Reversal Agent Use in Patients Treated With Direct Oral Anticoagulants (RADOA)
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Purpose
Patients treated with Vitamin K antagonists (VKA) or direct oral anticoagulants as Rivaroxaban, Apixaban, Edoxaban or Dabigatran, who experience severe bleeding and/or need urgent interventions/operations that cannot wait are included in this registry, when they receive intervention with a reversal agent (e.g. PCC, aPCC; rVIIa and/or hemodialysis (for removal of dabigatran)).
| Condition |
|---|
|
Severe Bleeding Urgent Surgery |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Prospective, Observational, Non-interventional Open-label Multicenter Registry Regarding the Management of Severe Bleeding and/or Urgent Interventions During Treatment With Direct Oral Anticoagulants |
- Primary Outcome [ Time Frame: open ] [ Designated as safety issue: Yes ]
- Stop of bleeding
- Fatality rate caused by non-stop bleeding
- In case of urgent operation satisfaction of surgeon during and after surgery concerning bleeding using a standardized questionnaire
- Secondary Outcome [ Time Frame: open ] [ Designated as safety issue: Yes ]
- use versus no use of reversal agents - difference in outcome?
- definition of supportive measures being effective in stopping bleeding
- effectiveness of dialysis vs. no dialysis in case of dabigatran accumulation associated with bleeding
Biospecimen Retention: Samples Without DNA
If possible, left-over from plasma samples ("retention sample") should be used to perform further analyses as drug concentrations. Retention samples of very low volume would suffice for HPLC (information on collection method needed) to assess plasma concentrations of anticoagulants in these patients.
| Estimated Enrollment: | 130 |
| Study Start Date: | August 2013 |
| Estimated Study Completion Date: | September 2015 |
| Estimated Primary Completion Date: | July 2015 (Final data collection date for primary outcome measure) |
| Groups/Cohorts |
|---|
|
DOA
Group 1: 130 patients treated with DOA
|
|
VKA
Group 2: 130 treated with VKA
|
Detailed Description:
The Registry will offer the opportunity to evaluate the effects of reversal agents as PCC, aPCC, rVIIa in e.g. severe bleeding patients treated with oral anticoagulants.
By collecting case reports from several university hospitals and clinics, different treatment strategies in clinical practice will be observed and evaluated, and may serve as a comprehensive information resource for the safe management with DOA, but also with the long-term anticoagulation based on coumarin derivatives in the near future.
Study Registry Design Prospective, Observational, Non-interventional Open-label Multicenter and International
- Non-interventional: TBC as specific analyses are planned on retention blood samples which are taken anyhow during patient management
- Prospective: inclusion into the registry will be done when the acute emergency situation has passed
- Observational: Treatment decision will be at the discretion of the treating physician based on individual patients situation The decision to enter the patient into the registry will occur after all treatment decisions have been taken.
The Main Registry Objective of this Registry is to:
- Document the clinical course, incidence and outcome of various clinical bleeding events associated with DOA in patients with severe bleeding making intervention necessary or who need urgent intervention/surgery that cannot wait AND
- Evaluate the effectiveness of their responses to its intervention treatment including: a. reversal agent; b. haemodialysis; c. waiting;
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Probability Sample |
N= 130 patients treated with DOA N= 130 treated with VKA
Patient Eligibility
a) Bleeding patients:
Anticoagulated patients with DOA or VKA with clinically overt major bleeding according to a specified ISTH definition for non-surgical patients:
- Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome
- Bleeding causing a fall in hemoglobin level of 20 g L-1 (1.24 mmol L-1 ) or more leading to transfusion of two or more units of whole blood or red cells.
OR b) Acute surgical need Patients treated with DOA or VKA and who need urgent operation which cannot wait (< 24 h after last intake of drug)
AND
with or without reversal agent use (e.g. PCC, aPCC, rVIIa) (and/or haemodialysis for dabigatran)
AND
- provides informed consent after the acute event
Contacts and Locations| Contact: Edelgard Lindhoff-Last, MD | +49-6963015096 | lindhoff-last@em.uni-frankfurt.de |
More Information
No publications provided
| Responsible Party: | Prof. Dr. E. Lindhoff-Last, Division of Angiology, Department of Internal Medicine, Johann Wolfgang Goethe University Hospitals |
| ClinicalTrials.gov Identifier: | NCT01722786 History of Changes |
| Other Study ID Numbers: | RADOA-Registry |
| Study First Received: | November 5, 2012 |
| Last Updated: | May 8, 2013 |
| Health Authority: | Germany: Ethics Commission |
Keywords provided by Johann Wolfgang Goethe University Hospitals:
|
severe bleeding dabigatran rivaroxaban apixaban edoxaban |
PCC aPCC rVIIa hemodialysis |
Additional relevant MeSH terms:
|
Hemorrhage Pathologic Processes Anticoagulants |
Hematologic Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on May 23, 2013