Effect of Prasugrel Versus Clopidogrel on Platelet Function After Bivalirudin Cessation
Status:
Completed
Trial end date:
2014-07-01
Target enrollment:
Participant gender:
Summary
Early stent thrombosis has been noted with increased frequency in acute coronary syndrome
(ACS) patients undergoing percutaneous coronary intervention (PCI) who are treated with
bivalirudin and clopidogrel. The brief half life of bivalirudin acting in concert with the
delayed action of clopidogrel likely exposes patients to thrombosis during a vulnerable
period of reduced antiplatelet effect in the immediate post stenting period. Combination
therapy with bivalirudin and prasugrel is conceptually attractive as the more rapid onset of
action of prasugrel could potentially significantly diminish the vulnerable period, likely
reducing the potential for acute stent thrombosis. The trials which have documented the
efficacy of prasugrel as compared to clopidogrel have, in general, not reported on patients
in whom bivalirudin was utilized. Currently, in the United States, bivalirudin is the most
commonly used adjunctive agent used during PCI. Using light transmission aggregometry, this
study will examine the inhibition of platelet aggregation in patients randomized to treatment
with clopidogrel vs prasugrel during the vulnerable period following the discontinuation of
bivalirudin therapy. The investigators anticipate that this study will document significant
enhancement of inhibition of platelet aggregation in patients randomized to prasugrel
treatment.