[SOCRATES -Acute Stroke Or Transient IsChaemic Attack TReated With Aspirin or Ticagrelor and Patient OutcomES] (SOCRATES)

May 12, 2017 updated by: AstraZeneca

A Randomised, Double-Blind, Multinational Study to Prevent Major Vascular Events With Ticagrelor Compared to Aspirin (ASA) in Patients With Acute Ischaemic Stroke or TIA.

The primary objective of the study is to compare the effect of 90-day treatment with ticagrelor (180 mg [two 90 mg tablets] loading dose on Day 1 followed by 90 mg twice daily maintenance dose for the remainder of the study) vs acetylsalicylic acid (ASA)-aspirin (300 mg [three 100 mg tablets] loading dose on Day 1 followed by 100 mg once daily maintenance dose for the remainder of the study) for the prevention of major vascular events (composite of stroke, myocardial infarction [MI], and death) in patients with acute ischaemic stroke or transient ischaemic attack (TIA).

Study Overview

Study Type

Interventional

Enrollment (Actual)

13307

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Buenos Aires, Argentina
        • Research Site
      • Capital Federal, Argentina
        • Research Site
      • Ciudad Autónoma de Bs. As., Argentina
        • Research Site
      • Mar del Plata, Argentina
        • Research Site
      • Rosario, Argentina
        • Research Site
      • San Martin, Argentina
        • Research Site
      • Adelaide, Australia
        • Research Site
      • Bedford Park, Australia
        • Research Site
      • Camperdown, Australia
        • Research Site
      • Clayton, Australia
        • Research Site
      • Darlinghurst, Australia
        • Research Site
      • Footscray, Australia
        • Research Site
      • Herston, Australia
        • Research Site
      • New Lambton Heights, Australia
        • Research Site
      • Parkville, Australia
        • Research Site
      • Southport, Australia
        • Research Site
      • Sydney, Australia
        • Research Site
      • Woodville, Australia
        • Research Site
      • Aalst, Belgium
        • Research Site
      • Assebroek, Belgium
        • Research Site
      • Brugge, Belgium
        • Research Site
      • Brussels (Woluwé-St-Lambert), Belgium
        • Research Site
      • Gent, Belgium
        • Research Site
      • Godinne, Belgium
        • Research Site
      • Leuven, Belgium
        • Research Site
      • Liège, Belgium
        • Research Site
      • Tielt, Belgium
        • Research Site
      • Wilrijk, Belgium
        • Research Site
      • Botucatu, Brazil
        • Research Site
      • Curitiba, Brazil
        • Research Site
      • Porto Alegre, Brazil
        • Research Site
      • Ribeirao Preto, Brazil
        • Research Site
      • Rio de Janeiro, Brazil
        • Research Site
      • Salvador, Brazil
        • Research Site
      • Sao Paulo, Brazil
        • Research Site
      • São José do Rio Preto, Brazil
        • Research Site
      • Botevgrad, Bulgaria
        • Research Site
      • Dupnitsa, Bulgaria
        • Research Site
      • Gotse Delchev, Bulgaria
        • Research Site
      • Kozloduy, Bulgaria
        • Research Site
      • Lukovit, Bulgaria
        • Research Site
      • Pazardzhik, Bulgaria
        • Research Site
      • Pernik, Bulgaria
        • Research Site
      • Pleven, Bulgaria
        • Research Site
      • Plovdiv, Bulgaria
        • Research Site
      • Ruse, Bulgaria
        • Research Site
      • Sandanski, Bulgaria
        • Research Site
      • Sliven, Bulgaria
        • Research Site
      • Sofia, Bulgaria
        • Research Site
      • Teteven, Bulgaria
        • Research Site
      • Yambol, Bulgaria
        • Research Site
      • Quebec, Canada
        • Research Site
    • Alberta
      • Calgary, Alberta, Canada
        • Research Site
      • Edmonton, Alberta, Canada
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    • British Columbia
      • Vancouver, British Columbia, Canada
        • Research Site
    • Newfoundland and Labrador
      • St. John's, Newfoundland and Labrador, Canada
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    • Ontario
      • London, Ontario, Canada
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      • Ottawa, Ontario, Canada
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      • Thunder Bay, Ontario, Canada
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      • Toronto, Ontario, Canada
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    • Quebec
      • Chicoutimi, Quebec, Canada
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      • Montreal, Quebec, Canada
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      • Concepcion, Chile
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      • Bron, France
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      • Corbeil Essonnes Cedex, France
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      • Dijon, France
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      • La Roche sur Yon, France
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      • Le Chesnay Cedex, France
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      • Le Coudray Cedex, France
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      • Lille, France
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      • NICE Cedex 01, France
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      • PARIS Cedex 12, France
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      • Paris Cedex 13, France
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      • Siena, Italy
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      • Vibo Valentia, Italy
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      • Aki-gun, Japan
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      • Asahikawa-shi, Japan
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      • Date-gun, Japan
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      • Fukuoka-shi, Japan
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      • Fukushima-shi, Japan
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      • Sendai-shi, Japan
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      • Shiroishi-shi, Japan
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      • Suita-shi, Japan
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      • Suwa-shi, Japan
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      • Tachikawa-shi, Japan
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      • Takasaki-shi, Japan
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      • Takayama-shi, Japan
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      • Tokushima-shi, Japan
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      • Toyama-shi, Japan
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      • Toyohashi-shi, Japan
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      • Toyota-shi, Japan
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      • Tsu-shi, Japan
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      • Uji-shi, Japan
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      • Busan, Korea, Republic of
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      • Daegu, Korea, Republic of
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      • Incheon, Korea, Republic of
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      • Seongnam-si, Korea, Republic of
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      • Seoul, Korea, Republic of
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      • Aguascalientes, Mexico
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      • New York, New York, United States
        • Research Site
      • Stony Brook, New York, United States
        • Research Site
      • Syracuse, New York, United States
        • Research Site
      • The Bronx, New York, United States
        • Research Site
    • North Carolina
      • Chapel Hill, North Carolina, United States
        • Research Site
      • Charlotte, North Carolina, United States
        • Research Site
      • Durham, North Carolina, United States
        • Research Site
      • Greensboro, North Carolina, United States
        • Research Site
      • Winston-Salem, North Carolina, United States
        • Research Site
    • Ohio
      • Akron, Ohio, United States
        • Research Site
      • Cleveland, Ohio, United States
        • Research Site
      • Columbus, Ohio, United States
        • Research Site
      • Maumee, Ohio, United States
        • Research Site
      • Toledo, Ohio, United States
        • Research Site
    • Oregon
      • Clackamas, Oregon, United States
        • Research Site
      • Portland, Oregon, United States
        • Research Site
    • Pennsylvania
      • Abington, Pennsylvania, United States
        • Research Site
      • Allentown, Pennsylvania, United States
        • Research Site
      • Doylestown, Pennsylvania, United States
        • Research Site
      • Erie, Pennsylvania, United States
        • Research Site
      • Hershey, Pennsylvania, United States
        • Research Site
      • Philadelphia, Pennsylvania, United States
        • Research Site
    • Rhode Island
      • Providence, Rhode Island, United States
        • Research Site
    • South Carolina
      • Charleston, South Carolina, United States
        • Research Site
      • Columbia, South Carolina, United States
        • Research Site
    • South Dakota
      • Sioux Falls, South Dakota, United States
        • Research Site
    • Tennessee
      • Chattanooga, Tennessee, United States
        • Research Site
      • Knoxville, Tennessee, United States
        • Research Site
      • Nashville, Tennessee, United States
        • Research Site
    • Texas
      • Baytown, Texas, United States
        • Research Site
      • Dallas, Texas, United States
        • Research Site
      • El Paso, Texas, United States
        • Research Site
      • Harlingen, Texas, United States
        • Research Site
      • Houston, Texas, United States
        • Research Site
      • Kingwood, Texas, United States
        • Research Site
      • Southlake, Texas, United States
        • Research Site
    • Virginia
      • Richmond, Virginia, United States
        • Research Site
      • Roanoke, Virginia, United States
        • Research Site
    • Washington
      • Seattle, Washington, United States
        • Research Site
    • West Virginia
      • Huntington, West Virginia, United States
        • Research Site
      • Morgantown, West Virginia, United States
        • Research Site
    • Wisconsin
      • Milwaukee, Wisconsin, United States
        • Research Site
      • Hanoi, Vietnam
        • Research Site
      • Ho Chi Minh City, Vietnam
        • Research Site
      • Hochiminh, Vietnam
        • Research Site

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

40 years to 130 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Men or women equal or elder 40 years of age
  • Either acute ischaemic stroke or high-risk TIA as defined here and randomisation occurring within 24 hours after onset of symptoms

Key Exclusion Criteria:

  • Planned use of antithrombotic therapy in addition to study medication including antiplatelets (eg, open label ASA, GPIIb/IIIa inhibitors, clopidogrel, ticlopidine, prasugrel, dipyridamole, ozagrel, cilostazol) and anticoagulants (eg, warfarin, oral thrombin and factor Xa inhibitors, bivalirudin, hirudin, argatroban, unfractionated and low molecular weight heparins). - Any history of atrial fibrillation, ventricular aneurysm or suspicion of cardioembolic pathology for TIA or stroke. - Planned carotid, cerebrovascular, or coronary revascularisation that requires halting study medication within 7 days of randomisation. - Receipt of any intravenous or intra-arterial thrombolysis or mechanical thrombectomy within 24 hours prior to randomisation - History of previous symptomatic non-traumatic intracerebral bleed at any time (asymptomatic microbleeds do not qualify), gastrointestinal (GI) bleed within the past 6 months, or major surgery within 30 days.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: ticagrelor
ticagrelor, 180 mg (two tablets of 90 mg) loading dose on Day 1 followed by 90 mg twice daily.
Active Comparator: Acetylsalicylic acid (ASA)
ASA, 300 mg (three tablets of 100 mg) on Day 1, followed by 100 mg once daily.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants With Composite of Stroke/MI/Death
Time Frame: From randomization up to 97 days
Participants with stroke, MI or death. If no event, censoring occures at the minimum of (last date of event assessment, end of treatment date, day 97).
From randomization up to 97 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants With Ischaemic Stroke
Time Frame: From randomization up to 97 days
Participants with ischaemic stroke. If no event, censoring occures at the minimum of (last date of event assessment, date of death, end of treatment date, day 97).
From randomization up to 97 days
Net Clinical Outcome
Time Frame: From randomization up to 97 days
Participants with stroke, MI, death or life-threatening bleeding. If no event, censoring occures at the minimum of (last date of event assessment, end of treatment date, day 97).
From randomization up to 97 days
Number of Participants With Composite of Ischaemic Stroke, MI and CV Death
Time Frame: From randomization up to 97 days
Participants with ischaemic stroke, MI or CV death. If no event, censoring at the minimum of (last date of event assessment, date of death from non-CV causes, end of treatment date, day 97).
From randomization up to 97 days
Number of Participants With All-Cause Death
Time Frame: From randomization up to 97 days
Participants with all-cause death. If no event, censoring at the minimum of (last date of event assessment, end of treatment date, day 97).
From randomization up to 97 days
Number of Participants With CV Death
Time Frame: From randomization up to 97 days
Participants with CV death. If no event, censoring at the minimum of (last date of event assessment, date of death from non-CV causes, end of treatment date, day 97).
From randomization up to 97 days
Number of Participants With MI
Time Frame: From randomization up to 97 days
Participants with MI. If no event, censoring at the minimum of (last date of event assessment, date of death, end of treatment date, day 97)
From randomization up to 97 days
Number of Participants by Severity of Stroke and Overall Disability
Time Frame: From randomization up to 97 days

Analysis of severity of stroke and overall disability of patients, using the modified Rankin Score, mRS.

Modified Rankin Score:

0 - No symptoms.

  1. - No significant disability. Able to carry out all usual activities, despite some symptoms.
  2. - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.
  3. - Moderate disability. Requires some help, but able to walk unassisted.
  4. - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted.
  5. - Severe disability. Requires constant nursing care and attention, bedridden, incontinent.
  6. - Dead.

Disability defined as mRS > 1.

Odds ratio and p-value are calculated for ticagrelor versus ASA from a logistic regression model with treatment group, history of stroke and NIHSS (National Institutes of Health Stroke Scale) at baseline as explanatory variables.

From randomization up to 97 days
Number of Participants With Stroke
Time Frame: From randomization up to 97 days
Participants with stroke. If no event, censoring at the minimum of (last date of event assessment, date of death, end of treatment date, day 97)
From randomization up to 97 days
Number of Participants With Fatal Stroke
Time Frame: From randomization up to 97 days
Participants with fatal stroke. If no event, censoring at the minimum of (last date of event assessment, date of death from non-CV causes, end of treatment date, day 97).
From randomization up to 97 days
Number of Participants With Disabling Stroke
Time Frame: From randomization up to 97 days
Participants with disabling stroke. If no event, censoring at the minimum of (last date of event assessment, date of death, end of treatment date, day 97).
From randomization up to 97 days
Change in NIHSS
Time Frame: From randomization up to 97 days

Change from baseline to end of treatment visit in NIHSS (National Institutes of Health Stroke Scale):

0 No stroke symptoms 1-4 Minor stroke 5-15 Moderate stroke 16-20 Moderate to severe stroke 21-42 Severe stroke.

From randomization up to 97 days
EQ-5D at Visit 1 (Enrolment)
Time Frame: Visit 1 (Enrolment)

EQ-5D (EuroQol five dimensions questionnaire) index score using the UK tariff.

EQ-5D is a self assessment of 5 dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. For each dimension responders are asked to state their status on a three level ordinal scale; whether they experience no problems (Level 1), some problems (Level 2) or severe problems (Level 3). Health states defined by the 5 dimensions can be converted into a weighted health state index (health state utility) by applying scores from the EQ-5D value sets elicited from general population samples.

The higher the index score the better the health state. In this study index scores ran from -0.59 to 1.

Visit 1 (Enrolment)
EQ-5D at Visit 2 (Day 7+-2d)
Time Frame: Visit 2 (Day 7+-2d)

EQ-5D (EuroQol five dimensions questionnaire) index score using the UK tariff.

EQ-5D is a self assessment of 5 dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. For each dimension responders are asked to state their status on a three level ordinal scale; whether they experience no problems (Level 1), some problems (Level 2) or severe problems (Level 3). Health states defined by the 5 dimensions can be converted into a weighted health state index (health state utility) by applying scores from the EQ-5D value sets elicited from general population samples.

The higher the index score the better the health state. In this study index scores ran from -0.59 to 1.

Visit 2 (Day 7+-2d)
EQ-5D (EuroQol Five Dimensions Questionnaire) at End of Treatment Visit
Time Frame: End of treatment visit (Day 90+-7d)

EQ-5D index score using the UK tariff.

EQ-5D is a self assessment of 5 dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. For each dimension responders are asked to state their status on a three level ordinal scale; whether they experience no problems (Level 1), some problems (Level 2) or severe problems (Level 3). Health states defined by the 5 dimensions can be converted into a weighted health state index (health state utility) by applying scores from the EQ-5D value sets elicited from general population samples.

The higher the index score the better the health state. In this study index scores ran from -0.59 to 1.

End of treatment visit (Day 90+-7d)
EQ-5D (EuroQol Five Dimensions Questionnaire) at Premature Treatment Discontinuation Visit
Time Frame: Premature treatment discontinuation visit(<15 days after last dose)

EQ-5D index score using the UK tariff.

EQ-5D is a self assessment of 5 dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. For each dimension responders are asked to state their status on a three level ordinal scale; whether they experience no problems (Level 1), some problems (Level 2) or severe problems (Level 3). Health states defined by the 5 dimensions can be converted into a weighted health state index (health state utility) by applying scores from the EQ-5D value sets elicited from general population samples.

The higher the index score the better the health state. In this study index scores ran from -0.59 to 1.

Premature treatment discontinuation visit(<15 days after last dose)
Number of Participants With PLATO Major Bleeding Event
Time Frame: From randomization up to 97 days

Participants with PLATO Major bleeding. If no event, censoring occures at the minimum of (last date of event assessment, date of death, end of treatment date, day 97).

PLATO Major bleeding is defined as a bleed that is any one of:

  • Fatal
  • Intracranial (excluding asymptomatic haemorrhagic transformations of ischemic brain infarctions and excluding micro-hemorrhages <10 mm evident only on gradient-echo MRI)
  • Intrapericardial bleed with cardiac tamponade
  • Hypovolaemic shock or severe hypotension due to bleeding and requiring pressors or surgery
  • Significantly disabling (eg. intraocular with permanent vision loss)
  • Clinically overt or apparent bleeding associated with a decrease in Hb of more than 30 g/L (1.9 mmol/L; 0.465 mmol/L)
  • Transfusion of 2 or more units (whole blood or packed red blood cells [PRBCs]) for bleeding.
From randomization up to 97 days
Number of Participants With Premature Discontinuation of Study Drug Due to Any Bleeding Adverse Event
Time Frame: Time from first dose and up to and including 7 days following the date of last dose of the study
Participants discontinuation of study drug due to any bleeding adverse event. If no event, censoring occures at the minimum of (last date of event assessment, date of death, end of treatment date, day 97).
Time from first dose and up to and including 7 days following the date of last dose of the study

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 7, 2014

Primary Completion (Actual)

March 2, 2016

Study Completion (Actual)

March 2, 2016

Study Registration Dates

First Submitted

November 18, 2013

First Submitted That Met QC Criteria

November 25, 2013

First Posted (Estimate)

November 26, 2013

Study Record Updates

Last Update Posted (Actual)

June 12, 2017

Last Update Submitted That Met QC Criteria

May 12, 2017

Last Verified

May 1, 2017

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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