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Apixaban Versus Dual-antiplatelet Therapy (Clopidogrel and Aspirin) in Acute Non-disabling Cerebrovascular Events (ADANCE)

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ClinicalTrials.gov Identifier: NCT01924325
Recruitment Status : Unknown
Verified August 2013 by Xijing Hospital.
Recruitment status was:  Not yet recruiting
First Posted : August 16, 2013
Last Update Posted : August 16, 2013
Sponsor:
Information provided by (Responsible Party):

Study Description
Brief Summary:

Nondisabling cerebrovascular events represent the largest group of cerebrovascular disease with a high risk of recurrent stroke. A recent trial indicated that clopidogrel and aspirin treatment reduced the risk of recurrent stroke and was not associated with increased hemorrhage events, compared with aspirin monotherapy. Apixaban, a new oral anticoagulant, is proved to be as effective as traditional anticoagulants with less risk of bleeding events.

To estimate whether apixaban is beneficial for acute TIA or minor stroke, a randomized, double-blind, multicenter, controlled clinical trial has been designed. The investigators will assess the hypothesis that a 21-days apixaban regimen is superior to clopidogrel and aspirin dual-therapy for the treatment of high-risk patients with acute nondisabling cerebrovascular event.


Condition or disease Intervention/treatment Phase
Ischemic Stroke TIA Drug: Apixaban Drug: Clopidogrel Drug: Aspirin Drug: placebo Phase 2 Phase 3

Detailed Description:

The ADANCE study is a randomized, double-blind clinical trial with a target enrollment of 3,000 Chinese patients. Two subtypes of patients will be enrolled: I, acute disabling ischemic stroke (<24 hours of symptoms onset); II, acute TIA (<24 hours of symptoms onset).

Patients will be randomized into 3 groups:

Ⅰ Receiving a 75 mg dose of clopidogrel and 75mg dose of aspirin from day 1 to day 21, with placebo apixaban twice daily.

Ⅱ Receiving a 2.5-mg twice daily of apixaban, with placebo clopidogrel and placebo aspirin from day 1 to day 21.

Ⅲ Receiving a 5-mg twice daily of apixaban, with placebo clopidogrel and placebo aspirin from day 1 to day 21.

From day 22 to 3 months, all patients will receive 75-mg dose of clopidogrel long-term antiplatelet therapy.

The primary efficacy end point is percentage of patients with new stroke (ischemic or hemorrhage) at 90 days.


Study Design

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 10000 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Apixaban Versus Dual-antiplatelet Therapy (Clopidogrel and Aspirin) in High-risk Patients With Acute Non-disabling Cerebrovascular Events (ADANCE): Rationale, Objectives, and Design
Study Start Date : January 2014
Estimated Primary Completion Date : December 2015
Estimated Study Completion Date : July 2016

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Active Comparator: Dual-antiplatelet Therapy
Receiving a 75 mg dose of clopidogrel and 75mg dose of aspirin from day 1 to day 21, with placebo apixaban twice daily
Drug: Clopidogrel
an irreversible inhibitor of the P2Y12 adenosine diphosphate receptor
Other Names:
  • Plavix
  • Clopivid
Drug: Aspirin
a non-steroidal anti-inflammatory drug
Other Name: Acetylsalicylic acid
Drug: placebo
Experimental: Apixaban 2.5mg
Receiving a 2.5-mg twice daily of apixaban, with placebo clopidogrel and placebo aspirin from day 1 to day 21
Drug: Apixaban
orally active direct factor Xa inhibitor
Other Names:
  • Eliquis
  • BMS-562247
  • BMS-562247-01
Drug: placebo
Experimental: Apixaban 5mg
Receiving a 5-mg twice daily of apixaban, with placebo clopidogrel and placebo aspirin from day 1 to day 21
Drug: Apixaban
orally active direct factor Xa inhibitor
Other Names:
  • Eliquis
  • BMS-562247
  • BMS-562247-01
Drug: placebo


Outcome Measures

Primary Outcome Measures :
  1. percentage of patients with new stroke (ischemic or hemorrhage) [ Time Frame: 90 days ]

Secondary Outcome Measures :
  1. Percentage of patients with new clinical vascular events (ischemic stroke/hemorrhagic stroke/TIA/myocardial infarction/vascular death) [ Time Frame: 30 days ]
  2. Percentage of patients with new clinical vascular events (ischemic stroke/hemorrhagic stroke/TIA/myocardial infarction/vascular death) [ Time Frame: 30 days and 90 days ]
  3. Changes in NIHSS scores [ Time Frame: 90 days ]
  4. moderate to severe bleeding events [ Time Frame: 90 days ]
  5. Total mortality [ Time Frame: 90 days ]
  6. Adverse events/severe adverse events reported by the investigators [ Time Frame: 90 days ]

Eligibility Criteria

Information from the National Library of Medicine

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

Inclusion Criteria:

  • Adult subjects (male or female ≥18 years old)
  • Acute nondisabling ischemic stroke (NIHSS ≤3 at the time of randomization) that can be treated with study drug within 24 hours of symptoms onset. Symptom onset is defined by the "last see normal" principle
  • TIA (neurologic deficit attributed to focal brain ischemia, with resolution of the deficit within 24 hours of symptom onset), that can be treated with investigational medication within 24 hours of symptoms onset. Symptom onset is defined by the "last see normal" principle
  • Informed consent signed

Exclusion Criteria:

  • Diagnosis of hemorrhage or other pathology, such as vascular malformation, tumor, abscess or other major nonischemic brain disease, on baseline head CT or MRI scan
  • mRS score >2 at randomization (premorbid historical assessment) NIHSS ≥4 at randomization
  • Clear indication for anticoagulation (atrial fibrillation, mechanical cardiac valves, deep venous thrombosis, pulmonary embolism or known hypercoagulable state)
  • Contraindication to investigational medications
  • Thrombolysis for ischemic stroke within preceding 7 days
  • History of intracranial hemorrhage
  • Current treatment (last dose given within 10 days before randomization) with heparin therapy or oral anticoagulation
  • Gastrointestinal bleed or major surgery within 3 months
  • Planned or likely revascularization (any angioplasty or vascular surgery) within the next 3 months
  • TIA or minor stroke induced by angiography or surgery
  • Severe noncardiovascular comorbidity with life expectancy <3 months
  • Women of childbearing age not practicing reliable contraception who do not have a documented negative pregnancy test result
  • Severe renal failure, defined as Glomerular Filtration Rate (GFR) <30 ml/min Severe hepatic insufficiency (Child-Pugh score B to C)
Contacts and Locations

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 ClinicalTrials.gov identifier (NCT number): NCT01924325


Contacts
Contact: Xuedong Liu, M.D. +86 029 84775055 liuxued@fmmu.edu.cn

Locations
China, Shaanxi
Xijing Hospital Not yet recruiting
Xi'an, Shaanxi, China, 710032
Contact: Fang Yang, M.D. Ph.D.    +86 029 84773214    fyangx@fmmu.edu.cn   
Principal Investigator: Gang Zhao, M.D.         
Sponsors and Collaborators
Xijing Hospital
Investigators
Principal Investigator: Gang Zhao, M.D. Neurology Department,Xijing Hospital
More Information

Responsible Party: Xijing Hospital
ClinicalTrials.gov Identifier: NCT01924325     History of Changes
Other Study ID Numbers: Xijing-ADANCE
First Posted: August 16, 2013    Key Record Dates
Last Update Posted: August 16, 2013
Last Verified: August 2013

Keywords provided by Xijing Hospital:
apixaban
clopidogrel
aspirin
new oral anticoagulant
TIA
acute minor ischemic stroke

Additional relevant MeSH terms:
Aspirin
Ticlopidine
Clopidogrel
Apixaban
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors
Cyclooxygenase Inhibitors
Enzyme Inhibitors
Antipyretics
Purinergic P2Y Receptor Antagonists
Purinergic P2 Receptor Antagonists
Purinergic Antagonists
Purinergic Agents
Neurotransmitter Agents
Cytochrome P-450 CYP2C19 Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Factor Xa Inhibitors
Antithrombins
Serine Proteinase Inhibitors
Protease Inhibitors