- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02978040
Randomized Comparison of Cangrelor, Tirofiban and Prasugrel in Patients With STEMI Referred for Primary PCI. (FABOLUS-FASTER)
Facilitation Through Aggrastat or Cangrelor Bolus and Infusion Over prasugreL: a mUlticenter Randomized Open-label Trial in patientS With ST-elevation Myocardial inFarction Referred for primAry percutaneouS inTERvention.FABOLUS FASTER Trial
Primary percutaneous coronary intervention (PCI) is the main reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI). The optimal platelet inhibition at the time of PCI is fundamental, however, the comparative speed of action of cangrelor as opposed to tirofiban and to chewed or integer loading dose of prasugrel is unknown.
The purpose of this trial is to assess the inhibition of platelet aggregation with different regimens on platelet inhibition (tirofiban bolus+infusion, cangrelor bolus+infusion, prasugrel chewed loading dose, prasugrel integer loading dose) in the early phase of primary PCI.
Study Overview
Status
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Ferrara, Italy, 44124
- University of Ferrara
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Naples, Italy, 80131
- University of Naples Federico II
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Bern, Switzerland, 3010
- Bern University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age greater than 18 years old
- ST-segment elevation myocardial infarction
- Referred for primary PCI either within 12 h of symptom onset or between 12 and 24 h after onset with evidence of continuing ischemia
Exclusion Criteria:
- Unconsciousness
- Other conditions that make the patient incapable receiving integer loading dose of prasugrel
- Any contraindication and/or known hypersensitivity or allergy to aspirin, prasugrel, intravenous unfractionated heparin, cangrelor, tirofiban
- Any contraindication to primary PCI
- Administration of glycoprotein IIb/IIIa inhibitors (GPI) or P2Y12-inhibitors or cangrelor < 7 days
- Chronic dialysis
- Recent (< 15 days) or current major bleeding
- Recent (< 15 days) major surgery
- Administration of fibrinolytics < 30 days
- Current use or indication to oral anticoagulant
- Previous stroke or transient ischemic attack (TIA)
- Inability to follow the procedures of the study (language problems, psychological disorders, dementia) or comorbidities associated with less than 6 months survival (active malignancies drug or alcohol abuse, etc.)
- Women who are pregnant or breast feeding or with potential to become pregnant during the course of the study (age < 55 years and last menstruation within the last 12 months) and did not undergo tubal ligation, ovariectomy or hysterectomy
- Participation in another study with investigational drug within the 30 days preceding and during the present study
- Enrolment of the investigator, his/her family members, employees and other dependent persons
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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EXPERIMENTAL: Cangrelor
Cangrelor bolus of 30 µg/Kg followed by infusion at 4 µg/Kg/min for 2 h (or to the end of PCI).
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Cangrelor will be administered as bolus of 30 µg/Kg followed by infusion at 4 µg/Kg/min for 2 h (or to the end of PCI); at the end of infusion, oral prasugrel at loading dose of 60 mg will be administrated, then 10 mg daily (5 mg daily if body weight < 60 kg or age > 75 years old).
Other Names:
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ACTIVE_COMPARATOR: Tirofiban
Tirofiban bolus of 25 µg/Kg bolus followed by infusion at 0.15 µg/Kg/min for 2 h (or to the end of PCI) (infusion rate of 0.075 µg/Kg/min for patients with creatinine clearance < 60 ml/min).
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Tirofiban will be administrated as 25 µg/Kg bolus followed by infusion at 0.15 µg/Kg/min for 2 h (or to the end of PCI) (infusion rate of 0.075 µg/Kg/min for patients with creatinine clearance < 60 ml/min); at the end of infusion, oral prasugrel at loading dose of 60 mg will be administrated, then 10 mg daily (5 mg daily if body weight < 60 kg or age > 75 years old) .
Other Names:
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ACTIVE_COMPARATOR: Prasugrel
Prasugrel oral integer or chewed at an identical loading dose of 60 mg
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In the prasugrel arm no intravenous anti-platelet drug will be administered.
Patients will be randomized to oral integer prasugrel or chewed oral prasugrel at an identical loading dose of 60 mg, then 10 mg daily (5 mg daily if body weight < 60 kg or age > 75 years old).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Inhibition of platelet activity (IPA, %) with LTA-ADP 20 µmol/l
Time Frame: 30 minutes
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Primary outcome is platelet inhibition assessed with light transmission aggregometry (LTA) in platelet rich plasma with the addition of adenosine diphosphate (ADP) 20 µmol/l at 30 minutes from drug administration
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30 minutes
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Inhibition of platelet activity (IPA, %) with LTA-ADP 20 µmol/l
Time Frame: 15 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Platelet inhibition assessed with light transmission aggregometry (LTA) in platelet rich plasma with the addition of ADP 20 µmol/l at 15 minutes, 1h, 2h, 3h and 4-6h from drug administration
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15 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Inhibition of platelet activity (IPA, %) with LTA-ADP 5 µmol/l
Time Frame: 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Platelet inhibition assessed with light transmission aggregometry (LTA) in platelet rich plasma with the addition of ADP 5 µmol/l at 15 minutes, 30 minutes, 1h, 2h, 3h and 4-6h from drug administration
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15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Inhibition of platelet activity (IPA, %) with LTA-TRAP 5 µmol/l
Time Frame: 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Platelet inhibition assessed with light transmission aggregometry (LTA) in platelet rich plasma with the addition of thrombin receptor-activating peptides (TRAP) 5 µmol/l at 15 minutes, 30 minutes, 1h, 2h, 3h and 4-6h from drug administration
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15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Inhibition of platelet activity (IPA, %) with LTA-TRAP 15 µmol/l
Time Frame: 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Platelet inhibition assessed with light transmission aggregometry (LTA) in platelet rich plasma with the addition of TRAP 15 µmol/l at 15 minutes, 30 minutes, 1h, 2h, 3h and 4-6h from drug administration
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15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Area under the curve (AUC) at Multiplate with ADP test
Time Frame: 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Platelet inhibition assessed with Multiplate ADP test at 15 minutes, 30 minutes, 1h, 2h, 3h and 4-6h from drug administration
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15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Area under the curve (AUC) at Multiplate with TRAP test
Time Frame: 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Platelet inhibition assessed with Multiplate TRAP test at 15 minutes, 30 minutes, 1h, 2h, 3h and 4-6h from drug administration
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15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4-6 hours
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Angiographic result
Time Frame: immediately after PCI procedure
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Final angiographic result evaluated by proportion of patients with TIMI flow<3
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immediately after PCI procedure
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Electrocardiographic result
Time Frame: immediately after PCI procedure and 90 minutes after PCI
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ST resolution at ECG recorded after PCI
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immediately after PCI procedure and 90 minutes after PCI
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Infarct size at Cardiac Magnetic Resonance Imaging (MRI)
Time Frame: 3 days and 4-6 months after PCI
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Infarct size assessed at cardiac MRI
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3 days and 4-6 months after PCI
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Intramyocardial haemorrhage at Cardiac Magnetic Resonance Imaging (MRI)
Time Frame: 3 days and 4-6 months after PCI
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Intramyocardial haemorrhage assessed at cardiac MRI
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3 days and 4-6 months after PCI
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Major adverse ischemic clinical events
Time Frame: 48 h and 30 days after PCI
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Major adverse ischemic clinical events (including death, cardiac death, myocardial infarction, stroke, urgent target vessel revascularization, definite/probable stent thrombosis and their combinations in composite endpoints) will be evaluated 48 hours and 30 days from primary PCI.
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48 h and 30 days after PCI
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Bleeding events
Time Frame: 48 h and 30 days after PCI
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Bleeding events according to Bleeding Academic Research Consortium (BARC), Thrombolysis in Myocardial Infarction (TIMI), Global Use of Strategies To Open occluded arteries (GUSTO) bleeding scales as well as Net adverse clinical events (NACE; defined as the composite of death, non-fatal myocardial infarction, definite/probable stent thrombosis, non-fatal stroke, and BARC 2, 3, or 5 bleeding) will be evaluated at 48 hours and 30 days from primary PCI
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48 h and 30 days after PCI
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Collaborators and Investigators
Investigators
- Study Chair: Marco Valgimigli, Prof, Department of Cardiology, Bern University Hospital
- Principal Investigator: Giuseppe Gargiulo, MD, Department of Cardiology, Bern University Hospital
Publications and helpful links
General Publications
- Gargiulo G, Esposito G, Avvedimento M, Nagler M, Minuz P, Campo G, Gragnano F, Manavifar N, Piccolo R, Tebaldi M, Cirillo P, Hunziker L, Vranckx P, Leonardi S, Heg D, Windecker S, Valgimigli M. Cangrelor, Tirofiban, and Chewed or Standard Prasugrel Regimens in Patients With ST-Segment-Elevation Myocardial Infarction: Primary Results of the FABOLUS-FASTER Trial. Circulation. 2020 Aug 4;142(5):441-454. doi: 10.1161/CIRCULATIONAHA.120.046928. Epub 2020 Jun 27. Erratum In: Circulation. 2020 Aug 4;142(5):e71.
- Gargiulo G, Esposito G, Cirillo P, Nagler M, Minuz P, Campo G, Gragnano F, Manavifar N, Piccolo R, Avvedimento M, Tebaldi M, Wahl A, Hunziker L, Billinger M, Heg D, Windecker S, Valgimigli M. Facilitation Through Aggrastat or Cangrelor Bolus and Infusion Over PrasugreL: a MUlticenter Randomized Open-label Trial in PatientS with ST-elevation Myocardial InFarction Referred for PrimAry PercutaneouS InTERvention (FABOLUS FASTER) Trial: Design and Rationale : The FABOLUS FASTER Trial. J Cardiovasc Transl Res. 2021 Feb;14(1):110-119. doi: 10.1007/s12265-020-09969-4. Epub 2020 Feb 24.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Ischemia
- Pathologic Processes
- Necrosis
- Myocardial Ischemia
- Heart Diseases
- Cardiovascular Diseases
- Vascular Diseases
- Arteriosclerosis
- Arterial Occlusive Diseases
- Coronary Disease
- Myocardial Infarction
- Infarction
- Coronary Artery Disease
- ST Elevation Myocardial Infarction
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Fibrinolytic Agents
- Fibrin Modulating Agents
- Platelet Aggregation Inhibitors
- Purinergic P2Y Receptor Antagonists
- Purinergic P2 Receptor Antagonists
- Purinergic Antagonists
- Purinergic Agents
- Tirofiban
- Prasugrel Hydrochloride
- Cangrelor
Other Study ID Numbers
- FABOLUS-FASTER
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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