Patients Undergoing Percutaneous Coronary Intervention (PCI) Through Optimal Platelet Inhibition

Study Overview
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Brief Summary
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The purpose of this study is to assess the the 1-year rates of ischemic and bleeding complications in patients whose dual antiplatelet therapy regimen post-PCI has been determined with the use of a clinical algorithm that includes both clinical risks and platelet reactivity while on chronic clopidogrel therapy.

Detailed Description
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Prospective multicenter registry. Patients already on chronic dual antiplatelet therapy with aspirin and clopidogrel will be assessed for (1) clinical risks factors for future bleeding and ischemic complications, and (2) on-treatment platelet reactivity as measured by the VerifyNow P2Y12 assay (Accumetrics, Inc., San Diego, CA, USA). These will be considered by utilization of a clinical algorithm to determine the dual antiplatelet regimen post-PCI (aspirin in combination with 1. clopidogrel, 2. prasugrel 5mg daily, or 3. prasugrel 10mg daily).

Official Title
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TRIAGE: Patients Undergoing Percutaneous Coronary Interventions to Improve Clinical Outcomes Through Optimal Platelet Inhibition

Conditions
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Percutaneous Coronary Intervention, Dual Antiplatelet Therapy, Aspirin, Clopidogrel

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The subject has provided informed written. The subject must be ≥ 18 years of age (or minimum age as required by local regulations) at the time of enrollment. Patient is established on chronic clopidogrel therapy when he/she returns for PCI, and the components of DAPT are determined by the clinical decision algorithm as local standard of care. The subject is willing and able to cooperate with the study procedures and required follow-ups. Exclusion Criteria: Patients with cardiogenic shock will be excluded. The subject is participating in an investigational device or drug study. Subject must have completed the follow up phase of any previous study at least 30 days prior to enrolment in this study. Pregnant women.

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| SA + 5mg prasugrel<br>Prasugrel 5 mg group: Patients with Intermediate or high bleeding risks and PRU ≥ 230 are Prescribed 5mg of prasugrel daily along with aspirin. | |
| ASA + 10 mg prasugrel<br>Prasugrel 10 mg group: Patients with Low bleeding risk and high ischemia risk and PRU ≥ 230 are prescribed 10 mg of prasugrel daily along with aspirin. | |
| ASA + 75 mg clopidogrel daily<br>Clopidogrel 75 mg group (control): PRU ≤ 230; high bleeding risk or high ischemic risk; patients with active malignancy, age >75; Wt< 60kg with previous CVA or TA are prescribed 75 mg of clopidogrel daily along with aspirin. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MACE | Major adverse cardiac events (all-cause death, myocardial infarction and stent thrombosis) | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rates of major bleeding | The rates of major bleeding in patients treated with a thienopyridine based on the clinical algorithm. | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bleeding, Risk Score, Outcomes, Prasugrel