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Prevention of Silent Cerebral Thromboembolism by Oral Anticoagulation With Dabigatran After Pulmonary Vein Isolation for Atrial Fibrillation (ODIn-AF)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2016 by University Hospital, Bonn
Boehringer Ingelheim
Information provided by (Responsible Party):
Georg Nickenig, University Hospital, Bonn Identifier:
First received: February 18, 2014
Last updated: October 26, 2016
Last verified: October 2016

February 18, 2014
October 26, 2016
August 2015
August 2018   (Final data collection date for primary outcome measure)
Incidence of new micro- and macro-embolic lesions on cerebral MRI incl. flare and diffusion weighted imaging 12 months after randomization compared to baseline MRI (3 months after AF catheter ablation) [ Time Frame: 12 months ]
Same as current
Complete list of historical versions of study NCT02067182 on Archive Site
  • Location, size and number of new micro- and macro-embolic lesions on cerebral MRI [ Time Frame: 12 months ]
  • Incidence of clinically evident cardio-embolic events (stroke, TIA, systemic embolism) [ Time Frame: 12 months ]
  • Severity of neurological deficits assessed by Modified Rankin Scale [ Time Frame: 12 months ]
  • Incidence of other thrombotic or thrombo-embolic events (myocardial in-farction, deep vein thrombosis, pulmonary embolism) [ Time Frame: 12 months ]
  • Life-threatening / major / minor bleedings [ Time Frame: 12 months ]
  • Hemorrhagic cerebral infarction [ Time Frame: 12 months ]
  • All-cause mortality / Cardiovascular mortality [ Time Frame: 12 months ]
  • Correlation of cardio-embolic events to method used for PVI (cryo-balloon versus RF) [ Time Frame: 12 months ]
  • Correlation of cardio-embolic events with arrhythmia recurrence (atrial fi-brillation or atrial flutter post ablationem with ECG documentation or symp-toms) [ Time Frame: 12 months ]
  • Quality of life questionnaire (AF-specific symptoms, SF36) [ Time Frame: 12 months ]
  • Neuropsychological questionnaire (RBANS A&B) [ Time Frame: 12 months ]
  • Assessment of neurocognitive deficits: Minimental Test [ Time Frame: 12 months ]
Same as current
  • Major / minor bleeding events [ Time Frame: 12 months ]
  • Clinically evident cardio-embolic events [ Time Frame: 12 months ]
  • Serious Adverse Events [ Time Frame: 12 months ]
Same as current
Prevention of Silent Cerebral Thromboembolism by Oral Anticoagulation With Dabigatran After Pulmonary Vein Isolation for Atrial Fibrillation
Prevention of Silent Cerebral Thromboembolism by Oral Anticoagulation With Dabigatran After Pulmonary Vein Isolation for Atrial Fibrillation
Oral anticoagulation treatment (OAC) following clinically successful catheter abla-tion of atrial fibrillation (AF) is controversial. Recent guidelines recommended con-tinuation of OAC in all patients with CHA2DS2VASc score ≥2 even if there is no evidence of recurrent AF (Camm JA et al., Eur Heart J 2012). The net clinical ben-efit of OAC after successful ablation in these patients remains to some extent un-clear. As OAC bears the risk of bleeding events, the ODIn-AF study aims to evalu-ate the positive effect of OAC on the incidence of silent cerebral embolic events in patients with a high risk for embolic events, free from AF after successful pulmo-nary vein ablation. ODIn-AF aims to determine that continued administration of dabigatran is superior in the preven-tion of silent cerebral embolism to discontinuation of OAC after 3 months in pa-tients free from symptomatic AF-episodes with a CHA2DS2VASc score ≥2 after the first pulmonary vein ablation for paroxysmal AF.
Not Provided
Phase 4
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
  • Atrial Fibrillation
  • Cardioembolic Events
  • Oral Anticoagulation
Drug: Dabigatran
  • Antral pulmonary vein ablation for patients with AF
  • left atrial fibrosis/electrical scar assessment by electroanatomical mapping
  • followed by 6 months OAC (3 months blanking period + 3 months observation period)
  • in case of AF-recurrence in month 4-6: re- pulmonary vein ablation
  • followed again by 6 months OAC (3 months blanking period + 3 months observation period)

AF-free patients as assessed by 72h Holter ECG and symptoms wil be random-izedals to the following two interventional arms:

  • Experimental arm (group A): OAC with dabigatran for 12 months
  • Control arm (group B): No OAC (no placebo medication) for 12 months - Cerebral MRI at randomisation and 12 months later
  • Experimental: Oral Anticoagulation with Dabigatran

    The recommended daily dose of Pradaxa is 300 mg taken as one 150 mg capsule twice daily.

    For the following patients the recommended daily dose of Pradaxa is 220 mg taken as one 110 mg capsule twice daily:

    • Patients aged 75 years or above
    • Cr-Cl 30-50 ml/min
    • Patients who receive concomitant verapamil

    For the following groups, the daily dose of Pradaxa of 300 mg or 220 mg should be selected based on an individual assessment of the thromboembolic risk and the risk of bleeding:

    • Patients with moderate renal impairment
    • Patients with gastritis, esophagitis or gastroesophageal reflux
    • Other patients at increased risk of bleeding
    Intervention: Drug: Dabigatran
  • No Intervention: No Oral Anticoagulation
Schrickel JW, Linhart M, Bänsch D, Thomas D, Nickenig G. Rationale and design of the ODIn-AF Trial: randomized evaluation of the prevention of silent cerebral thromboembolism by oral anticoagulation with dabigatran after pulmonary vein isolation for atrial fibrillation. Clin Res Cardiol. 2016 Feb;105(2):95-105. doi: 10.1007/s00392-015-0933-1. Epub 2015 Oct 29.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
August 2019
August 2018   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Written informed consent
  • Patients scheduled for circumferential antral PV ablation for non-valvular (mitral regurgitation less than moderate- severe; no relevant mitral steno-sis with a mean pressure gradient >5mmHg) symptomatic, paroxysmal AF or persistent AF (duration < 12 months) using a cooled tip RF- or cryobal-loon-catheter
  • CHA2DS2VASc score ≥ 2

Randomization criteria:

  • Sinus rhythm after AF ablation (as assessed by 72h Holter ECG) following the 3 months blanking period
  • No clinical evidence of recurrent AF after completing 3 months blanking period as assessed by symptoms

Exclusion Criteria:

  • Lack of written informed consent
  • Severe mental disorder, drug or alcohol addiction (> 8 drinks/week)
  • Pregnancy/breast feeding
  • Severely impaired renal function, GFR < 30 ml/min
  • Impaired liver function (ALT/AST transaminase count 3fold higher than normal values)
  • Age > 80 years
  • Valvular (less than moderate- severe; no relevant mitral stenosis with a mean pressure gradient >5mmHg) AF
  • Long standing persistent (>12 months) and permanent AF
  • NSTEMI/STEMI/implantated drug eluting stent with indication for dual an-tiplatelet therapy within 12 months before enrolment
  • History of any left atrial ablation procedure
  • Clinical indication for extended left atrial ablation procedures (lines, CFAE-, rotorablation)
  • History or presence of left atrial or ventricular thrombus
  • History of cardioembolic stroke / TIA
  • History of major bleeding or predisposition to bleeding incidences
  • Cerebral lesions or clinical situations of other organ systems with a high risk of severe bleeding
  • History of previous surgery with contraindication for OAC
  • History of malignoma with contraindication for OAC
  • Significant carotid stenosis
  • Mechanical prosthetic heart valve or other indication for permanent OAC
  • Contraindication for MRI
  • Hypersensitivity against dabigatran or other ingredients of the medicinal product
  • Concomitant use of another OAC or heparines
  • Concomitant medication with dronedarone, ketoconazole, itraconazole, cyclosporine, tacrolimus or other interacting drugs as specified in the drug information
  • Simultaneous participation in any clinical trial involving administration of an investigational medicinal product within 30 days prior to clinical trial beginning
  • Females of childbearing potential, who are not using or not willing to use medically reliable methods of contraception for the entire study duration (such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices) unless they are surgically sterilized / hysterecto-mized or there are any other criteria considered sufficiently reliable by the investigator in individual cases
  • Conditions which interfere with the study treatment at the discretion of the investigator
Sexes Eligible for Study: All
18 Years to 80 Years   (Adult, Senior)
Contact: Georg Nickenig, Prof. +49-228-287-15217
Contact: Jan W Schrickel, Prof. +49-228-287-15217
2013-003492-35 ( EudraCT Number )
Not Provided
Not Provided
Not Provided
Georg Nickenig, University Hospital, Bonn
Georg Nickenig
Boehringer Ingelheim
Not Provided
University Hospital, Bonn
October 2016

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP