Prasugrel 5mg Versus High Dose Clopidogrel in Clopidogrel Resistant Patients Aged ≥75 Years and/or Weighing <60 kg Post Percutaneous Coronary Intervention (PCI)

Study Overview
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Brief Summary
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The use of dual antiplatelet therapy is considered standard of care in patients post percutaneous coronary intervention (PCI) with stenting. However, a significant proportion of patients is considered clopidogrel resistant and this resistance is shown to be accompanied by future adverse events. The aim of the study is to define in consecutive patients with acute coronary syndrome (ACS) undergoing PCI, those aged>75years and/or weighted<60 Kg with high on-clopidogrel platelet reactivity (Platelet Reactivity Units-PRU≥235) as estimated 24 hours post PCI with the VerifyNow assay. Those patients will be randomized after informed concent in 1:1 fashion to prasugrel 5 mg or clopidogrel 150mg daily. Platelet reactivity will be assessed at day 15 and then treatment crossover will be performed. At day 30 platelet reactivity will be determined as well.

Official Title
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Prasugrel 5mg Versus High Dose Clopidogrel in Clopidogrel Resistant Patients Aged ≥75 Years and/or Weighing <60 kg Post Percutaneous Coronary Intervention (PCI)

Conditions
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Platelet Reactivity

Intervention / Treatment
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* Drug: Clopidogrel
* Drug: Prasugrel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥18 years old Patients having PCI with stenting 24 hours prior randomization, meeting the following criteria : Acute coronary syndrome (unstable angina or myocardial infarction) TIMI risk score>2 Platelet reactivity in PRU ≥235 24 hours post-PCI Age≥75 years and/or weight<60 Kg 4. Informed consent obtained in writing Exclusion Criteria: A history of bleeding diathesis Chronic oral anticoagulation treatment Contraindications to antiplatelet therapy Known platelet function disorders PCI or coronary artery bypass surgery < 3 months Unsuccessful PCI (residual stenosis > 30% or flow < Thrombolysis in myocardial infarction flow 3) Planned staged PCI in the next 30 days Hemodynamic instability hemodialysis Creatinine clearance <25 ml/min inability to give informed consent High likelihood of being unavailable for the Day 30 History of gastrointestinal bleeding, genitourinary bleeding or other site abnormal bleeding within the previous 6 months. Other bleeding diathesis, or considered by investigator to be at high risk for bleeding on longterm antiplatelet therapy. Any previous history of ischemic stroke, transient ischemic attack, intracranial hemorrhage or disease (neoplasm, arteriovenous malformation, aneurysm). Thrombocytopenia (<100.000 / μL) at randomization Anaemia (Hct <30%) at randomization Polycythaemia (Hct > 52%) at randomization Periprocedural IIb/IIIa inhibitor administration

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 95 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Clopidogrel<br>Clopidogrel 150mg per day for 15 days | Drug: Clopidogrel<br>* Clopidogrel 150mg per day for 15 days<br>|
| Experimental: Prasugrel<br>Prasugrel 5mg for 15 days | Drug: Prasugrel<br>* Prasugrel 5mg per day for 15 days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Platelet reactivity | Platelet reactivity assessed with the VerifyNow assay at the end of each treatment period | 15 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hyporesponsiveness rate (PRU≥235) at the end of the 2 treatment periods | Hyporesponsiveness rate will be assessed 15 days after the onset of each study drug | 15 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Platelet reactivity, Clopidogrel, Prasugrel