A Study of Apixaban in Patients With Atrial Fibrillation, Not Caused by a Heart Valve Problem, Who Are at Risk for Thrombosis (Blood Clots) Due to Having Had a Recent Coronary Event, Such as a Heart Attack or a Procedure to Open the Vessels of the Heart
- Conditions
- Acute Coronary Syndromes
- Interventions
- Other: Acetylsalicylic acid placebo
- Registration Number
- NCT02415400
- Lead Sponsor
- Bristol-Myers Squibb
- Brief Summary
The purpose of this study is to determine if Apixaban is safer than a Vitamin K Antagonist given for 6 months in terms of bleeding in patients with an irregular heart beat (atrial fibrillation) and a recent heart attack or a recent procedure to open up a blood vessel in the heart. All patients would also be taking a class of medicines called P2Y12 inhibitors (such as clopidogrel/Plavix) and be treated for up to 6 months. The primary focus will be a comparison of the bleeding risk of Apixaban, with or without aspirin, versus a Vitamin K antagonist, such as warfarin, with or without aspirin.
- Detailed Description
Patients will be recruited from either inpatient coronary care or general medical units, or recruited from outpatient cardiology offices.
Masking:
Apixaban: Open label.
VKA: Open label.
Acetylsalicylic acid film coated tablet: Double Blinded.
Placebo matching Acetylsalicylic acid film coated tablet: Double Blinded.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 4614
- Adults with either active or a history of non-valvular atrial fibrillation or flutter with the planned or existing use of an oral anticoagulant for prophylaxis of thromboembolism. In addition, subjects must have had an acute coronary syndrome or percutaneous coronary intervention with a stent within the prior 14 days
- Planned use of antiplatelet agents for at least 1 to 6 months
- Males and Females ≥ 18 years of age
- Women of childbearing potential must have a negative serum or urine pregnancy test within 24 hours prior to the start of study drug
- Conditions other than atrial fibrillation that require chronic anticoagulation. (e.g. prosthetic mechanical heart valve)
- Severe renal insufficiency (serum creatinine > 2.5 mg/dL or a calculated creatinine clearance < 30 mL/min
- Patients with a history of intracranial hemorrhage
- Patients have had or will undergo Coronary arterial bypass graft (CABG) for their index acute coronary syndrome (ACS) event
- Patients with known ongoing bleeding and patients with known coagulopathies
- Any contraindications or allergies to VKA, apixaban, or to intended P2Y12 antagonists or to aspirin
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Placebo matching Acetylsalicylic acid film coated tablet Acetylsalicylic acid placebo Placebo matching Acetylsalicylic acid film coated tablet once daily Vitamin K Antagonist vitamin K antagonist VKA tablets orally once daily Apixaban Apixaban 5 mg or 2.5 mg Apixaban tablets orally twice per day Acetylsalicylic acid film coated tablet Acetylsalicylic acid 81 mg Acetylsalicylic acid film coated tablet orally once daily
- Primary Outcome Measures
Name Time Method The Rate of International Society on Thrombosis and Haemostasis (ISTH) Major or Clinically Relevant Non-Major (CRNM) Bleeding With Apixaban Versus Vitamin K Antagonist (VKA) During the Treatment Period Approximately 6 months Time to first ISTH major or CRNM bleeding during the 6-month period of treatment with Apixaban or VKA.
N is the number of participants treated with Apixaban or VKA.
n is the number of participants treated with Apixaban or VKA with major or CRNM bleeding in each treatment group during the 6-month period of treatment.
Event rates are calculated based on the number of participants with major or CRNM bleeding divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.The Rate of ISTH Major or CRNM Bleeding With Aspirin Versus no Aspirin During the Treatment Period Approximately 6 months Time to first ISTH major or CRNM bleeding during the treatment period of 6 months with aspirin or placebo.
N is the number of participants with aspirin or placebo.
n is the number of participants treated with aspirin or placebo with major or CRNM bleeding in each treatment group during the 6-month period of treatment.
Event rates are calculated based on the number of participants with event of interest divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.
- Secondary Outcome Measures
Name Time Method Superiority on ISTH Major or CRNM Bleeding for Apixaban Versus VKA Approximately 6 months Time to first occurrence during the time the participants were treated with Apixaban or VKA.
N is the number of participants treated with Apixaban or VKA.
n is the number of participants treated with Apixaban or VKA with major or CRNM bleeding in each treatment group during the 6-month period of treatment.
Event rates are calculated based on the number of participants with event of interest divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.The Rate of All-cause Death or All-cause Rehospitalization With Apixaban Versus VKA Approximately 6 months Time to first all-cause death or all-cause hospitalization during the during the 6-month treatment period with Apixaban or VKA.
N is the number of participants treated with Apixaban or VKA.
n is the number of participants treated with Apixaban or VKA with all-cause death or all-cause hospitalization in each treatment group during the 6-month period of treatment.
Event rates are calculated based on the number of participants with all-cause death or all-cause hospitalization divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.The Rate of All-cause Death or All-cause Rehospitalization With Aspirn Versus no Aspirin Approximately 6 months Time to first all-cause death or all-cause hospitalization during the 6-month period of treatment with aspirin or placebo.
N is the number of participants treated with aspirin or placebo.
n is the number of participants treated with aspirin or placebo with all-cause death or all-cause hospitalization in each treatment group during the 6-month period of treatment.
Event rates are calculated based on the number of participants with all-cause death or all-cause hospitalization divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.The Rate of the Composite Endpoint of Death or Ischemic Events (Stroke, Myocardial Infarction, Stent Thrombosis, Urgent Revascularization) With Apixaban Versus VKA Approximately 6 months Time to first occurrence during the 6-month treatment period with Apixaban or VKA.
N is the number of participants treated with Apixaban or VKA.
n is the number of participants treated with Apixaban or VKA with death or ischemic events in each treatment group during the during the 6-month period of treatment.
Event rates are calculated based on the number of participants with death or ischemic events divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.The Composite Endpoints of Death and Ischemic Events (Stroke, Myocardial Infarction, Stent Thrombosis, Urgent Revascularization) With Aspirin Versus no Aspirin Approximately 6 months Time to first death or ischenic event during the 6-month treatment period with aspirin or placebo.
N is the number of participants treated with aspirin or placebo.
n is the number of participants treated with aspirin or placebo with death or ischemic events in each treatment group during the 6-month treatment period.
Event rates are calculated based on the number of participants with death or ischemic events divided by the sum of the number of days from the first dose of study drug to the event date or censoring date and expressed as percentage per year.
Trial Locations
- Locations (93)
Scottsdale Osborn Medical Center
🇺🇸Scottsdale, Arizona, United States
Southern Arizona VA Health Care System
🇺🇸Tucson, Arizona, United States
Saint Lukes Idaho Cardiology Associates
🇺🇸Boise, Idaho, United States
Imperial Health
🇺🇸Lake Charles, Louisiana, United States
Clinical Trials of America LA LLC - PPDS
🇺🇸Monroe, Louisiana, United States
New Jersey Heart
🇺🇸Linden, New Jersey, United States
Renown Regional Medical Center.
🇺🇸Reno, Nevada, United States
Bryan Heart Hospital
🇺🇸Lincoln, Nebraska, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Local Institution
🇻🇮Christiansted, Virgin Islands (U.S.)
Washington Township Medical Foundation
🇺🇸Fremont, California, United States
Colorado Heart and Vascular
🇺🇸Lakewood, Colorado, United States
Comprehensive Cardiovascular Specialists
🇺🇸Alhambra, California, United States
California Heart Specialist, Inc.
🇺🇸Huntington Beach, California, United States
Foundation For Cardiovascular Medicine
🇺🇸La Jolla, California, United States
Orlando Heart Specialists
🇺🇸Altamonte Springs, Florida, United States
Manshadi Heart Institute
🇺🇸Stockton, California, United States
Daytona Heart Group
🇺🇸Daytona Beach, Florida, United States
Mediquest Research
🇺🇸Ocala, Florida, United States
Clearwater Cardiovascular and Interventional Consultants
🇺🇸Clearwater, Florida, United States
Tenet Florida Physician Services
🇺🇸Jupiter, Florida, United States
CP Cardiology Partners
🇺🇸Palm Beach Gardens, Florida, United States
Bayfront Health St. Petersburg
🇺🇸Saint Petersburg, Florida, United States
Georgia Heart Specialists
🇺🇸Covington, Georgia, United States
Cardiology Partners
🇺🇸Wellington, Florida, United States
Medicoricium, LLC
🇺🇸Fairview Heights, Illinois, United States
Augusta University
🇺🇸Augusta, Georgia, United States
Athens Regional Cariology Group
🇺🇸Athens, Georgia, United States
Gateway Cardiology PC
🇺🇸Saint Louis, Missouri, United States
Advocate Medical Group ? Cardiology and Pulmonology
🇺🇸Normal, Illinois, United States
South Suburban Cardiology
🇺🇸Olympia Fields, Illinois, United States
Reid Hospital and Health Care Services
🇺🇸Richmond, Indiana, United States
Elkhart Clinic LLC
🇺🇸Elkhart, Indiana, United States
Roudebush VA Medical Center
🇺🇸Indianapolis, Indiana, United States
University of Iowa Stead Family Children's Hospital
🇺🇸Iowa City, Iowa, United States
Midwest Cardiovascular Research Foundation
🇺🇸Davenport, Iowa, United States
Alexandria Cardiology Clinic
🇺🇸Alexandria, Louisiana, United States
Northeast Iowa Family Practice Center
🇺🇸Waterloo, Iowa, United States
Saint Elizabeth Healthcare
🇺🇸Crestview Hills, Kentucky, United States
Great Lakes Heart Center of Alpena
🇺🇸Alpena, Michigan, United States
Covenant Center for the Heart
🇺🇸Saginaw, Michigan, United States
Hattiesburg Clinic
🇺🇸Hattiesburg, Mississippi, United States
Cardiology Associates Research LLC
🇺🇸Tupelo, Mississippi, United States
St. Louis Heart and Vascular
🇺🇸Saint Louis, Missouri, United States
HCP Clinical Research LLC
🇺🇸Las Vegas, Nevada, United States
New York-Presbyterian Brooklyn Methodist Hospital
🇺🇸Brooklyn, New York, United States
Capital Cardiology Associates
🇺🇸Albany, New York, United States
Buffalo Heart Group LLP
🇺🇸Buffalo, New York, United States
Hudson Valley Cardiovascular Practice, PC
🇺🇸Poughkeepsie, New York, United States
Asheville Cardiology Associates PA
🇺🇸Asheville, North Carolina, United States
Mount Sinai-St. Lukes
🇺🇸New York, New York, United States
Clinical Trials of America-NC, LLC - PPDS
🇺🇸Lenoir, North Carolina, United States
Duke Cardiology and Cardiovascular Surgery of Lumberton
🇺🇸Lumberton, North Carolina, United States
Aultman Hospital
🇺🇸Canton, Ohio, United States
PMG Research of Wilmington
🇺🇸Wilmington, North Carolina, United States
Saint Vincent Hospital
🇺🇸Erie, Pennsylvania, United States
Heart Group
🇺🇸Lancaster, Pennsylvania, United States
WellSpan York Hospital
🇺🇸York, Pennsylvania, United States
Mercer Bucks Cardiology
🇺🇸Newton, Pennsylvania, United States
Columbia Heart
🇺🇸Columbia, South Carolina, United States
Roper St. Francis Healthcare
🇺🇸North Charleston, South Carolina, United States
Cardiovascular Associates of the Southeast, LLC
🇺🇸Birmingham, Alabama, United States
University of Alabama at Birmingham
🇺🇸Birmingham, Alabama, United States
Arizona Heart Rhythm Center
🇺🇸Phoenix, Arizona, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Metropolitan Cardiology Consultants
🇺🇸Minneapolis, Minnesota, United States
Durham VA Medical Center
🇺🇸Durham, North Carolina, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Mercury Medical LLC
🇺🇸San Antonio, Texas, United States
Victoria Heart and Vascular Center
🇺🇸Victoria, Texas, United States
Knoxville Health Managment Associates Cardiology PPM LLC
🇺🇸Knoxville, Tennessee, United States
Angiocardiac Care of Texas PA
🇺🇸Houston, Texas, United States
University of Vermont
🇺🇸Burlington, Vermont, United States
San Antonio Military Medical Center
🇺🇸Fort Sam Houston, Texas, United States
Research Associates of Jackson
🇺🇸Jackson, Tennessee, United States
Grace Research, LLC
🇺🇸Huntsville, Texas, United States
Caprock Cardiac Center Research Institute
🇺🇸Lubbock, Texas, United States
Carolina Cardiology Clinical Research Institute
🇺🇸Rock Hill, South Carolina, United States
Parkway Cardiology Associates PC
🇺🇸Oak Ridge, Tennessee, United States
Cardiovascular Research of Knoxville
🇺🇸Knoxville, Tennessee, United States
Virginia Heart
🇺🇸Falls Church, Virginia, United States
Aspirus Research Institute
🇺🇸Wausau, Wisconsin, United States
St Mary's Medical Center
🇺🇸Huntington, West Virginia, United States
Virginia Heart Group Ltd
🇺🇸Leesburg, Virginia, United States
University Of Colorado
🇺🇸Aurora, Colorado, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Missouri Cardiovascular Specialists
🇺🇸Columbia, Missouri, United States
Cox Health Systems
🇺🇸Springfield, Missouri, United States
CJW Medical Center
🇺🇸Richmond, Virginia, United States
University of Louisville
🇺🇸Louisville, Kentucky, United States
University of North Carolina School of Medicine
🇺🇸Chapel Hill, North Carolina, United States
Upstate Cardiology PA
🇺🇸Greenville, South Carolina, United States
Rhode Island Hospital
🇺🇸Providence, Rhode Island, United States