Optimal Anticoagulation for Higher Risk Patients Post-Catheter Ablation for Atrial Fibrillation Trial (OCEAN)
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|ClinicalTrials.gov Identifier: NCT02168829|
Recruitment Status : Active, not recruiting
First Posted : June 20, 2014
Last Update Posted : February 28, 2023
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|Condition or disease||Intervention/treatment||Phase|
|Atrial Fibrillation Stroke||Drug: Rivaroxaban Drug: Acetylsalicylic acid||Phase 4|
This is a prospective, open-label, randomized trial to investigate whether a strategy of ongoing, long-term oral anticoagulation with rivaroxaban 15 mg daily is superior to a strategy of antiplatelet therapy, ASA 75-160 mg, alone in preventing cerebral embolic events in moderately high risk patients following successful catheter ablation for atrial fibrillation..
At least one year post-successful catheter ablation for AF or left atrial flutter/tachycardia without evidence of any clinically apparent arrhythmia recurrence based on at least one 24 hour Holter and ECG within 6 months after the last ablation procedure and at least one 24 hour Holter and ECG between 6 and 12 months post-ablation or beyond. Patient must have no atrial fibrillation, atrial flutter or atrial tachycardia > 30 seconds detected on a minimum 48 hour Holter monitor within two months prior to enrollment.
Patients will be randomized in a 1:1 fashion to ASA 75-160 mg daily or rivaroxaban 15 mg daily. Patients will be seen at 6 months, one year and every year thereafter for a minimum of 3 years. Blood chemistry tests, ECG, holters and patient quality of life questionnaires will be done annually.
Cerebral MRI scanning at baseline and at three years will be done for assessment of silent cerebral infarction. MRI imaging will be performed using a specific protocol.
A pre-specified subset of patients will undergo insertion of a implantable loop recorder (ILR) capable of automated AF detection.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||1284 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||The Optimal Anticoagulation for Enhanced Risk Patients Post-Catheter Ablation for Atrial Fibrillation Trial|
|Study Start Date :||January 2016|
|Estimated Primary Completion Date :||July 2025|
|Estimated Study Completion Date :||August 2025|
Active Comparator: Rivaroxaban
Rivaroxaban 15 mg daily
Other Name: Xarelto
Active Comparator: Acetylsalicylic acid (ASA)
ASA 75-160 mg daily (if intolerant to ASA, no antiplatelet therapy will be prescribed)
Drug: Acetylsalicylic acid
- Composite of stroke, systemic embolism and covert embolic stroke as detected by cerebral MRI [ Time Frame: 3 years ]Composite of stroke, systemic embolism and covert embolic stroke as detected by cerebral MRI. A patient will be considered to have a covert stroke if one or more lesions > 15 mm has been detected between the baseline, and final (3 year) MRI on T2 weighted and/or FLAIR imaging protocols.
- Clinical, overt stroke [ Time Frame: Up to 3 years ]Clinical, Overt stroke
- Incidence of one or more covert MRI stroke(s) >15 mm [ Time Frame: Up to 3 years ]Incidence of one or more covert MRI stroke(s) >15 mm
- Composite of all major and minor bleeding [ Time Frame: Up to 3 years ]Composite of all major and minor bleeding
- Major bleeding only [ Time Frame: Up to 3 years ]Major bleeding only
- Minor bleeding only [ Time Frame: Up to 3 years ]Minor bleeding only
- Intracranial hemorrhage [ Time Frame: Up to 3 years ]Intracranial hemorrhage (clinical and covert on MRI alone)
- Transient ischemic attack [ Time Frame: Up to 3 years ]Transient ischemic attack defined as presence of a new focal neurologic deficit thought to be vascular in origin, with signs or symptoms lasting <24 hours
- All-cause mortality [ Time Frame: Up to 3 years ]All-cause mortality
- Net clinical benefit based on reduction in stroke/TIA rate compared to major bleeding events. [ Time Frame: Up to 3 years ]Net clinical benefit based on reduction in stroke/TIA rate compared to major bleeding events.
- Occurrence of non-primary endpoint MRI changes from baseline to final scan [ Time Frame: 3 years ]Occurrence of non-primary endpoint MRI changes from baseline to final scan including: quantification of cerebral atrophy, quantification of cerebral white matter changes, number of all new MRI lesions > 3mm, >5 mm, > 15 mm, and > 20 mm, and number of lesions detected exclusively on DW-MRI
- Neuropsychological testing [ Time Frame: 3 years ]Neuropsychological testing - performed at baseline and repeated at 3 years.
- Health economics [ Time Frame: 3 years ]Cost utilization and cost effectiveness analysis
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|Ages Eligible for Study:||18 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- Patient must be at least one year post-successful catheter ablation(s) for atrial fibrillation without evidence of any clinically apparent arrhythmia recurrence defined as all of the following: No AF/AT/AFL on at least 24 hour Holter and an ECG (or equivalent) from 2-6 months after the last ablation, AND no AF/AT/AFL on at least 24 hour Holter and an ECG any time after 6 months after the last ablation AND no AF/AT/AFL on at least 24 hour Holter and ECG 2 months before enrolment in the study. The Holter/ECG within 2 months of enrolment may also serve as the Holter performed 6 months or later after the last ablation - see section 2.3.1 for details.
- Patient must have a CHA2DS2-VASc risk score of 1 or more. Patients in whom female sex or vascular disease are their sole risk factor may not be enrolled.
- Patient must be >18 years of age.
- Patient must have non-valvular AF.
- Patient does not meet all of the above listed inclusion criteria.
- Patient is unable or unwilling to provide informed consent.
- Patient is included in another randomized clinical trial or a clinical trial requiring an insurance.
- Patient has been on an investigational drug within 30 days of enrolment.
- Patient has been on strong CYP3A inducers (such as rifampicin, phenytoin, phenobarbital, or carbamazepine) or strong CYP3A inhibitors (such as ketoconazole or protease inhibitors) within 4 days of enrolment.
- Patient has creatinine clearance < 30 mL/min.
- Patient has bleeding contra-indication to oral anticoagulation (such as bleeding diathesis, hemorrhagic disorder, significant gastrointestinal bleeding within 6 months, intracranial/intraocular/ atraumatic bleeding history, fibrinolysis within 48 hours of enrollment).
- Patient has other contraindication to oral anticoagulation or treatment with antiplatelet agent (such as allergy).
- Patient has a contraindication to magnetic resonance imaging (MRI) or is unlikely to tolerate due to severe claustrophobia.
- Patients with a contraindication to implantation of an implantable loop recorder if the patient opts for a loop recorder as part of the study (such as limited immunocompetence or a wound healing disorder).
- Patient has valvular atrial fibrillation [reference AHA guidelines].
- Patient has a non-arrhythmic condition necessitating long-term oral anticoagulation.
- Patient had a severe, disabling stroke within one year prior to enrollment or any stroke within 14 days of enrollment.
- Patient with special risk factors for stroke unrelated to AF, specifically known thrombophilia/ hypercoagulability, uncontrolled hypertension (systolic blood pressure >180 mmHg and/or diastolic blood pressure >100 mmHg within 4 days of enrollment), untreated familial hyperlipidemia, known vascular anomaly (intracranial aneurysm/ arteriovenous malformation or chronic vascular dissection), or known severe carotid disease.
- Pregnancy or breastfeeding.
- Women of childbearing age who refuse to use a highly effective and medically acceptable form of contraception throughout the study.
- Patients who are > 85 years of age.
- Patients who are critically ill or who have a life expectancy <3 years.
- Patients for whom the investigator believes that the trial is not in the interest of the patient.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02168829
|Principal Investigator:||Atul Verma, MD||Southlake Regional Health Centre|
|Principal Investigator:||David H Birnie, MD||Ottawa Heart Institute Research Corporation|
|Responsible Party:||Ottawa Heart Institute Research Corporation|
|Other Study ID Numbers:||
|First Posted:||June 20, 2014 Key Record Dates|
|Last Update Posted:||February 28, 2023|
|Last Verified:||February 2023|
|Individual Participant Data (IPD) Sharing Statement:|
|Plan to Share IPD:||Undecided|
Anticoagulation AF ablation
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Peripheral Nervous System Agents
Physiological Effects of Drugs
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors
Factor Xa Inhibitors
Serine Proteinase Inhibitors