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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT00125671
Other study ID # MCT-37413
Secondary ID T4913
Status Active, not recruiting
Phase Phase 3
First received July 29, 2005
Last updated September 27, 2009
Start date January 2000
Est. completion date April 2006

Study information

Verified date September 2009
Source Warfarin and Antiplatelet Vascular Evaluation
Contact n/a
Is FDA regulated No
Health authority Canada: Health Canada
Study type Interventional

Clinical Trial Summary

The purpose of this study is to evaluate whether the addition of warfarin (a blood-thinning medication) to an antiplatelet therapy like aspirin is better than antiplatelet therapy alone (i.e. usual treatment) for the prevention of leg surgery, heart attacks, stroke and death in people with peripheral vascular disease.


Description:

Atherosclerosis is the underlying cause of peripheral vascular disease (PVD) of the lower extremities, and leads to intermittent claudication, leg ulceration and gangrene. More importantly, symptomatic PVD is an ominous sign that widespread atherosclerosis is present and patients with this condition suffer a threefold increase in myocardial infarction (MI), stroke, and CV death. These CV events are a consequence of rupture of an atherosclerotic plaque, which leads to platelet activation and thrombin generation, thrombus formation and occlusion of a critical blood vessel. Antiplatelet therapy has been clearly demonstrated to reduce major CV events. It is also reasonable to expect that this process may be further attenuated by the addition of an anti-thrombin agent (such as warfarin) in combination with antiplatelet agents.

WAVE is a large, international, multicentre, randomized clinical trial in high-risk PVD patients to evaluate the additional benefit of moderate intensity warfarin (target INR of 2.4-3.0) to antiplatelet therapy compared to antiplatelet therapy alone in reducing serious cardiovascular events.

There are currently 80 active centres following participants in Canada, Poland, Australia, Hungary, China, Ukraine, and the Netherlands. Following randomization to one of the two treatment groups, participants will require clinic or phone follow-up visits every 3 months for 2.5 or 3.5 years. For participants on warfarin, INRs will be measured monthly or more frequently if required. For participants who stop warfarin therapy prematurely, every attempt will be made to have them restart it


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 2400
Est. completion date April 2006
Est. primary completion date
Accepts healthy volunteers No
Gender Both
Age group 35 Years to 85 Years
Eligibility Inclusion Criteria:

- Intermittent claudication with objective evidence of PVD (e.g. ankle-brachial index [ABI] < 0.90)

- Ischemic rest pain of the lower limbs

- Ischemic non-healing ulcers or focal gangrene

- Amputation for vascular causes

- Previous peripheral vascular revascularization (angioplasty or bypass surgery)

- Blue toe syndrome

- Other significant peripheral arterial disease (e.g. carotid stenosis)

- Vascular disease and evidence of asymptomatic peripheral arterial disease [PAD] (i.e. ABI < 0.90)

Exclusion Criteria:

Temporary:

- Potential subjects will be temporarily excluded if they need to undergo:

- vascular diagnostic (angiography) or interventional procedures (arterial bypass graft surgery or angioplasty); or

- limb amputation for vascular insufficiency.

Permanent:

- Subjects will be excluded for the following:

- active bleeding or high risk bleeding;

- clear indication for long-term warfarin use (i.e. atrial fibrillation);

- previous allergy or intolerance to warfarin;

- stroke in the last 6 months;

- renal failure requiring dialysis;

- known significant abdominal aortic or cerebral aneurysm;

- peripheral arterial aneurysms (iliac or femoral) without evidence of lower limb ischemia;

- significant liver disease (i.e. cirrhosis);

- cancer with a life expectancy < 6 months;

- anticipated non-adherence to warfarin;

- excessive alcohol use;

- pregnancy or planning to become pregnant; or

- failure to provide informed consent.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention


Intervention

Drug:
Warfarin


Locations

Country Name City State
Canada Population Health Research Institute, McMaster University Hamilton Ontario

Sponsors (3)

Lead Sponsor Collaborator
Anand, Sonia, M.D. Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Ontario

Country where clinical trial is conducted

Canada, 

References & Publications (1)

WAVE Investigators. The effects of oral anticoagulants in patients with peripheral arterial disease: rationale, design, and baseline characteristics of the Warfarin and Antiplatelet Vascular Evaluation (WAVE) trial, including a meta-analysis of trials. Am Heart J. 2006 Jan;151(1):1-9. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary The composite of cardiovascular (CV) death, first occurrence of myocardial infarction (MI), or stroke
Primary The composite of CV death, first occurrence of MI, stroke, or severe ischemia requiring urgent intervention of the coronary (PTCA, CABG) or peripheral artery circulation (thrombolytic therapy, angioplasty, bypass surgery, limb amputation)
Secondary CV death, MI, stroke, amputation, revascularization of the coronary or peripheral arteries, or admission to hospital for unstable angina with electrocardiogram (ECG) changes
Secondary CV death, MI, stroke, transient ischemic attack (TIA), amputation or revascularization of the coronary, carotid, or leg arteries
Secondary All cause death, MI, TIA, stroke, amputation, or revascularization of the coronary or peripheral arteries
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