine, heroin, etc.)

Locations

  • Zuckerberg San Francisco General accepting new patients
    San Francisco, California, 94110, United States
  • Sharp HealthCare in progress, not accepting new patients
    San Diego, California, 92123, United States
  • Mayo Clinic in Arizona accepting new patients
    Scottsdale, Arizona, 85259, United States
  • Vancouver General Hospital, UBC Division of Cardiology in progress, not accepting new patients
    Vancouver, British Columbia, V5N 3W9, Canada
  • Hospital REgional No. 1 not yet accepting patients
    Mexico City, 03100, Mexico
  • Hospital de Cardiologia, Centro Medico Nacional Siglo XXI accepting new patients
    Mexico City, 06720, Mexico
  • Minneapolis Heart Institute in progress, not accepting new patients
    Minneapolis, Minnesota, 55407, United States
  • University of Minnesota accepting new patients
    Minneapolis, Minnesota, 55455, United States
  • Mayo Clinic in Rochester accepting new patients
    Rochester, Minnesota, 55905, United States
  • MHS, Eau Claire accepting new patients
    Eau Claire, Wisconsin, 54702, United States
  • Mayo Clinic Health System accepting new patients
    La Crosse, Wisconsin, 54601, United States
  • Essentia Institute of Rural Health accepting new patients
    Duluth, Minnesota, 55805, United States
  • The University of Mississippi Medical Center accepting new patients
    Jackson, Mississippi, 39216, United States
  • Aurora Health Care accepting new patients
    Milwaukee, Wisconsin, 53215, United States
  • Loyola University Medical Center accepting new patients
    Maywood, Illinois, 60153, United States
  • Thunder Bay Regional Health Sciences Centre accepting new patients
    Thunder Bay, Ontario, P7B 6V4, Canada
  • NorthShore University Health System accepting new patients
    Evanston, Illinois, 60201, United States
  • St. Elizabeth Healthcare in progress, not accepting new patients
    Crestview Hills, Kentucky, 41017, United States
  • Henry Ford Hospital accepting new patients
    Detroit, Michigan, 48202, United States
  • Greenville Health System accepting new patients
    Greenville, South Carolina, 29605, United States
  • Hospital de Especialidades, Centro Medico Nacional 'La Raza' not yet accepting patients
    Mexico City, 02990, Mexico
  • Humber River Hospital accepting new patients
    Toronto, Ontario, M3M 0B2, Canada
  • Sunnybrook Health Services Center accepting new patients
    Toronto, Ontario, M4N 3M5, Canada
  • St Michael's Hospital accepting new patients
    Toronto, Ontario, M5B 1W8, Canada
  • Toronto General Hospital - UHN accepting new patients
    Toronto, Ontario, M5B 2C4, Canada
  • Mayo Clinic in Florida accepting new patients
    Jacksonville, Florida, 32224, United States
  • NCH Heart Institute in progress, not accepting new patients
    Naples, Florida, 34102, United States
  • University of Ottawa Heart Institute accepting new patients
    Ottawa, Ontario, K1Y 4W7, Canada
  • Cardiology Associates of Schenectady accepting new patients
    Schenectady, New York, 12309, United States
  • Albany Medical College accepting new patients
    Albany, New York, 12208, United States
  • New York University Langone Medical Center accepting new patients
    New York, New York, 10016, United States
  • Columbia University Medical Center accepting new patients
    New York, New York, 10032, United States
  • The Feinstein Institute for Medical Research in progress, not accepting new patients
    Manhasset, New York, 11030, United States
  • Winthrop University Hospital accepting new patients
    Mineola, New York, 11501, United States
  • Rhode Island Hospital accepting new patients
    Providence, Rhode Island, 02903, United States
  • The Miriam Hospital accepting new patients
    Providence, Rhode Island, 02906, United States
  • Konyang University College of Medicine accepting new patients
    Daejeon, 302-718, Korea, Republic of
  • Chonnam National University Hospital accepting new patients
    Gwangju, 501-757, Korea, Republic of
  • Ajou University Hospital in progress, not accepting new patients
    Gyeonggi-do, Korea, Republic of
  • Chung-Ang University Hospital in progress, not accepting new patients
    Seoul, 156-755, Korea, Republic of

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
Mayo Clinic
ID
NCT01742117
Phase
Phase 4
Lead Scientist
Alan Wu
Study Type
Interventional
Last Updated
November 17, 2017
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