Antithrombotic Triple Therapy in Humans

Tracking Information
First Submitted Date ICMJE	March 9, 2013
First Posted Date ICMJE	March 18, 2013
Last Update Posted Date	March 6, 2014
Study Start Date ICMJE	October 2012
Actual Primary Completion Date	May 2013 (Final data collection date for primary outcome measure)
Current Primary Outcome Measures ICMJE; (submitted: March 13, 2013)	Changes of β-TG, F1+2 and TAT in shed blood [ Time Frame: Changes from baseline at 3 hours and 5 days after intervention ]; Changes from baseline β-TG, F1+2 and TAT concentrations in shed blood at 3 hours and 5 days (steady state condition) after study drug administration(s) will be assessed
Original Primary Outcome Measures ICMJE	Same as current
Change History	Complete list of historical versions of study NCT01812200 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures ICMJE; (submitted: March 13, 2013)	Changes of D-Dimer, TxB2, CD40L and p-Selectin in shed blood; β-TG, F1+2, TAT, D-Dimer, TxB2, CD40L, p-Selectin, ETP, aPTT, PT, inhibition of factor Xa, Biophen®, Hemoclot® in venous blood [ Time Frame: Changes from baseline at 3 hours and 5 days after intervention (shed blood parameters); changes from baseline at 1, 2, 3 hours and 5 days after intervention (venous blood parameters) ]; Changes from baseline secondary outcome parameters at (1 hour, 2 hours - if applicable), 3 hours and 5 days (steady state condition) after study drug administration(s) will be assessed
Original Secondary Outcome Measures ICMJE	Same as current
Current Other Outcome Measures ICMJE	Not Provided
Original Other Outcome Measures ICMJE	Not Provided
Descriptive Information
Brief Title ICMJE	Antithrombotic Triple Therapy in Humans
Official Title ICMJE	A Prospective, Randomized, Controlled, Analyst-blinded, Parallel Group Study to Investigate the Effect of Antithrombotic Triple Therapy With Ticagrelor and Acetylsalicylic Acid in Combination With Dabigatran or Rivaroxaban or Phenprocoumon on Markers of Coagulation Activation in Venous and Shed Blood in Healthy Male Subjects
Brief Summary	Background:The acute coronary syndrome (ACS) is a complication of coronary artery disease (CAD) and associated with increased mortality. Dual antiplatelet therapy of acetylsalicylic acid (ASA) with P2Y12 receptor antagonists such as clopidogrel is a cornerstone in the treatment of patients with advanced CAD. Due to delayed onset of action, intersubject variability or resistance to clopidogrel, different platelet aggregation inhibitors have been developed. Ticagrelor is a reversible P2Y12 receptor antagonist with superior efficacy compared to clopidogrel in the prevention of cardiovascular death in these patients. Atrial fibrillation (AF) is also associated with thromboembolic events and substantial mortality. Beside vitamin K antagonists (VKA, phenprocoumon) for stroke prevention in patients with AF, the direct factor Xa inhibitor rivaroxaban and the direct thrombin inhibitor dabigatran have recently received approval for prophylactic treatment of patients with non-valvular AF. However, there is a lack of efficacy or safety data for the combined impact of antithrombotic drugs in patients requiring arterial and venous thromboembolic prophylaxis due to their underlying co-morbidities. Study objectives: To evaluate the effect of ticagrelor + ASA in combination with dabigatran, rivaroxaban or phenprocoumon at steady state on markers of coagulation activation. The effects on coagulation activation will also be studied after a single dose of dabigatran, rivaroxaban or ticagrelor and at a therapeutic INR of phenprocoumon. Study design: A single-centre, prospective, randomized, controlled, analyst-blinded study in three parallel-groups. Subjects will receive ticagrelor + ASA in combination with dabigatran (treatment A), rivaroxaban (treatment B) or phenprocoumon (treatment C). All IMPs will be administered at doses indicated for stroke prevention in AF or ACS. Markers on thrombin generation and platelet activation will be studied in venous blood where coagulation is in resting state and in shed blood where the clotting system is activated in the microvasculature in vivo: prothrombin fragment 1+2 (F1+2), thrombin-anti-thrombin (TAT), β-thromboglobulin (β-TG), D-Dimer, thromboxane B2 (TxB2), CD40 ligand (CD40L), p-Selectin. Further, the endogenous thrombin potential (ETP), inhibition of factor Xa activity, activated partial thromboplastin time (aPTT), prothrombin time (PT), Biophen® and Hemoclot® will be assessed in venous blood. Study population: A total of 60 healthy, non-smoking and drug-free male volunteers will be enrolled in this trial and randomized into one of three balanced groups (treatment A, B and C; n = 20 per group). Main outcome variables: β-TG, F1+2 and TAT in shed blood Additional outcome variables: D-Dimer, TxB2, CD40L and p-Selectin in shed blood; β-TG, F1+2, TAT, D-Dimer, TxB2, CD40L, p-Selectin, ETP, aPTT, PT, inhibition of factor Xa, Biophen® and Hemoclot® in venous blood Risk/ benefit assessment:Total blood loss will be, dependent on treatment allocation, between 330 ml and 510 ml throughout the entire study period of 4 - 5 weeks. This amount of venous blood is considered to be acceptable in this healthy population. Blood sampling procedures may cause mild and transient pain. A minor haematoma may occur at the site of needle insertions. Bleeding time incisions may leave small persistent scars. Administration of the study drugs, in particular as triple combination for 5 days, results in transient hypocoagulability and may cause overt or occult bleeding. The risk is considered low in the healthy subjects under study. Continuous monitoring of safety parameters (haemoglobin, haematocrit, platelet count, coagulation) and surveillance of the overall status will be performed during study participation. Subjects will be instructed to avoid vigorous physical exercise and handling of hazardous machinery during study participation. ASA, dabigatran and rivaroxaban can cause gastrointestinal discomfort. Other side effects are rare. The combination of these novel anticoagulants (dabigatran, rivaroxaban, ticagrelor) has not been investigated so far. Conducting this study in a healthy population limits potential bleeding risk reported from drug interactions and impaired liver or renal function, which may influence the pharmacokinetics and -dynamics of the investigational products. This study can provide information on haemostatic system activation in vivo during triple treatment with antithrombotic drugs, which is indicated for patients with AF and ACS. The results of this study may provide dosing guidance for risk reduction of patients with ACS and AF.
Detailed Description	Not Provided
Study Type ICMJE	Interventional
Study Phase	Phase 4
Study Design ICMJE	Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: None (Open Label); Primary Purpose: Basic Science
Condition ICMJE	Atrial Fibrillation; Acute Coronary Syndrome
Intervention ICMJE	Drug: Dabigatran, Ticagrelor, ASA; Drug: Rivaroxaban, Ticagrelor, ASA; Drug: Phenprocoumon, Ticagrelor, ASA
Study Arms	Active Comparator: Dabigatran, Ticagrelor, ASA Dabigatran 150mg td Ticagrelor 90 mg td ASA 100 mg od for 5 days Intervention: Drug: Dabigatran, Ticagrelor, ASA; Active Comparator: Rivaroxaban, Ticagrelor, ASA Rivaroxaban 20 mg od Ticagrelor 90 mg td ASA 100 mg od for 5 days Intervention: Drug: Rivaroxaban, Ticagrelor, ASA; Active Comparator: Phenprocoumon, Ticagrelor, ASA Phenprocoumon X mg to reach an INR of 2-3 on day 5 of triple therapy Ticagrelor 90 mg td ASA 100 mg od for 5 days Intervention: Drug: Phenprocoumon, Ticagrelor, ASA
Publications *	Weisshaar S, Litschauer B, Gouya G, Mayer P, Smerda L, Kapiotis S, Kyrle PA, Eichinger S, Wolzt M. Antithrombotic triple therapy and coagulation activation at the site of thrombus formation: a randomized trial in healthy subjects. J Thromb Haemost. 2014 Nov;12(11):1850-60. doi: 10.1111/jth.12726. Epub 2014 Oct 16.
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status ICMJE	Completed
Actual Enrollment ICMJE; (submitted: March 13, 2013)	60
Original Estimated Enrollment ICMJE	Same as current
Actual Study Completion Date	July 2013
Actual Primary Completion Date	May 2013 (Final data collection date for primary outcome measure)
Eligibility Criteria ICMJE	Inclusion Criteria: Healthy male subjects; 18 - 40 years of age; body mass index between 18 and 27 kg/m2; Written informed consent; Normal findings in medical & bleeding history; Non-smoking behaviour Exclusion Criteria: Regular intake of any medication including OTC drugs within 2 weeks before IMP administration; Known coagulation disorders (e.g. haemophilia, von Willebrand´s disease); Known disorders with increased bleeding risk (e.g. peridontosis, haemorrhoids, acute gastritis, peptic ulcer, intestinal ulcer); Known sensitivity to common causes of bleeding (e.g. nasal); History of thromboembolism; Impaired liver function (AST, ALT, GGT >3 x ULN, Bilirubin >2 x ULN); Impaired renal function (serum creatinine > 1.3 mg/dl); Any other relevant deviation from the normal range in clinical chemistry, haematology or urine analysis; HIV-1/2-Ab, HbsAg or HCV-Ab positive serology; Systolic blood pressure below 100 mmHg or above 145 mmHg, diastolic blood pressure above 95 mmHg; Known allergy against test agents; Regular daily consumption of more than on litre of xanthine-containing beverages or more than 40g alcohol; Participation in another clinical trial during the preceding 3 weeks
Sex/Gender	Sexes Eligible for Study: Male
Ages	18 Years to 40 Years (Adult)
Accepts Healthy Volunteers	Yes
Contacts ICMJE	Contact information is only displayed when the study is recruiting subjects
Listed Location Countries ICMJE	Austria
Removed Location Countries
Administrative Information
NCT Number ICMJE	NCT01812200
Other Study ID Numbers ICMJE	ATTT-1.0
Has Data Monitoring Committee	Yes
U.S. FDA-regulated Product	Not Provided
IPD Sharing Statement	Not Provided
Responsible Party	Michael Wolzt, Prof. MD, Medical University of Vienna
Study Sponsor ICMJE	Medical University of Vienna
Collaborators ICMJE	Not Provided
Investigators ICMJE	Principal Investigator: Michael Wolzt, Prof. MD Department of Clinical Pharmacology, Medical University of Vienna
PRS Account	Medical University of Vienna
Verification Date	March 2014
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP