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Apixaban Versus Warfarin in Patients With Left Ventricular Thrombus

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02982590
Recruitment Status : Completed
First Posted : December 5, 2016
Results First Posted : July 8, 2021
Last Update Posted : July 8, 2021
Institut Jantung Negara
Information provided by (Responsible Party):
Dr W. Yus Haniff W. Isa, Universiti Sains Malaysia

Brief Summary:
The purpose of this study is to compare the novel oral anticoagulant apixaban with the standard therapy of warfarin on the size reduction or resolution of left ventricular thrombus over 3 months.

Condition or disease Intervention/treatment Phase
Left Ventricular Thrombosis Drug: Apixaban 5 MG Oral Tablet [ELIQUIS] Drug: Warfarin Sodium Phase 3

Detailed Description:

Current treatment for left ventricular thrombus is anti-coagulant or blood thinning agent known as warfarin. Recently at least three novel oral anticoagulant agents were used in the treatment of atrial fibrillation, pulmonary embolism and deep vein thrombosis (DVT).

Novel oral anticoagulant drugs will require no blood taking for INR monitoring, hence less visit and more convenience to patients. Latest studies also showed lesser rate of bleeding as compared to warfarin and hence relatively safer.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 27 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Apixaban Versus Warfarin in Patients With Left Ventricular Thrombus: A Prospective Randomized Outcome Blinded Study on the Size Reduction or Resolution of Left Ventricular Thrombus
Actual Study Start Date : November 2016
Actual Primary Completion Date : November 2018
Actual Study Completion Date : November 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: warfarin sodium
warfarin daily, dosage according to INR monitor. Aim INR 2-3
Drug: Warfarin Sodium
as controlled arm since warfarin is the standard therapy for LV thrombus
Other Name: Coumadin

Experimental: apixaban
Apixaban 5 MG Oral Tablet [ELIQUIS] will be given for randomly selected patients for 3 months.
Drug: Apixaban 5 MG Oral Tablet [ELIQUIS]
Apixaban is licensed for treatment of deep vein thrombosis and pulmonary embolism. Hence, a good study drug for left ventricular thrombosis for possibility of a new indication.
Other Name: ELIQUIS

Primary Outcome Measures :
  1. Percent Change in Left Ventricular Thrombus (LVT) Size [ Time Frame: 3 months ]
    Percentage of change in left ventricular thrombus (LVT) size after 12 weeks of Warfarin or Apixaban treatment

Secondary Outcome Measures :
  1. Change of Left Ventricular Thrombosis (LVT) by More Than 50% [ Time Frame: 3 months ]
    Percentage of participants who achieved left ventricular thrombus (LVT) reduction more than 50% in both Warfarin and Apixaban arms.

  2. Clinically Definite Cardiac Embolic Ischemic Stroke [ Time Frame: 3 months ]
    Number of participants who showed evidence of clinically definite cardiac embolic ischemic stroke (focal neurological deficits persisting for more than 24 hours) confirmed by CT scan

  3. Life Threatening Bleeding [ Time Frame: 3 months ]
    Number of participants who experienced life threatening bleeding attributed to the use of anti-coagulation.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age 18 - 80 years old
  2. Presence of LV thrombus or spontaneous echo contrast (SEC) grade 3 or 4 (Patel VG 1996), with regional wall motion abnormalities
  3. HASBLED score less than 3
  4. No episodes of major bleeding in the past 6 months a) Major bleeding defined as i. episodes of bleeding with significant drop in haemoglobin(Hb)level of at least 2gm/dL - Includes upper and lower gastrointestinal bleed ii. The need for blood transfusion (pack cell) of at least 2 unit iii. Recent surgery with bleeding complications and lost of Hb as in (i) or (ii) iv. Any intracranial bleeds with neurological deficits

Exclusion Criteria:

  1. Patient with unstable arrhythmias and/or recurrent cardiogenic shock
  2. Patient with large ischemic stroke on recruitment-defined as involving >1/3 of cerebral hemisphere or deemed to have high chance of haemorrhagic transformation
  3. Patient with permanent pacemaker
  4. Patient who is post valve replacement therapy
  5. Patient who is pregnant.
  6. Patient with advanced kidney disease at stage V and not on dialysis (CrCl <15 mL/min)
  7. Patient with advanced liver disease with coagulopathy
  8. Patient with organized and old left ventricular thrombus

Information from the National Library of Medicine

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 identifier (NCT number): NCT02982590

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Hospital Universiti Sains Malaysia
Kota Bharu, Kelanatan, Malaysia, 16150
Sponsors and Collaborators
Universiti Sains Malaysia
Institut Jantung Negara
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Principal Investigator: Dr W. Yus Haniff W. Isa, M.MED Universiti Sains Malaysia
  Study Documents (Full-Text)

Documents provided by Dr W. Yus Haniff W. Isa, Universiti Sains Malaysia:
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Responsible Party: Dr W. Yus Haniff W. Isa, DR, Universiti Sains Malaysia Identifier: NCT02982590    
Other Study ID Numbers: 304/PPSP/61313197
First Posted: December 5, 2016    Key Record Dates
Results First Posted: July 8, 2021
Last Update Posted: July 8, 2021
Last Verified: June 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
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Embolism and Thrombosis
Vascular Diseases
Cardiovascular Diseases
Factor Xa Inhibitors
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action