Safety and Efficacy of Rivaroxaban and Apixaban in Comparison to Warfarin in Left Ventricular Clot- Clinical Trial (WRAP)
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ClinicalTrials.gov Identifier: NCT05973188 |
Recruitment Status :
Recruiting
First Posted : August 2, 2023
Last Update Posted : August 2, 2023
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The investigators aimed to design this randomized control trial to compare rivaroxaban and apixaban with warfarin in Left ventricular thrombus resolution by
- Success rate of left ventricular thrombus resolution on follow up echocardiograms to be done at 1st, 3rd and 6th months after starting on these drugs.
- Compare the adverse events of each drug in terms of major bleeding and stroke on follow up.
Left ventricular thrombus (LVT) leads to thromboembolism in about 10-15% cases. Currently, guidelines recommended therapy for LVT is warfarin but treating LVT with warfarin is challenging due to
- Its narrow therapeutic window.
- Drug-drug and drug-food interaction.
- Frequently tested International normalization ratio (INR) and cost effectiveness especially in low to middle income countries.
In contrast Rivaroxaban and Apixaban has no drug-food or major drug-drug interaction and moreover it doesn't require frequent checks on INR and that's the reason Rivaroxaban and apixaban use in LVT is gaining traction over time but there is paucity of data both nationally and internationally. So further studies are required to evaluate the efficacy and safety of rivaroxaban and apixaban in comparison to warfarin in LVT, especially in low to middle income countries.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Left Ventricular Thrombus | Drug: Warfarin Drug: Rivaroxaban 20 MG Oral Tablet Drug: Apixaban 5mg or 2.5mg oral tablet | Phase 4 |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 141 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | Randomized and open label. We will randomly assign first patient into group A that is control group (warfarin group) then next patient to group B (rivaroxaban group) and then next patient into group C (Apixaban group). We will repeat the cycle to achieve the target sample size in each group. Patients will be randomized in group A, B and C in a ratio of 1:1:1, to either control group A (Warfarin group with dose adjusted, target INR 2-3), group B (Rivaroxaban 20mg QD) and group C (Apixaban 5mg BD or 2.5mg BD if having two or more of the following, patients with age ≥80years and/or creatinin≥1.5 and/or body weight ≤60kg). LVT resolution will be assessed by blinded cardiologist via transthoracic echocardiogram at 1, 3 and 6 months' interval after starting on the respective regimen. |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Safety and Efficacy of Rivaroxaban and Apixaban in Comparison to Warfarin in Left Ventricular Clot- a Clinical Trial |
Actual Study Start Date : | May 1, 2023 |
Estimated Primary Completion Date : | June 30, 2024 |
Estimated Study Completion Date : | June 30, 2024 |
Arm | Intervention/treatment |
---|---|
Active Comparator: Group A, warfarin group
Patients started on warfarin, dose will be adjusted according to patient target INR (2-3)
|
Drug: Warfarin
Anticoagulant
Other Name: Warfarin oral tablet |
Experimental: Group B, Rivaroxaban (Xcept)
Patients started on rivaroxaban 20mg single dose in 24hours
|
Drug: Rivaroxaban 20 MG Oral Tablet
Anticoagulant
Other Name: Xcept |
Experimental: Group C, Apixaban ( Apixaget)
Patients started on Apixaban 5mg or 2.5mg (12hours apart)
|
Drug: Apixaban 5mg or 2.5mg oral tablet
Anticoagulant
Other Name: Apixaget |
- Successful resolution of LV thrombus by Rivaroxaban and Apixaban in comparison to Warfarin [ Time Frame: Within 6months of randamization ]Presence or absence of LV thrombus at one, three and six months follow up on echocardiogram.
- Time from start of drug to thrombus resolution in months [ Time Frame: Within 6 months of randomization ]Secondary end point will be time in months after starting on drugs to LVT resolution (which will be assessed by follow up echocardiogram at one, three and six months duration)
- No of events of major bleeding (defined by International Society of Thrombosis and Hemostasis criteria) [ Time Frame: Within 6 months of randomization ]Number of events of major bleedings (defined by International Society of Thrombosis and Hemostasis criteria as, (a) a fall in hemoglobin level of 2 g/dL or more or documented transfusion of at least 2 units of packed red blood cells, (b) involvement of a critical anatomical site (intracranial, spinal, ocular, pericardial, articular, intramuscular with compartment syndrome, retroperitoneal) in all three groups of patients after starting on drugs till resolution of thrombus and/or maximum 6 months follow up after start of therapy if failed to resolve thrombus.
- No of events of stroke (both ischemic and hemorrhagic) [ Time Frame: Within 6 months of randomization ]No of events of stroke (both ischemic and hemorrhagic) in all three groups of patients after starting on drugs till resolution of thrombus and/or maximum 6 months follow up, after start of therapy if failed to resolve thrombus.
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion criteria
- All hemodynamically stable patients with LV thrombus on echocardiogram after.
Exclusion criteria
- Chronic Liver Disease (CLD) patients
- Creatinine clearance less than 15ml/min
- Recent Hemorrhagic stroke
- Thrombocytopenia, platelets <50k or anemia with baseline HB <9mg/dl
- Recent Major GI bleed
- History of atrial fibrillation and mitral stenosis
- History of deep vein thrombosis/pulmonary embolism and Patients already on anticoagulation
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): NCT05973188
Contact: Ihsan Ullah, MD | +923365948083 | dr.ihsanulla@gmail.com | |
Contact: Ali Raza, MRCP | +923430978366 |
Pakistan | |
Peshawar Institute of Cardiology | Recruiting |
Peshawar, KPK, Pakistan, 25000 | |
Contact: Ihsan Ullah, MD +923365949083 dr.ihsanulla@gmail.com | |
Contact: Ali Raza, MBBS/MRCP +447833250880 ali.raza@pic.edu.pk |
Principal Investigator: | Ihsan Ullah, MD | Peshawar Institute of Cardiology |
Responsible Party: | Dr. Ihsan Ullah, Doctor, Peshawar Institute of Cardiology |
ClinicalTrials.gov Identifier: | NCT05973188 |
Other Study ID Numbers: |
IRC/23/09 |
First Posted: | August 2, 2023 Key Record Dates |
Last Update Posted: | August 2, 2023 |
Last Verified: | July 2023 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | Yes |
Left ventricular thrombus, warfarin, rivaroxaban, apixaban |
Thrombosis Embolism and Thrombosis Vascular Diseases Cardiovascular Diseases Warfarin Rivaroxaban Apixaban |
Anticoagulants Factor Xa Inhibitors Antithrombins Serine Proteinase Inhibitors Protease Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action |