Platelet-Dependent Thrombosis: a Placebo-Controlled Trial of Antiplatelet Therapy (Clopidogrel) - Full Text View

Purpose

Patients with diabetes are more likely to develop furring of their coronary arteries and present with angina and heart attacks. Furthermore, after such an event, they have poorer outcomes (higher rates of death) and survivors are more likely to have recurring symptoms. Using a novel "clotting chamber" the investigators have shown that patients with diabetes are more likely to develop blood clots. This study will look at the role of different blood thinning medications in patients with diabetes. If successful, the investigators will provide evidence to conduct large clinical studies to look at the role of additional blood thinning medication in reducing heart attacks and strokes in patients with diabetes.

Condition	Intervention	Phase
Type 2 Diabetes Mellitus Coronary Artery Disease	Drug: clopidogrel Drug: placebo	Phase IV

MedlinePlus related topics:

Coronary Artery Disease Diabetes

ChemIDplus related topics:

Cellulose Cellulose sodium phosphate Phosphocellulose Acetylsalicylic acid Clopidogrel Clopidogrel Bisulfate Methylcellulose BaseLine

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Efficacy Study

Official Title:	Assessment of Platelet-Dependent Thrombosis by an ex Vivo Arterial Injury Model: a Placebo Controlled Trial of Clopidogrel as Antiplatelet Therapy in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease

Further study details as provided by Newcastle-upon-Tyne Hospitals NHS Trust:

Primary Outcome Measures:

To compare the effect of Clopidogrel in reduction of thrombogenicity in patients with T2DM and CAD with placebo [ Time Frame: seven days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

To identify patients (in particular T2DM patients with CAD) resistant to oral antiplatelet therapy [ Time Frame: seven days ] [ Designated as safety issue: No ]
To characterise features in T2DM patients responsible for increased thrombogenicity [ Time Frame: seven days ] [ Designated as safety issue: No ]

Estimated Enrollment:	90
Study Start Date:	December 2008
Estimated Study Completion Date:	July 2011
Estimated Primary Completion Date:	December 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
C: Active Comparator Patients assigned to clopidogrel in addition to their standard care.(all patients will be on aspirin)	Drug: clopidogrel 75 milligrams, oral, clopidogrel, one tablet daily, for seven days after the baseline chamber study.
P: Placebo Comparator Patients assigned to placebo in addition to their standard care.(all patients will be on aspirin)	Drug: placebo Placebo: Hydroxy methyl cellulose, similar in weight to the active medication 75 mgs, oral tablets, once a day

Detailed Description:

The objective of this study is to compare the effect of Clopidogrel on platelet dependent thrombosis in patients with T2DM and CAD with placebo. The Badimon chamber, an ex vivo arterial injury model is used for this purpose. This model simulates the in vivo situation of high shear arterial wall damage and helps to quantify thrombus which is the sum endpoint of all haemostatic abnormalities seen in vitro.

Eligibility

Ages Eligible for Study:	18 Years to 75 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients with T2DM and CAS as defined below:
- Clinical definitions
- T2DM: Diagnosed according to the WHO criteria [53].
- CAD:Presence of any one of the following: Angina plus positive exercise tolerance test, enzyme and/or Q wave positive myocardial infarction, angiographic evidence ( >50% stenosis of one vessel), percutaneous or surgical coronary revascularisation.
Aged between 18 and 75
Provided written consent for participation in the trial prior to any study-specific procedures or requirements.

Exclusion Criteria:

Contraindication to Clopidogrel
Smoking (current smokers and patients who quit smoking less than six months)
Malignancy(diagnosed or under investigation)
Haematological disorders (Anaemia, malignancy, bleeding disorders)
Women of child-bearing potential
Use of corticosteroids/other antithrombotic agents(warfarin)
Chronic liver disease (Cirrhosis, malignancy and patients with more than twice the upper limit of liver function tests)
Unable to consent.
Use of other investigational study drugs within 1 year prior to study entry
Previous participation in this study

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00728156

Contacts


Contact: Girish N Viswanathan, MRCP	+441912824210	girish.viswanathan@newcastle.ac.uk

Contact: Azfar G Zaman, MD FRCP	+44 191 2336161 ext 37277	Azfar.Zaman@nuth.nhs.uk

Locations


United Kingdom, Tyne and Wear
	Newcastle Diabetes Centre, Newcastle General Hospital	Not yet recruiting
	Newcastle upon Tyne, Tyne and Wear, United Kingdom, NE4 6BE
	Contact: Girish N Viswanathan, MRCP +44 191 2824210 girish.viswanathan@newcastle.ac.uk
	Contact: Sally M Marshall, MD FRCP +44 191 2820114 s.m.marshall@ncl.ac.uk
	Sub-Investigator: Girish N Viswanathan, MRCP
	Principal Investigator: Sally M Marshall, MD FRCP
	Freeman Hospital	Not yet recruiting
	Newcastle upon Tyne, Tyne and Wear, United Kingdom, NE77DN
	Contact: Girish N Viswanathan, MRCP +441912824210 girish.viswanathan@newcastle.ac.uk
	Contact: Azfar G Zaman, MD MRCP +441912336161 ext 37277 azfar.zaman@nuth.nhs.uk
	Sub-Investigator: Girish N Viswanathan, MRCP
	Principal Investigator: Azfar G Zaman, MD FRCP

Sponsors and Collaborators

Newcastle-upon-Tyne Hospitals NHS Trust

British Heart Foundation

University of Newcastle Upon-Tyne

Investigators


Principal Investigator:	Azfar G Zaman, MD FRCP	Consultant cardiologist and Honoraray Lecturer

More Information

Publications:

Osende JI, Badimon JJ, Fuster V, Herson P, Rabito P, Vidhun R, Zaman A, Rodriguez OJ, Lev EI, Rauch U, Heflt G, Fallon JT, Crandall JP. Blood thrombogenicity in type 2 diabetes mellitus patients is associated with glycemic control. J Am Coll Cardiol. 2001 Nov 1;38(5):1307-12.

Shechter M, Merz CN, Paul-Labrador MJ, Kaul S. Blood glucose and platelet-dependent thrombosis in patients with coronary artery disease. J Am Coll Cardiol. 2000 Feb;35(2):300-7.

Helft G, Osende JI, Worthley SG, Zaman AG, Rodriguez OJ, Lev EI, Farkouh ME, Fuster V, Badimon JJ, Chesebro JH. Acute antithrombotic effect of a front-loaded regimen of clopidogrel in patients with atherosclerosis on aspirin. Arterioscler Thromb Vasc Biol. 2000 Oct;20(10):2316-21.

Natarajan A, Zaman AG, Marshall SM. Platelet hyperactivity in type 2 diabetes: role of antiplatelet agents. Diab Vasc Dis Res. 2008 Jun;5(2):138-44.

Responsible Party:	Regional Cardiothoracic Centre, Freeeman Hospital ( Dr Azfar G Zaman, Consultant Cardiologist and Honorary Senior Lecturer )
Study ID Numbers:	3639a, British Heart Foundation, funder, BHF/FS/07/033
First Received:	August 1, 2008
Last Updated:	August 5, 2008
ClinicalTrials.gov Identifier:	NCT00728156
Health Authority:	United Kingdom: Medicines and Healthcare Products Regulatory Agency; United Kingdom: National Health Service; United Kingdom: Research Ethics Committee

Keywords provided by Newcastle-upon-Tyne Hospitals NHS Trust:

Type 2 Diabetes mellitus

Coronary artery disease

Platelet dependent thrombogenicity

Aspirin

Clopidogrel

Badimon Chamber

Study placed in the following topic categories:

Arterial Occlusive Diseases

Heart Diseases

Metabolic Diseases

Myocardial Ischemia

Diabetes Mellitus

Vascular Diseases

Endocrine System Diseases

Arteriosclerosis

Ischemia

Thrombosis

Coronary Disease

Embolism and Thrombosis

Aspirin

Embolism

Clopidogrel

Diabetes Mellitus, Type 2

Endocrinopathy

Metabolic disorder

Glucose Metabolism Disorders

Coronary Artery Disease

Additional relevant MeSH terms:

Therapeutic Uses

Hematologic Agents

Platelet Aggregation Inhibitors

Cardiovascular Diseases

Pharmacologic Actions

ClinicalTrials.gov processed this record on September 22, 2008

Sponsors and Collaborators:	Newcastle-upon-Tyne Hospitals NHS Trust British Heart Foundation University of Newcastle Upon-Tyne
Information provided by:	Newcastle-upon-Tyne Hospitals NHS Trust
ClinicalTrials.gov Identifier:	NCT00728156