Safety and Efficacy of TAK-442 in Subjects With Acute Coronary Syndromes

The purpose of this study is to determine the safety and tolerability of multiple doses of TAK-442once daily, (QD) or twice daily (BID), in subjects with acute coronary syndrome (unstable angina, myocardial infarction).

Acute coronary syndrome, including myocardial infarction with or without ST-segment elevation and stable or unstable angina, is acknowledged to represent collectively a major global healthcare problem. Despite existing treatments, the rates of patient mortality, myocardial infarction and hospital readmissions during follow-up remain very high.

Due to its critical role in propagating the blood coagulation cascade, activated factor X now is considered to be a major therapeutic target in the development of novel antithrombotic therapy by blocking thrombin generation and attenuating the formation of fibrin. Therefore, activated factor X inhibitors, exhibiting either indirect or direct modes of action, are among the novel agents under investigation in the treatment of acute coronary syndrome.

This study will evaluate the safety and tolerability of TAK-442 compared with placebo in post-acute coronary syndrome subjects who are also receiving standard antiplatelet and other cardiovascular therapy.

Individuals who want to participate in this study will be required to provide written informed consent. Study participation is anticipated to be approximately 3.5 months. Multiple procedures will occur at each visit which may include fasting, blood collection, urine collection, physical examinations, electrocardiograms and bilateral venogram.

Eligibility Criteria:
Inclusion Criteria:

* Has been hospitalized for acute coronary syndrome
* Is able to initiate study drug if:

  * The index event occurred within the past 7 days (the date of initial hospitalization will be utilized for the date on which the index event occurred), and
  * The final acute medical or cardiac procedural intervention for the treatment of acute coronary syndrome was last administered or performed at least 36 hours before administration of the first dose of study drug.
* Has at least 1 of the following additional ischemic risk factors:

  * Previous myocardial infarction.
  * The index event was an anterior myocardial infarction.
  * Presence of multivessel coronary disease
  * Left bundle branch block.
  * Left ventricular ejection fraction less than 40% at any time during hospitalization for the index event.
  * Killip class greater than or equal to II at any time during hospitalization for the index event.
  * History of symptomatic congestive heart failure
  * History of ischemic stroke or transient ischemic attack.
  * Presence of peripheral arterial obstructive disease.
  * Diabetes mellitus requiring medical therapy to maintain glycemic control.
  * Current smoker
  * Moderate renal impairment
* Females of childbearing potential who are sexually active must agree to use adequate contraception, and can neither be pregnant nor lactating from Screening throughout the duration of the study.

Exclusion Criteria:

* Has low body weight greater than 50 kg.
* Has severe hypertension.
* Has a known bleeding/clotting disorder.
* Has acute pericarditis.
* Has a history of intracranial or intraocular bleeding.
* Has a history of gastrointestinal bleeding or gastric or duodenal ulceration.
* Has a history of ischemic stroke or transient ischemic attack.
* Has had major surgery, including coronary artery bypass graft or has undergone non-major laparoscopic surgery or non-major minimally invasive surgery, within 2 weeks prior to Randomization.
* Has a history of cancer that has not been in remission for at least 5 years.
* Has a condition for which long-term anticoagulation therapy is indicated or requires ongoing use of other excluded medications.
* Has severe renal dysfunction.
* Has anemia or thrombocytopenia that has not resolved prior to Randomization.
* Has alanine aminotransferase or total bilirubin levels greater than 2 times the upper limit of normal, active liver disease or jaundice.
* Has a history of illicit drug use or excessive alcohol intake.
* Has any other serious disease or condition that would compromise subject safety, increase the risk of bleeding, or make it difficult to successfully manage and follow the subject according to the protocol.
* Has received TAK-442 in a previous clinical study or as a therapeutic agent.
* Has a history of hypersensitivity or allergies to other fXa inhibitors.
* Has received any investigational compound within 30 days prior to Screening or is currently participating in another study which entails the administration of an investigational or marketed drug, supplement or intervention including, but not limited to diet, exercise, lifestyle or invasive procedure.
* Is required to take or intends to continue taking any disallowed medication, any prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including:

  * azole antifungal agents
  * cyclosporine
  * clarithromycin
  * HIV protease inhibitors
  * nefazodone
  * ritonavir
  * quinidine
  * amiodarone
  * verapamil