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The aim of this study is to compare circadian variability of antiplatelet effect of prasugrel and ticagrelor maintenance doses during the initial days after acute myocardial infarction.
Prasugrel and ticagrelor are two oral P2Y12 receptor antagonists recommended as a part of dual antiplatelet therapy with aspirin in patients with acute myocardial infarction. Both drugs exert comparable antiplatelet effect following a loading dose. However, pharmacodynamic differences exist between these P2Y12 receptor inhibitors. Prasugrel is a prodrug that requires hepatic activation and permanently binds to platelet P2Y12 receptors, whereas ticagrelor is an active drug and blocks P2Y12 receptors reversibly. Another important difference is that prasugrel maintenance dose is administered once daily, while ticagrelor requires next dosage every 12 hours. These fundamental distinctions may affect the degree of platelet inhibition on maintenance doses during the first days after acute myocardial infarction.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Prasugrel | Patients with myocardial infarction will receive prasugrel as a part of dual antiplatelet therapy with aspirin. |
| |
| Ticagrelor | Patients with myocardial infarction will receive ticagrelor as a part of dual antiplatelet therapy with aspirin. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prasugrel | Drug | Patients with myocardial infarction will receive a 60 mg prasugrel loading dose, followed by a maintenance dose of 10 mg once daily |
|
| Measure | Description | Time Frame |
|---|---|---|
| Circadian variability of platelet inhibition assessed with VASP | Platelet inhibition evaluated with VASP assay at 8:00, 12:00, 16:00 and 20:00 | Day 4 after acute myocardial infarction |
| Circadian variability of platelet inhibition assessed with Multiplate | Platelet inhibition evaluated with Multiplate at 8:00, 12:00, 16:00 and 20:00 | Day 4 after acute myocardial infarction |
| Measure | Description | Time Frame |
|---|---|---|
| High platelet reactivity at 8:00 assessed with VASP | Number of patients with high platelet reactivity evaluated with VASP assay at 8:00 | Day 4 after acute myocardial infarction |
| High platelet reactivity at 12:00 assessed with VASP |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with acute myocardial infarction treated invasively.
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| Name | Affiliation | Role |
|---|---|---|
| Jacek Kubica, Prof. | Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Cardiology, Dr. A. Jurasz University Hospital, Collegium Medicum, Nicolaus Copernicus University | Bydgoszcz | Kuyavian-Pomeranian Voivodeship | 85-094 | Poland |
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| ID | Term |
|---|---|
| D000072657 | ST Elevation Myocardial Infarction |
| D000072658 | Non-ST Elevated Myocardial Infarction |
| ID | Term |
|---|---|
| D009203 | Myocardial Infarction |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D000068799 | Prasugrel Hydrochloride |
| D000077486 | Ticagrelor |
| ID | Term |
|---|---|
| D013876 | Thiophenes |
| D013457 | Sulfur Compounds |
| D009930 | Organic Chemicals |
| D010879 | Piperazines |
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| Ticagrelor | Drug | Patients with myocardial infarction will receive a 180 mg ticagrelor loading dose, followed by a maintenance dose of 90 mg twice daily |
|
|
Number of patients with high platelet reactivity evaluated with VASP assay at 12:00
| Day 4 after acute myocardial infarction |
| High platelet reactivity 16:00 assessed with VASP | Number of patients with high platelet reactivity evaluated with VASP assay at 16:00 | Day 4 after acute myocardial infarction |
| High platelet reactivity 20:00 assessed with VASP | Number of patients with high platelet reactivity evaluated with VASP assay at 20:00 | Day 4 after acute myocardial infarction |
| High platelet reactivity 08:00 assessed with Multiplate | Number of patients with high platelet reactivity evaluated with Multiplate at 08:00 | Day 4 after acute myocardial infarction |
| High platelet reactivity 12:00 assessed with Multiplate | Number of patients with high platelet reactivity evaluated with Multiplate at 12:00 | Day 4 after acute myocardial infarction |
| High platelet reactivity 16:00 assessed with Multiplate | Number of patients with high platelet reactivity evaluated with Multiplate at 16:00 | Day 4 after acute myocardial infarction |
| High platelet reactivity 20:00 assessed with Multiplate | Number of patients with high platelet reactivity evaluated with Multiplate at 20:00 | Day 4 after acute myocardial infarction |
| Department of Cardiology, Wrocław Medical University | Wroclaw | Lower Silesian Voivodeship | 50-556 | Poland |
| D014652 |
| Vascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
| D006573 |
| Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D000241 | Adenosine |
| D011684 | Purine Nucleosides |
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D012263 | Ribonucleosides |