POPular GUILTY PILOT: Genotype-guided Clopidogrel Monotherapy

Summary

The goal of this pilot clinical trial is to test the safety and effectiveness of genotype-guided clopidogrel monotherapy in patients presenting with Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS) who have undergone successful Percutaneous Coronary Intervention (PCI). The main questions it aims to answer are: * Is genotype-guided clopidogrel monotherapy effective in reducing ischemic risk during the first six months following successful PCI? * Is genotype-guided clopidogrel monotherapy safe in terms of reducing bleeding risk during the first six months following successful PCI? Participants will be given genotype-guided clopidogrel monotherapy after their successful PCI procedure and will be monitored for any bleeding or ischemic complications over the next six months. Researchers will compare these results to the typical outcomes associated with traditional Dual antiplatelet therapy (DAPT) to see if genotype-guided clopidogrel monotherapy provides similar or improved protection from ischemic events, but with fewer bleeding complications.

Eligibility

Inclusion Criteria:

Patients aged 18 years or older are eligible for inclusion if all of the following criteria are met:

* Clinical diagnosis of NSTE-ACS (i.e. NSTEMI or unstable angina)
* Successful PCI (according to the treating physician) with implantation of new generation drug eluting stents.
* CYP2C19 extensive or ultra-rapid metabolizer

Exclusion Criteria:

A potential subject who meets any of the following criteria will be excluded from participation in this study:

* CYP2C19 poor or intermediate metabolizer
* Known allergy or contraindication for aspirin or clopidogrel.
* Concurrent use of oral anticoagulants (e.g. because of atrial fibrillation)
* Ongoing indication for DAPT at admission (e.g. due to recent PCI or ACS)
* High-risk features for PCI including left main disease, chronic total occlusion, bifurcation lesion requiring 2-stent treatment, saphenous or arterial graft lesion, severely calcified lesion requiring the use of the Rotablator system, ≥3 treated vessels, ≥ 3 stents implanted and total stent length \>60 mm
* Recent stroke, transient ischemic attack (TIA) or intracranial bleeding
* Severe hepatic impairment (Child Pugh class C)
* Planned surgical intervention within 6 months of PCI
* Patients requiring staged procedure (to avoid heterogeneity in the duration of pharmacological treatment between index and staged procedures)
* Pregnant or breastfeeding women at time of enrolment
* Participation in another trial with an investigational drug or device

Conditions3

Interventions1

Related trials

• Anti-platelet Effect of Berberine in Patients After Percutaneous Coronary Intervention — Peking Union Medical College Hospital
• Clopidogrel Versus Cilostazol on Vessels — Seoul National University Bundang Hospital
• Efficacy and Safety Study of Vicagrel in Patients With Acute Coronary Syndrome (ACS) Undergoing Percutaneous Coronary Intervention (PCI) — Jiangsu vcare pharmaceutical technology co., LTD
• Study of the Long-term Effects of P2Y12 Inhibitor Monotherapy and Coagulation Markers After Percutaneous Coronary Angioplasty. — Cardiocentro Ticino
• Dual Antiplatelet Therapy Escalation From Standard-dose Clopidogrel to Low-Dose Prasugrel in Patients With High Bleeding and Ischemic Risk Undergoing PCI: A Prospective, Randomized Pharmacodynamic Study (TAILOR-BLEED-2) — University of Florida
• Effects of Low-dose Ticagrelor vs. Clopidogrel in Stable Patients Undergoing Elective Percutaneous Coronary Intervention — University of Florida

Browse More Trials