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Completed

NCT Number: NCT01099566

The Role of the P2Y12 Receptor in Tissue Factor Induced Coagulation

Severe sepsis still carries a high mortality rate despite advantages in intensive care medicine and antimicrobial therapy. The inflammatory and procoagulant host response to infection are intricately linked and interactions between platelets, leukocytes and the endothelium play a central role in the pathogenesis of septic shock and disseminated intravascular coagulation (DIC). Interestingly, one key player cell in coagulation, i.e. the platelet, has been somewhat neglected as to its position in the pathogenesis of coagulation abnormalities in sepsis. However, thienopyridines, irreversible platelet P2Y12 ADP-receptor antagonists, e.g. prasugrel, could potentially provide beneficial anticoagulatory and antiinflammatory effects: P2Y12 ADP-receptor antagonists reduce TF-induced coagulation activation in various ex vivo and in vitro models. Moreover, various lines of evidence indicate that thienopyridines may block platelet leukocyte interactions and thereby reduce the propagation of the coagulation and inflammation process.

LPS-infusion in healthy volunteers provides a standardized model to safely study non overt DIC and to document possible effects of therapeutic and prophylactic interventions.

The investigators hypothesize that thienopyridines, irreversible platelet P2Y12 ADP-receptor antagonists, may blunt TF-triggered coagulation activation in humans, which will be studied in a TF-dependent coagulation model in humans.

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Key information

Age range

19 year–40 year

Sex eligibility

Male

Study type

Interventional

Phase

Phase 4

Primary location

Medical University of Vienna, Department of Clinical Pharmacology

Vienna, State of Vienna, A-1090, Austria

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Signed informed consent obtained before any trial-related activities.
  • Men aged >18 and <41 years
  • Normal findings in medical history and physical examination unless the investigator considers an abnormality to be clinically irrelevant
  • Normal laboratory values unless the investigator considers an abnormality to be clinically irrelevant

Exclusion criteria

  • Known or suspected allergy to trial product or related products (Prasugrel, Clopidogrel, Ticlopidine)
  • Known or suspected hereditary problems of galactose intolerance, Lapp lactase deficiency or glucosegalactose malabsorption
  • Treatment with an investigational drug within three weeks prior to this trial
  • Treatment with a drug (e.g. ketoconazole, omeprazole) that interferes with cytochrome P450, the enzyme responsible for the conversion of prasugrel to its active form, three weeks prior to this trial
  • Participation in an LPS trial within the last 6 weeks
  • Smoking of more than 5 cigarettes per day
  • Hereditary deficiency of protein C or S, or a mutation of FV (Leiden), or any other known abnormality affecting coagulation, fibrinolysis or platelet function
  • History of gastro-duodenal ulcera, cardiovascular disease, vasculitis, diabetes mellitus, or hypertension
  • History of brain tumor or history of neurosurgery
  • Hemorrhagic diathesis, trauma or surgery within last 3 months
  • History of hemorrhagic retinopathy
  • Hematuria or detection of occult blood in stool sample
  • Liver or kidney dysfunction
  • Regular use of medication or abuse of alcohol
  • Use of any medication within one week prior to the first trial day
  • Symptoms of a clinically relevant illness in the 3 weeks before the first trial day
  • Excessive sporting activities
  • Weight >95kg and <60kg

Treatment and study plan

Prasugrel

Drug

Prasugrel will be given as loading dose (60mg) on the first trial day two hours prior to endotoxin infusion. Prasugrel is an orally administered prodrug that is converted in the liver by CYP to its active metabolite.

Other names: Generic name: Prasugrel, Brand name: Efient, Manufacturer: Eli Lilly, Dose: 60mg loading dose (6 tablets a 10mg) on trial day 1

Placebo

Drug

A pharmacist not otherwise involved in the trial will encapsulate pills consisting of lactose-starch. Six pills will be administered as placebo 2 hours before LPS administration on trial day 1.

Other names: Content: Pills consisting of lactose-starch, Manufacturer: AKH Anstaltsapotheke, Dose: Same number of pills as in the prasugrel period (6 tablets on trial day 1); identically encapsulated by a pharmacist not otherwise involved in the trial

Primary outcomes

  1. prothrombin fragments (F1+2)

    Time frame: -2 to 24 hours after LPS infusion

    To explore whether P2Y12 ADP-receptor antagonism can block activation of the coagulation cascade induced by endotoxemia, in particular decrease LPS mediated thrombin formation as measured by prothrombin fragment (F1+2).

Secondary outcomes

  1. platelet-leukocyte co-aggregation

    Time frame: -2 to 24 hours after LPS infusion

    to explore whether P2Y12 ADP-receptor antagonism decreases platelet -leukocyte co-aggregation

  2. tissue factor expression

    Time frame: -2 to 24 hours after LPS infusion

    to investigate the influence of P2Y12 ADP-receptor antagonism on tissue factor expression

  3. anti-platelet effects of prasugrel

    Time frame: -2 to 24 hours after LPS infusion

    to explore if low dose endotoxemia interferes with the anti-platelet effects of prasugrel

Sponsors and collaborators

Lead sponsor

Medical University of Vienna

Other

Registry information

Important dates

Study start
2009
Primary completion
2010
Study completion
2010
First posted
Apr 7, 2010
Registry last updated
Jul 11, 2011

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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