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Study Comparing Ticagrelor With Aspirin for Prevention of Vascular Events in Patients Undergoing CABG (TiCAB)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2014 by Deutsches Herzzentrum Muenchen
Sponsor:
Collaborator:
AstraZeneca
Information provided by (Responsible Party):
Deutsches Herzzentrum Muenchen
ClinicalTrials.gov Identifier:
NCT01755520
First received: December 19, 2012
Last updated: October 23, 2014
Last verified: October 2014

December 19, 2012
October 23, 2014
April 2013
September 2017   (final data collection date for primary outcome measure)
MACCE [ Time Frame: at 12 months after coronary artery bypass surgery ] [ Designated as safety issue: No ]
Composite of cardiovascular death, myocardial infarction, target vessel revascularization, and stroke
Same as current
Complete list of historical versions of study NCT01755520 on ClinicalTrials.gov Archive Site
  • Cardiovascular death [ Time Frame: at 12 months after coronary artery bypass surgery ] [ Designated as safety issue: No ]
  • Major bleeding events [ Time Frame: within 12 months after coronary arerty bypass surgery ] [ Designated as safety issue: Yes ]
    Incidence of major bleeding events
  • All cause death [ Time Frame: at 12 months after coronary artery bypass surgery ] [ Designated as safety issue: No ]
    All cause death
  • Myocardial Infarction [ Time Frame: at 12 months after coronary artery bypass surgery ] [ Designated as safety issue: No ]
  • Target Lesion Revascularization [ Time Frame: at 12 months after coronary artery bypass surgery ] [ Designated as safety issue: No ]
  • Stroke [ Time Frame: at 12 months after coronary artery bypass surgery ] [ Designated as safety issue: No ]
Same as current
Not Provided
Not Provided
 
Study Comparing Ticagrelor With Aspirin for Prevention of Vascular Events in Patients Undergoing CABG
A Randomized, Parallel Group, Double-Blind Study of Ticagrelor Compared With Aspirin for Prevention of Vascular Events in Patients Undergoing Coronary Artery Bypass Graft Operation TiCAB- Ticagrelor in CABG

This study (TiCAB) is designed as a pivotal efficacy and safety study of Ticagrelor in patients undergoing coronary artery bypass operation. It is designed for the prevention of fatal and non-fatal cardiovascular events in this patient population, a significant, yet unmet medical need.

For stable patients who underwent coronary bypass operation, Aspirin alone currently represents the gold standard of antiplatelet treatment. A few smaller studies using a combination therapy of antiplatelet drugs including Aspirin and Clopidogrel have shown conflicting results. Albeit a number of cardiac surgeons prefer dual antiplatelet therapy with Aspirin and Clopidogrel, Aspirin monotherapy is currently the only guideline recommended therapy after CABG.

A sub-analysis of PLATO trial comprising more than 1200 ACS patients who were not considered to be appropriately suited for PCI and therefore subjected to CABG operation demonstrated an impressive reduction in mortality in those patients treated with Ticagrelor and Aspirin as compared to Clopidogrel and Aspirin. The labeling of Ticagrelor says that the drug should be paused 7 days prior to surgery. However, a further analysis of this substudy revealed that the largest benefit in the Ticagrelor + Aspirin group as compared to the Clopidogrel + Aspirin group was found in those who stopped study medication at about 48 - 72 hours prior to surgery. There have been pharmacological studies that showed that Ticagrelor may precondition the heart for the trauma of surgery via adenosine mediated effects. Thus, the enormous benefit in the Ticagrelor arm of the PLATO study may be secondary to a pleiotropic action. There was no indication of an accelerated bleeding risk in this study and pharmacological studies document that platelet function should be largely restored of a pause of 48 - 72 hours, such that this duration may allow the optimal preparation for CABG surgery.

Based on the unmet clinical need regarding optimal antiplatelet therapy after CABG, the results of the PLATO CABG substudy and the observation that Ticagrelor benefits increase with decreasing Aspirin doses, Ticagrelor monotherapy (2x 90mg/day) appears to offer the best balance of safety with anticipated improved efficacy over Aspirin alone. However, there are no data available to support this hypothesis.

Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Coronary Artery Disease
  • Stable Angina
  • Acute Coronary Syndrome
  • Drug: Ticagrelor
    90mg twice daily dose
    Other Name: Brilique
  • Drug: Aspirin
    Aspirin 100mg once daily
    Other Name: ASS
  • Drug: Placebo - Ticagrelor
    Placebo
    Other Name: Placebo
  • Drug: Placebo - Aspirin
    Placebo
    Other Name: Placebo
  • Experimental: Ticagrelor
    Intervention: Drug: Ticagrelor verum + Aspirin placebo
    Interventions:
    • Drug: Ticagrelor
    • Drug: Placebo - Aspirin
  • Active Comparator: Aspirin
    Intervention: Drug: Aspirin verum + Ticagrelor placebo
    Interventions:
    • Drug: Aspirin
    • Drug: Placebo - Ticagrelor
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
3850
September 2017
September 2017   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Patients 18 years of age or older
  2. Informed, written consent by the patient
  3. Indication for CABG surgery:

    • coronary three vessel disease, or
    • left main stenosis, or
    • two vessel disease with impaired left ventricular function (<50%)

Exclusion Criteria:

  1. Indication for oral anticoagulation therapy (i.e. AF) at the time of randomization
  2. Cardiogenic shock, haemodynamic instability
  3. Indication for dual antiplatelet therapy post operatively
  4. Need for concomitant non-coronary surgery (e.g. valve replacement)
  5. Contraindication for ASA or Ticagrelor use (i.e. known allergy)
  6. History of bleeding diathesis within three months prior presentation
  7. History of significant GI bleed within 6 months prior presentation
  8. History of intra cranial hemorrhage
  9. History of moderate to severe liver impairment
  10. Patient requires dialysis
  11. Patient with an increased risk of bradycardic events (e.g. patients without a pacemaker who have sick sinus syndrome, 2nd or 3rd degree AV block or bradycardic-related syncope)
  12. Known, clinically important thrombocytopenia (i.e. <100.000/µl)
  13. Known, clinically important anaemia (i.e. <10mg/dl)
  14. Participation in another investigational drug or device study in the last 30 days
  15. Pregnancy or lactation (for premenopausal women 2 methods of reliable contraception, one of which must be barrier method, are required)
  16. Concomitant oral or intravenous therapy (see examples below) with strong CYP3A inhibitors, CYP3A substrates with narrow therapeutic indices, or strong CYP3A inducers which cannot be stopped for the course of the study

    • Strong inhibitors: ketoconazole, itraconazole, voriconazole, telithromycin, clarithromycin, nefazadone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir, over 1 litre daily of grapefruit juice.
    • Substrates with narrow therapeutic index: cyclosporine, quinidine.
    • Strong inducers: rifampin/rifampicin, phenytoin, carbamazepine.
  17. Any other severe comorbidity such as active cancer
  18. Life expectancy less than 12 months that may result in protocol non-compliance or a risk for being lost to follow-up
  19. Indication for major surgery (e.g. cancer treatment, carotid surgery, cerebral surgery, major vascular surgery)
  20. Previous enrollment or randomization of treatment in the present study.
Both
18 Years and older
No
Contact: Heribert Schunkert, MD 00498912184073 schunkert@dhm.mhn.de
Contact: Gisela Schoemig 00498912181547 gschoemig@dhm.mhn.de
Austria,   Germany
 
NCT01755520
GE IDE No. D00112, 2012-003630-16
Yes
Deutsches Herzzentrum Muenchen
Deutsches Herzzentrum Muenchen
AstraZeneca
Principal Investigator: Heribert Schunkert, MD Deutsches Herzzentrum Munich Germany
Deutsches Herzzentrum Muenchen
October 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP