Crushed Ticagrelor Versus Eptifibatide Bolus + Clopidogrel
Condition: Acute Coronary Syndrome; Angina, Unstable
MeSH terms: Acute Coronary Syndrome; Angina, Unstable
Intervention: Ticagrelor; Eptifibatide; Clopidogrel
Intervention description: After randomization, a blood sample will be obtained at baseline for platelet function study, the study drugs, crushed ticagrelor will be administered. Patients will undergo PCI using drug-eluting stents or bare-metal stents. Blood samples will be obtained at 30 mins, 2, 4, and 24 h after PCI for platelet function tests.; After randomization, a blood sample will be obtained at baseline for platelet function test, the study drugs, clopidogrel and eptifibatide bolus will be administered. Patients will undergo PCI using drug-eluting stents or bare-metal stents. Blood samples will be obtained at 30 mins, 2, 4, and 24 h after PCI for platelet function tests.
Intervention MeSH terms: Clopidogrel; Ticagrelor; Eptifibatide
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 100.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Patients with troponin-negative acute coronary syndrome (ACS) are not routinely pre-treated
      with P2Y12 inhibitors and the rate of high on-treatment platelet reactivity (HPR) remains
      elevated after a loading dose of ticagrelor at the time of percutaneous coronary intervention
      (PCI). This suggests that faster platelet inhibition with crushed ticagrelor , eptifibatide ,
      or cangrelor is needed to reduce HPR and periprocedural myocardial infarction and injury
      (PMI). The present study compared the effects of crushed ticagrelor vs. eptifibatide bolus +
      clopidogrel in troponin-negative ACS patients undergoing PCI.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients with unstable angina/troponin negative ACS.

        Exclusion Criteria:

          1. need for oral anticoagulation therapy (Warfarin, Dabigatran, Rivaroxaban, Apixaban,
             Edoxaban)

          2. increased risk of bradycardia, and the associated therapy with a strong cytochrome
             P-450 inhibitors (anti-retroviral agents, antifungal agents and some antibiotics eg.
             Indinavir, Nelfinavir, Lopinavir, Ritonavir, Itraconazole, Ketoconazole, Voriconazole,
             Clarithromycin, Telithormycin)

          3. surgery<4 weeks

          4. use of any thienopyridines (Clopidogrel, Prasugrel) 7 days prior to randomization

          5. administration of GP IIb/IIIa inhibitors

          6. bleeding diathesis or major bleeding episode within 2 weeks

          7. thrombocytopenia (Platelet count < 100000)

          8. incessant chest pain

          9. hemodynamic instability (Mean arterial pressure < 65 mm Hg; need for vasopressor or
             inotropic agents; need for mechanical circulatory support for coronary intervention),
             NSTEMI as evidenced by elevation of troponin levels (Troponin > 0.034 ng/ml); renal
             failure with a serum creatinine >2.0 mg/dL

         10. anemia with HCT<30%.