Body Weight Adjusted Clopidogrel Treatment in Patients With CORonary Artery Disease

Extreme body weights (BW) or body mass index (BMI) affect the pharmacokinetics of antithrombotic drugs and consequently may affect cardiovascular risk during treatment. The goal of this clinical trial is to establish if clopidogrel treatment can be optimized in patients with a low or high BW compared to patients with a normal BW by adjusting the dosage of clopidogrel and evaluating platelet reactivity.Participants are stratified into three groups based on their BW (Low BW: BW <60kg; normal BW: 60-100kg; High BW: >100 kg)Clopidogrel dosage will then be adjusted to the BW, as follows:Low BW: >10 days clopidogrel 50mg 1dd1, followed by >10 days clopidogrel 25mg 1dd1.Normal BW: Clopidogrel 75mg 1dd1.High BW: >10 days clopidogrel 150mg 1dd1 followed by >10 days prasugrel 10mg 1dd1.The primary endpoint of the study is P2Y12 Reaction Units (PRU) and platelet inhibition measured using the VerifyNow measured before starting new treatment regimen (at the end of 10 days of treatment).

Inclusion Criteria:Patients, male or female, ≥18 years of agePatients treated for CCS with clopidogrel 75mg QD (aspirin 100mg QD).Patients must be treated with clopidogrel 75mg for at least one monthPatients must give consent by means of a signed informed consentExclusion Criteria:Contra-indication for aspirinContra-indication for clopidogrel or prasugrelOccurrence of an ischemic event after PCI or ACS (stroke, myocardial infarction, or coronary revascularization)Presence of unstable angina complaints.Presence of two CYP2C19 Loss-of-function (LOF) alleles (*2 or *3)Scheduled for cardiac valve surgeryIndication for chronic oral anticoagulantsExpected life span of less than one yearPregnancySuboptimal stent placement as determined by the cardiologist.Patients at increased risk of bleeding with two of the following characteristics: liver cirrhosis with portal hypertension, enhanced bleeding tendency, active malignancy in the past 12 months, thrombocytopenia, major surgery in the past month, spontaneous intracerebral haemorrhage, traumatic intracerebral haemorrhage in the past 12 months, major bleeding requiring hospitalisation or blood transfusion in the past month, ischaemic CVA in the past 5 months.Known with established stent thrombosis