Early Versus Late Loading of Ticagrelol in Patients With STEMI

NCT04267224 | Unknown

• 1 other identifier: Ticagrelor in STEMI patients
• Study Type: observational
• Target: 800
• Locations: 0 countries
• Sites: N/A

Brief Summary

Current guidelines recommend percutaneous coronary intervention (PCI) for most patients with ST segment elevation acute myocardial infarction (STEMI) or with non ST segment elevation acute coronary syndrome (NSTEACS) . In STEMI patients, PCI is advised in all patients in the first 12 hours after onset of symptoms, the earlier the better. This condition is referred to as "no-reflow phenomenon." , no-reflow is defined as suboptimal myocardial reperfusion through a part of coronary circulation without angiographic evidence of mechanical vessel obstruction. Effective antiplatelet therapy combining the inhibition of both thromboxane A2-dependent platelet aggregation and P2Y12 receptors is necessary in patients undergoing percutaneous coronary intervention (PCI), particularly those with ST-segment elevation myocardial infarction (STEMI). The goal of DAPT (Aspirin and P2Y12 receptor inhibitors) is to reduce the risk of ischemic events such as (re)-infarction and the risk of stent thrombosis after PCI. It is logical to assume that early administration of a P2Y12 inhibitor prior to PCI (referred to as pre-treatment) should provide greater benefit given the fact that even the fastest acting oral P2Y12 inhibitors take at least 30-60 min. Various studies and meta-analyses suggested that pretreatment with Clopidogrel in patients with STEMI could reduce the rate of ischemic events without excess bleeding, but its effectiveness may be limited by its slow onset of action and the variable response. In contrast, the new oral P2Y12-receptor antagonists (Prasugrel or Ticagrelol) inhibit platelet function in less than 1 hour, which is compatible with transfer times for primary PCI. Ticagrelor is a direct-acting inhibitor of the platelet P2Y12 receptor with a rapid antiplatelet effect. It has been shown to reduce the rate of major cardiovascular events among patients with acute coronary syndromes, as compared with Clopidogrel, and has the potential to improve coronary reperfusion and the prognosis for patients with STEMI treated with primary PCI. but The issue of pre-treatment with ticagrelor for patients with STEMI remains an area of ongoing debate; whether they are initiated in the pre-hospital setting, emergency department, or anywhere .

Conditions

Myocardial Infarction

Outcome Measures

Primary Outcomes (2)

• The incidence of Major adverse cardiovascular events (MACE)

  Efficacy end point

  6 weeks

• The occurrence of major or minor bleeding

  safety endpoints

  6 weeks

Study Arms (2)

Early group

Patients receiving the loading dose of Ticagrelol 90 mg more than 60 minutes before PCI.

Drug: Ticagrelor 90mg

Late group

Patients receiving the loading dose of Ticagrelol 90 mg less than 60 minutes before PCI.

Drug: Ticagrelor 90mg

Interventions

Ticagrelor 90mg DRUG

Ticagrelor is a direct-acting inhibitor of the platelet P2Y12 receptor with a rapid antiplatelet effect. It has been shown to reduce the rate of major cardiovascular events among patients with acute coronary syndromes, as compared with Clopidogrel, and has the potential to improve coronary reperfusion and the prognosis for patients with STEMI treated with primary PCI.

Also known as: Early versus late loading with Ticagrelol

Early group; Late group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

The study will include 800 patients (divided in 2 groups), 400 patients receiving the loading dose early more than 60 minutes before the procedure and 400 patients receiving the loading dose in late less than 60 minutes before the procedure.

You may qualify if:

• Patients who were diagnosed as STEMI according to criteria developed by the European Society of Cardiology.
• Onset of maximal intensity of chest pain within 12 hours before procedure.

You may not qualify if:

• Contraindication to Ticagrelor (e.g., hypersensitivity, active bleeding, history of previous intracranial hemorrage, moderate to severe hepatic impairment, GI bleeding within the past 6 months, major surgery within past 4 weeks)
• Patient who has recently received loading dose of Clopidogrel or are on chronic treatment of Clopidogrel.
• Patients who are on oral anticoagulation therapy that cannot be stopped (i.e., patient with prosthetic valves, chronic AF…etc)
• Patients with clinically significant thrombocytopenia.
• Previous enrolment in the present study (Upstream use of GPIIb/IIIa is not recommended as a concomitant treatment)

Sponsors & Collaborators

• Assiut University: lead

MeSH Terms

Conditions

Myocardial Infarction

Interventions

Ticagrelor

Condition Hierarchy (Ancestors)

Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Infarction; Ischemia; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Necrosis

Intervention Hierarchy (Ancestors)

Adenosine; Purine Nucleosides; Purines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Nucleosides; Nucleic Acids, Nucleotides, and Nucleosides; Ribonucleosides

Study Officials

• Hany R. Maher

  Assiut University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Hany R. Maher, Resident

CONTACT

+201221842617; Hanyrayek5287@gmail.com

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident doctor

Study Record Dates

• First Submitted: September 25, 2019
• First Posted: February 12, 2020
• Study Start: March 1, 2020
• Primary Completion: March 1, 2021
• Study Completion: April 1, 2021
• Last Updated: February 12, 2020

Record last verified: 2020-02