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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT04977076
Other study ID # METCZ20210099
Secondary ID
Status Not yet recruiting
Phase N/A
First received
Last updated
Start date October 1, 2021
Est. completion date December 31, 2023

Study information

Verified date July 2021
Source Zuyderland Medisch Centrum
Contact Jasper Luijkx, MD
Phone 08854597522
Email j.luijkx@zuyderland.nl
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

A prospective, multicenter, 1:1 randomized, investigator initiated study. Goal of this study is to examine the safety of uninterrupted periprocedural NOAC use.


Description:

Rationale: Patients with atrial fibrillation (AF) often have coexisting coronary artery disease (CAD). An estimated 5 to 15% of all AF patients will require coronary stenting. Direct Oral Anticoagulants (DOAC) are more commonly used in preventing thromboembolic complications in patients with AF, thereby substituting the use of Vitamin-K Antagonists (VKA). Therefore, many patients undergoing invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) are taking direct oral anticoagulants (DOAC). In patients using VKA it is recommended to defer elective coronary angiography until INR is <2.2 when radial artery access is used. However, no large clinical trials have proven the safety of continuing DOAC use when undergoing ICA or PCI. The current guidelines recommend interrupting DOAC treatment at least 24 before ICA or PCI; however, this recommendation is only based on limited data. Clinical decisions on DOAC use must therefore be based on clinical trials in which substantial numbers of patients with Acute Coronary Syndrome (ACS) were included. Objective: To study the safety of DOAC continuation in patients undergoing ICA or PCI. Study design: A prospective, multicenter, 1:1 randomized, investigator initiated study. Study population: Patients aged >18 years using DOAC and undergoing elective ICA or PCI. Intervention: The intervention group will continue using DOAC as usual. No adjustments of DOAC use will be made before and after ICA or PCI. The control group will receive standard care. DOAC use will be interrupted at least 24-48 hours in advance of ICA or PCI, based on renal clearance and DOAC specimen. Main study parameters/endpoints: : Non-CABG related in-hospital major bleeding (BARC 3 or 5). Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Only a small burden is associated with participation. Patients are asked to fill out a questionnaire after 30 days. Patients in the control group may have a mildly higher risk of thromboembolic complications and patients in the intervention group may have a mildly higher risk of bleeding complications.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 1214
Est. completion date December 31, 2023
Est. primary completion date December 31, 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Patients aged >18 years using DOAC and undergoing elective ICA or PCI. - Provided signed informed consent Exclusion Criteria: A potential subject who meets any of the following criteria will be excluded from participation in this study: Any of the following: - Patients initially presenting with Acute Coronary Syndrome (STEMI, NSTEMI, UA) - Patients <18 years old - Calculated CLCR <30 mL/min - Patients simultaneously participating in another clinical trial - History or condition associated with increased bleeding risk, as listed below: - Major surgical procedure within 30 days before the procedure - Known inaccessible radial artery during previous procedure - History of GI bleeding in the previous 6 months - History of intracranial, intraocular, spinal, or atraumatic intra-articular bleeding - Chronic bleeding disorder - Known intracranial neoplasm, arteriovenous malformation, or aneurysm - Known anemia with last measured haemoglobin value <6 mmol/L [9.67 g/dL] - Current pregnancy or breast-feeding - Known significant liver disease (e.g., acute clinical hepatitis, chronic active hepatitis, cirrhosis), or ALT >3 x the ULN - Participation in another clinical trial

Study Design


Intervention

Other:
Uninterrupted NOAC use
Continuing NOAC use in advance of elective CAG or PCI.
Interrupted NOAC use
Usual care, interruption of NOAC prior to procedure.

Locations

Country Name City State
n/a

Sponsors (1)

Lead Sponsor Collaborator
Zuyderland Medisch Centrum

Outcome

Type Measure Description Time frame Safety issue
Primary Major Bleeding Non-CABG related in-hospital major bleeding (BARC 3 or 5) 30 days
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