Influence of treatment adhesion to clopidogrel on platelet aggregation in subjects carrying coronary stent
ISRCTN | ISRCTN85949729 |
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DOI | https://doi.org/10.1186/ISRCTN85949729 |
Secondary identifying numbers | N/A |
- Submission date
- 31/08/2010
- Registration date
- 14/01/2011
- Last edited
- 15/10/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Plain English summary of protocol
Not provided at time of registration
Contact information
Prof Michel Burnier
Scientific
Scientific
Head of the Division of Nephrology and Hypertension
Centre Hospitalier Universitaire Vaudois
Rue du Bugnon 17
Lausanne
1011
Switzerland
Phone | +41 (0)21 314 11 29 |
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michel.burnier@chuv.ch |
Study information
Study design | Interventional single centre randomised double-blinded open label trial with three parallel arms |
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Primary study design | Interventional |
Secondary study design | Randomised controlled trial |
Study setting(s) | Hospital |
Study type | Treatment |
Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
Scientific title | Influence of treatment adhesion to clopidogrel on platelet aggregation in subjects carrying coronary stent: an interventional single centre randomised double-blinded open label trial with three parallel arms |
Study acronym | Eurostar |
Study objectives | The analysis of therapeutic adhesion finds a particularly interesting application in the specific case of clopidogrel, an anti-platelet drug, cornerstone in association with aspirin in the treatment of patients undergoing percutaneous coronary interventions. However, the evidence that some patients persist with enhanced platelet reactivity despite treatment with clopidogrel suggest that individual responsiveness to clopidogrel is not uniform and is subject to inter- and intra-individual variability. Notably, there is a growing degree of evidence that a poor biological response to clopidogrel is associated with the recurrence of cardiovascular ischaemic events. Therefore, the identification of patients "non-responders" constitutes a major therapeutic challenge. To prove lack of efficacy of clopidogrel in a particular patient, we must previously ensure that the drug was administered correctly by answering a key question: Is the patient really a "non-responder" or rather a "non-adherent" to treatment? The monitoring of treatment adhesion by an electronic control device called MEMS® (Medication Event Monitoring System; AARDEX, Zug, Switzerland) is presently considered the most accurate and sensitive approach to get full information on drug intake. The MEMS® consists in a usual bulk pill container fitted with a special cap, which contains a microelectronic system that automatically records the date and hour of each opening of the bottle. For therapeutic study purpose, the MEMS® can be utilised in an "usual care" setting (blinding of investigator, physician and patient for adhesion results) or in a classical "integrated care" setting (regular individual drug adhesion results reporting and discussion). Several methods have been used to assess in vitro clopidogrel-induced anti-platelet effects. Flow cytometric assessment of VASP-P (VASP assay) is a marker of P2Y12 receptor reactivity, thus specific of clopidogrel-induced inhibition. A reduced P2Y12 reactivity ratio is indicative of more enhanced clopidogrel-induced inhibition. |
Ethics approval(s) | This study was presented to the Commission cantonale (VD) d'éthique de la recherche sur l'être humain in Switzerland, and approved on the 12th March 2010 (ref: 56/10 EUROSTAR) |
Health condition(s) or problem(s) studied | Coronary stenting |
Intervention | Group 1: standard care 6 month follow-up, without electronic pillbox. Total visits: 3. Group 2: 6 months follow-up with double blinded electronic pillbox (MEMS®), usual care, without feed-back on adherence results. Total visits: 3. Group 3: 6 months follow up with electronic pillbox (MEMS®), integrated care, with motivational feed-back on adherence results. Total visits: 5. For each group, a follow-up of the cardiologic events will be made at 12, 24 and 36 months by phone. |
Intervention type | Drug |
Pharmaceutical study type(s) | |
Phase | Not Applicable |
Drug / device / biological / vaccine name(s) | Clopidogrel |
Primary outcome measure | Platelets aggregation (determined by the VASP assay, as index of platelet reactivity) at 6 months |
Secondary outcome measures | 1. Incidence of cardiovascular events, including: acute non-lethal myocardial infarction, stent thrombosis, cardiovascular mortality 2. Incidence of hemorrhagic complications 3. Drug adherence to clopidogrel using the MEMS® on a 6 months period. The adherence will be measured by 4 parameters: percentage of doses taken, taking adherence, percentage of drug holidays, persistence. 4. Influence of the CYP2C19 polymorphism on aggregation studies in the long term follow-up of patients after coronary stent implantation |
Overall study start date | 01/04/2010 |
Completion date | 01/10/2015 |
Eligibility
Participant type(s) | Patient |
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Age group | Adult |
Lower age limit | 18 Years |
Sex | Both |
Target number of participants | Total 225 patients: Group 1: n = 90, Group 2 : n = 45, Group 3: n = 90 |
Total final enrolment | 120 |
Key inclusion criteria | 1. Adult patients greater than 18 years, either sex 2. Treated with clopidogrel (Plavix®) for greater than 6 months after coronary stent implantation (indication: stable/unstable angina or non-invasive functional test positive for myocardial ischaemia ) in the interventional cardiology department |
Key exclusion criteria | 1. Heart failure classification according to New York Heart Association (NYHA) class III or IV 2. ST and non-ST elevation myocardial infarction (less than 1 month) 3. Platelets less than 100,000/l 4. Inflammatory diseases requiring prednisone treatment 5. Medical history of: 5.1. Acute or chronic thrombocytopenia 5.2. Ticlopidine allergy 5.3. Active gastric ulcer (less than 2 months) 5.4. Cerebral hemorrhage (less than 6 months) 5.5. Uncontrolled hypertension greater than or equal to 180/110 mmHg 5.6. Liver Insufficiency CHILD-score greater than or equal to 1 5.7. Bleeding diathesis 5.8. Pregnancy, breast feeding 5.9. Associated drug therapy with CYP2C19 inhibitors |
Date of first enrolment | 01/04/2010 |
Date of final enrolment | 01/10/2015 |
Locations
Countries of recruitment
- Switzerland
Study participating centre
Head of the Division of Nephrology and Hypertension
Lausanne
1011
Switzerland
1011
Switzerland
Sponsor information
University Hospital Centre and University of Lausanne (CHUV) (Switzerland)
Hospital/treatment centre
Hospital/treatment centre
Rue du Bugnon 46
Lausanne
1011
Switzerland
michel.burnier@chuv.ch | |
Website | http://www.chuv.ch/ |
https://ror.org/05a353079 |
Funders
Funder type
Government
Swiss Federal Office of Training and Technology (OFFT) (Switzerland) (ref: Eurostar project no. 4776; OFFT contract no: INT.2009.0026)
No information available
EUROSTAR Consortium (a consortium of international partners funds the European project):
No information available
ABR Pharma (France)
No information available
Citobi (Belgium)
No information available
Pharmionic Systems Ltd (Switzerland)
No information available
Results and Publications
Intention to publish date | |
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Individual participant data (IPD) Intention to share | No |
IPD sharing plan summary | Not provided at time of registration |
Publication and dissemination plan | Not provided at time of registration |
IPD sharing plan |
Study outputs
Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
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Results article | results | 25/10/2017 | 15/10/2020 | Yes | No |
Editorial Notes
15/10/2020: Publication reference and total final enrolment number added.