- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT01283282
Investigation of the Athero-Protective Effects of Clopidogrel (APECS)
15. april 2015 oppdatert av: Arshed A. Quyyumi, Emory University
Phase 4 Study of Clopidogrel in Patients With Stable Coronary Artery Disease to Determine Effects on Vascular Function, Biomarkers and Endothelial Progrenitor Cells
The investigators would like to investigate whether clopidogrel will help lower the level of harmful markers in patients with coronary artery disease, and at the same time will help increase the cells that are useful in repairing the damaged blood vessels.
The investigators will give half of the patients clopidogrel and the other half a sugar pill, placebo, and check the levels of these markers and helpful cells in each group.
At the same time the investigators will check how well these patient's blood vessels work using ultrasound imaging of the forearm to see how blood vessels relax and tonometry to see how stiff the patient's blood vessels are.
After 6 weeks of drug therapy, the patients will switch to the other drug and these same tests will be performed after an additional 6 weeks of therapy.
The drug taken by the patient will not be known to the patient or the researchers.
The patients will continue on their prescribed medical therapy during the duration of the 12 week study.
Studieoversikt
Status
Fullført
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
Blockages in the blood vessels of the heart are caused by atherosclerosis.
Atherosclerosis is the main cause for chest pain and heart attacks.
Gradual narrowing of the vessels of the heart caused by blockages causes chronic symptoms, such as chest pain.
Those with these findings often have a cardiac catheterization to detect these blockages.
Additionally these patients may have an angioplasty or stent placed to help relieve these symptoms.
With this angioplasty/stent procedure, patients are placed on the drug clopidogrel to help prevent clots from forming and narrowing of the blood vessels.
Clopidogrel is a blood thinner that prevents clots from forming similar to an aspirin, but is more powerful and effective.
Markers, or substances, have been identified that cause worsening of the blockages in the blood vessels of the heart.
Many of these substances have been shown to decrease with the use of clopidogrel.
This occurs separately from clopidogrel's ability to prevent clots.
Endothelial progenitor cells, or EPCs, come mostly from the bone marrow and is helpful in repairing damage to the lining of the blood vessels of the heart.
The EPCs help balance out the damage incurred in the blood vessels from those harmful markers.
Several other drugs commonly used in heart disease have recently been shown to improve EPCs function.
With this in mind, it is important to understand more of clopidogrel's function.
A decrease in markers that cause worsening of the blockages, and an increase in the number of cells that will help repair damaged blood vessels of the heart is important in avoiding future chest pain and heart attacks.
This may be how clopidogrel is currently protecting patients from developing new blockages.
The investigators would like to investigate whether clopidogrel will help lower the level of harmful markers in patients with coronary artery disease, and at the same time will help increase the cells that are useful in repairing the damaged blood vessels.
The investigators will give half of the patients clopidogrel and the other half a sugar pill, placebo, and check the levels of these markers and helpful cells in each group.
At the same time the investigators will check how well these patient's blood vessels work using ultrasound imaging of the forearm to see how blood vessels relax and tonometry to see how stiff the patient's blood vessels are.
After 6 weeks of drug therapy, the patients will switch to the other drug and these same tests will be performed after an additional 6 weeks of therapy.
The drug taken by the patient will not be known to the patient or the researchers.
The patients will continue on their prescribed medical therapy during the duration of the 12 week study.
Studietype
Intervensjonell
Registrering (Faktiske)
48
Fase
- Fase 4
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
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Georgia
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Atlanta, Georgia, Forente stater, 30322
- Emory University Hospital
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-
Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
21 år til 80 år (Voksen, Eldre voksen)
Tar imot friske frivillige
Nei
Kjønn som er kvalifisert for studier
Alle
Beskrivelse
Inclusion Criteria:
- Male or females without child bearing potential aged 21-80 years
- Known coronary artery disease by angiogram or documented myocardial infarction.
- Able to provide written informed consent
Exclusion Criteria:
- Treated with clopidogrel or ticlodipine in the previous 3 months
- Age < 21 or >80 years
- Premenopausal females with potential for pregnancy
- Allergy to clopidogrel or aspirin
- Initiation or change in dose of any concomitant medical therapy within 2 months before the study
- Uncontrolled hypertension with BP>180 mmHg systolic and >120 mmHg diastolic
- Treated with coumadin therapy
- Intolerance or allergy to statins
- Acute infection in previous 4 weeks
- History of substance abuse
- Uninterpretable PAT test
- Current neoplasm
- Chronic renal failure [creatinine > 2.5 mg/dL] or liver failure (Liver enzymes >2X normal)
- Acute coronary syndrome, heart failure, CVA, coronary intervention within 3 months
- Known aortic stenosis, hypertrophic cardiomyopathy, symptomatic heart failure.
- Inability to give informed consent
- Inability to return to Emory for follow-up
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Grunnvitenskap
- Tildeling: Randomisert
- Intervensjonsmodell: Crossover-oppdrag
- Masking: Firemannsrom
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Aktiv komparator: Clopidogrel/Placebo
Subjects were randomized to clopidogrel 75 mg daily for 6 weeks.
Then immediately transitioned to a placebo daily for 6 weeks.
|
Clopidogrel 75 mg PO qday for 6 weeks
Andre navn:
Placebo PO qday for 6 weeks
|
Aktiv komparator: Placebo/Clopidogrel
Subjects were randomized to a placebo daily for 6 weeks.
Then immediately transitioned to clopidogrel 75 mg daily for 6 weeks.
|
Clopidogrel 75 mg PO qday for 6 weeks
Andre navn:
Placebo PO qday for 6 weeks
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Flow-mediated Dilation (FMD)
Tidsramme: Baseline, Week 12
|
Flow-mediated dilation (FMD) collected by an ultrasound and is measured by the percent change in diameter of the brachial artery from baseline to 12 weeks.
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Baseline, Week 12
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Nitroglycerin-mediated Vasodilation
Tidsramme: Baseline, Week 12
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Nitroglycerin (NTG)-mediated vasodilation was measured after 0.4 mg of NTG was administered sublingually.
Brachial artery images were obtained via ultrasound after three minutes of NTG administration.
Measurements from the twelve frames will be averaged to calculate the percent change in diameter of the brachial artery from baseline to 12 weeks.
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Baseline, Week 12
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Endothelial Progenitor Cells (EPCs)
Tidsramme: Week 12
|
The circulating progenitor-enriched population of cells was measured by the expression of surface antigens using direct flow cytometry for CD34+, CD34+/CD133+, CD34+/ VEGF2R+ and CD34+/CD133+/VEGF2R+
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Week 12
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Pulse Wave Velocity (PWV)
Tidsramme: Week 12
|
PWV was measured between the carotid and femoral arteries using the SphygmoCor device.
Pressure waveforms at the carotid and femoral arteries were acquired using EKG gating.
Velocity (distance per time in seconds) was calculated using the foot-to-foot method and the distance between the sites was measured manually.
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Week 12
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Oxidative Stress Markers
Tidsramme: Week 12
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Oxidative stress was measured by using liquid chromatography to collect plasma cystine, cysteine, gluthione, and oxidized glutathione levels.
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Week 12
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Inflammatory Marker High-sensitivity C-reactive Protein (hsCRP)
Tidsramme: Week 12
|
High-sensitivity C-reactive protein (hsCRP) was measured.
The hsCRP levels were measured by Dade Behring nephelometry.
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Week 12
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Inflammatory Marker CD40 Ligand
Tidsramme: Week 12
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CD40 ligand levels were measured.
The level of CD40 ligand were measured using the Flurokine MultiAnalyte profiling (MAP) Human Base Kit B.
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Week 12
|
Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Etterforskere
- Hovedetterforsker: Ziyad Ghazzal, MD, American University of Beirut, Emory University
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart
1. januar 2008
Primær fullføring (Faktiske)
1. desember 2010
Studiet fullført (Faktiske)
1. desember 2010
Datoer for studieregistrering
Først innsendt
24. januar 2011
Først innsendt som oppfylte QC-kriteriene
24. januar 2011
Først lagt ut (Anslag)
25. januar 2011
Oppdateringer av studieposter
Sist oppdatering lagt ut (Anslag)
1. mai 2015
Siste oppdatering sendt inn som oppfylte QC-kriteriene
15. april 2015
Sist bekreftet
1. april 2015
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Hjertesykdommer
- Kardiovaskulære sykdommer
- Vaskulære sykdommer
- Arteriosklerose
- Arterielle okklusive sykdommer
- Koronararteriesykdom
- Myokardiskemi
- Koronar sykdom
- Fysiologiske effekter av legemidler
- Nevrotransmittere agenter
- Molekylære mekanismer for farmakologisk virkning
- Blodplateaggregasjonshemmere
- Purinergiske P2Y-reseptorantagonister
- Purinergiske P2-reseptorantagonister
- Purinergiske antagonister
- Purinergiske midler
- Klopidogrel
Andre studie-ID-numre
- IRB00005145
- APECS (Annen identifikator: Other)
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .
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