Trial of Andexanet in Patients Receiving an Oral FXa Inhibitor Who Require Urgent Surgery

Surgery Clinical Trial

— Annexa-S  

Official title:

Prospective, Open-Label Clinical Study of Andexanet Alfa in Patients Receiving FXa (Activated Factor X) Inhibitor Who Require Urgent Surgery

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04233073
• Other study ID #: ALXN2070-19-515
• Status: Terminated
• Phase: Phase 2
• Start date: June 27, 2021
• Est. completion date: January 25, 2022

Study information

• Verified date: February 2023
• Source: Alexion
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Prospective, open-label clinical trial to evaluate the efficacy and safety of andexanet alfa patients who require urgent surgery that have been anticoagulated with the FXa (activated factor X) inhibitors.

Description:

This is a multicenter, prospective, open-label study to determine the efficacy and safety of andexanet in patients who require urgent surgery who have received 1 of the following FXa inhibitors: apixaban, rivaroxaban, edoxaban, or enoxaparin. The start of surgery must be within 15 hours following the last dose of FXa inhibitor. The primary efficacy outcome will be adjudicated by an independent Endpoint Adjudication Committee.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 10
• Est. completion date: January 25, 2022
• Est. primary completion date: November 23, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 84 Years

Eligibility

Inclusion Criteria:

All of the following criteria must be met for the patient to be eligible:

• Either the patient or their medical proxy (or legal designee) has given written informed consent.
• Age = 18 and < 85 years old.
• Requires urgent surgical intervention that must occur within 12 hours of consent, for which reversal of anti-fXa activity is judged necessary.
• Treatment with an oral FXa inhibitor (apixaban [last dose 2.5 mg or greater], rivaroxaban [last dose 10 mg or greater], edoxaban [last dose 30 mg or greater] or

enoxaparin [= 1 mg/kg/d]):

• = 15 hours prior to start of surgery.
• > 15 hours prior to start of surgery or unknown time from the last dose, if documented anti fXa activity is > 100 ng/mL (> 0.5 IU/mL for enoxaparin, or over the equivalent IU/mL threshold on a low molecular weight heparin assay; see Laboratory Manual) within 2 hours prior to consent. Note: Patients enrolled in this manner should receive a high-andexanet dosing regimen.
• Have a negative pregnancy test documented prior to enrollment (for women of childbearing potential).
• Willingness to use highly effective methods of contraception through 30 days following study drug dose (for female and male patients who are fertile). Exclusion Criteria:

If a patient meets any of the following criteria, he or she is not eligible:

• Surgery for which the risk of clinically meaningful uncontrolled or unmanageable bleeding is low.
• Acute life-threatening bleeding (ISTH criteria) at the time of Screening:

1. The patient has acute-overt bleeding that is potentially life-threatening, e.g., with signs or symptoms of hemodynamic compromise, such as severe hypotension, poor skin perfusion, mental confusion, low urine output that cannot be otherwise explained.

2. The patient has overt bleeding associated with a fall in hemoglobin level by =2g/dL, OR, a hemoglobin =8 g/dL if no baseline hemoglobin is available.

3. The patient has acute bleeding in a critical area or organ, such as pericardial, intracranial, or intraspinal.

• Any surgical procedure that involves the intraoperative use of systemic, intravascular, unfractionated heparin.
• Primary procedure for efficacy assessment is a non-surgical interventional procedure (e.g, lumbar puncture, skin biopsy, cardiac catheterization, endoscopic retrograde cholangio-pancreatography).
• Expected survival of < 1 month due to comorbidity.
• Known "Do Not Resuscitate" order or similar advanced directive.
• The patient has a recent history (within 30 days prior to screening) of a diagnosed TE as follows: venous thromboembolism (including deep vein thrombosis, pulmonary embolism, intracardiac thrombus), myocardial infarction (including asymptomatic troponin elevations), disseminated intravascular coagulation, acute traumatic coagulopathy, cerebrovascular accident, transient ischemic attack, unstable angina pectoris hospitalization, or severe peripheral vascular disease.
• Acute decompensated heart failure or cardiogenic shock at the time of screening.
• The patient has sepsis or septic or severe hemorrhagic shock at the time of Screening.
• The patient has heparin-induced thrombocytopenia (with or without thrombosis).
• Inherited coagulopathy (e.g., anti-phospholipid antibody syndrome, protein C/S deficiency, Factor V Leiden) at time of Screening.
• Platelet count < 80,000/µL at the time of Screening.
• Last dose of apixaban < 2.5 mg, rivaroxaban < 10 mg, edoxaban < 30 mg, or enoxaparin 40 mg.
• The patient is pregnant or a lactating female.
• The patient has received any of the following drugs or blood products within 7 days of

enrollment:

• Vitamin K antagonists (e.g., warfarin).
• Dabigatran.
• Prothrombin complex concentrate products (e.g., Kcentra®) or recombinant factor VIIa (e.g., NovoSeven®).
• Whole blood, plasma fractions. Note: Administration of tranexamic acid, platelets or packed red blood cells is not an exclusion criterion.
• The patient was treated with an investigational drug < 30 days prior to Screening.
• Prior treatment with andexanet.
• Known hypersensitivity to any component of andexanet.
• Known allergic reaction to hamster proteins.
• Known or suspected (i.e., presumed positive) COVID-19-related illness at the time of Screening.

Related Conditions & MeSH terms

• Surgery

Intervention

Drug:
• andexanet alfa
Andexanet is a recombinant version of human FXa

Locations

Country	Name	City	State
Austria	Clinical Trial Site	Graz
Austria	Clinical Trial Site	Innsbruck
Austria	Clinical Trial Site	Klagenfurt am Wörthersee
Austria	Clinical Trial Site	Wien
France	Clinical Trial Site	Clermont-Ferrand
France	Clinical Trial Site	Dijon
France	Clinical Trial Site	Lille
France	Clinical Trial Site	Nantes
France	Clinical Trial Site	Paris
France	Clinical Trial Site	Paris
Germany	Clinical Trial Site	Aachen
Germany	Clinical Trial Site	Bonn
Germany	Clinical Trial Site	Dortmund
Germany	Clinical Trial Site	Freiburg
Germany	Clinical Trial Site	Gießen
Germany	Clinical Trial Site	Heidelberg
Germany	Clinical Trial Site	Köln
Germany	Clinical Trial Site	Konstanz
Germany	Clinical Trial Site	Mainz
Germany	Clinical Trial Site	Murnau Am Staffelsee
Germany	Clinical Trial Site	Würzburg
Israel	Clinical Trial Site	Ashkelon
Israel	Clinical Trial Site	Haifa
Israel	Clinical Trial Site	Jerusalem
Israel	Clinical Trial Site	Jerusalem
Israel	Clinical Trial Site	Petah Tikva
Japan	Clinical Trial Site	Kamakura
Japan	Clinical Trial Site	Kasuga
Japan	Clinical Trial Site	Kawasaki
Japan	Clinical Trial Site	Kumamoto
Japan	Clinical Trial Site	Kumamoto
Japan	Clinical Trial Site	Kurume
Japan	Clinical Trial Site	Nagoya
Japan	Clinical Trial Site	Sakai
Japan	Clinical Trial Site	Sendai
Japan	Clinical Trial Site	Tokyo
United States	Clinical Trial Site	Boston	Massachusetts
United States	Clinical Trial Site	Boston	Massachusetts
United States	Clinical Trial Site	Camden	New Jersey
United States	Clinical Trial Site	Charlotte	North Carolina
United States	Clinical Trial Site	Columbus	Ohio
United States	Clinical Trial Site	Durham	North Carolina
United States	Clinical Trial Site	Iowa City	Iowa
United States	Clinical Trial Site	Long Beach	California
United States	Clinical Trial Site	Moreno Valley	California
United States	Clinical Trial Site	Philadelphia	Pennsylvania
United States	Clinical Trial Site	Phoenix	Arizona
United States	Clinical Trial Site	Pittsburgh	Pennsylvania
United States	Clinical Trial Site	Pittsburgh	Pennsylvania
United States	Clinical Trial Site	Portland	Oregon
United States	Clinical Trial Site	Sarasota	Florida
United States	Clinical Trial Site	Staten Island	New York
United States	Clinical Trial Site	Tampa	Florida
United States	Clinical Trial Site	Tucson	Arizona
United States	Clinical Trial Site	Tulsa	Oklahoma
United States	Clinical Trial Site	Washington	District of Columbia

Sponsors (1)

Lead Sponsor	Collaborator
Alexion

Countries where clinical trial is conducted

United States,  Austria,  France,  Germany,  Israel,  Japan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants Achieving Effective Hemostasis	Effective hemostasis is defined as excellent or good as assessed by the Investigator; Ineffective hemostasis is defined as moderate or poor as assessed by the Investigator. All data were prespecified to be collected as a single Arm/Group for any participant who received at least 1 dose of the study drug, regardless of their dose level.	Hemostasis will be assessed from the start of surgery to the end of the procedure
Secondary	Percent Change From Baseline In Anti-fXa Activity To Treatment Nadir	Baseline is defined as the last non-missing value on or before first study drug administration. On treatment nadir is the minimum value of anti-fXa activity during the period of time from the end of the andexanet bolus to the end of the andexanet infusion. All data were prespecified to be collected as a single Arm/Group for any participant who received at least 1 dose of the study drug, regardless of their dose level.	Baseline, Treatment nadir (not to exceed a total of 6.5 hours of andexanet dosing)