Assessment of Cardioversion Using Transesophageal Echocardiography II (ACUTE II)

NCT ID: NCT00289042

Last Updated: 2007-01-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

1999-12-31

Study Completion Date

2004-11-30

Brief Summary

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SPECIFIC AIM: To test the safety and feasibility of using low molecular weight heparin (LMWH, enoxaparin sodium; Lovenox, Sanofi-Aventis) in lieu of unfractionated heparin (UFH) as antithrombotic therapy for patients in atrial fibrillation undergoing transesophageal echocardiography (TEE) guided chemical or electrical cardioversion to sinus rhythm.

HYPOTHESIS: Early cardioversion from atrial fibrillation can be safely performed using a short-term anticoagulation strategy of low molecular weight heparin (Lovenox, Sanofi-Aventis) compared to unfractionated heparin, accompanied by a TEE examination prior to cardioversion. The use of LMWH with TEE will result in a safe, cost-effective, and possible efficacious approach to cardioversion of atrial fibrillation compared to UFH with TEE.

Detailed Description

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Conditions

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Atrial Fibrillation

Keywords

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atrial fibrillation atrial thrombus cardioversion enoxaparin low molecular weight heparin transesophageal echocardiography

Study Design

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Allocation Method

RANDOMIZED

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Interventions

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Enoxaparin

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients with chronic or paroxysmal atrial fibrillation of \> 2 days duration who are candidates for early chemical or electrical cardioversion
* Patients with atrial flutter with a documented history (electrocardiography) of atrial fibrillation
* Males and females 18 years of age or older
* Patients have available results of routine clinical labs for standard clinical chemistry and complete blood count within the previous 14 days

Exclusion Criteria

* An INR \> 1.4 in patients who have received warfarin prior to enrollment.
* Use of IV heparin for more than 72 hours immediately prior to randomization.
* Patients with contraindications to TEE, such as dysphagia, or esophageal strictures.
* Patients who will need anticoagulation discontinued because of elective intervening procedure, such as cardiac catheterization or surgery.
* Patients with contraindications to warfarin or heparin
* Patients who require concomitant therapy during the study period with any drug known to affect coagulation or platelet function (i.e. ASA, NSAID, antiplatelet drugs)
* Women of childbearing potential, unless pregnancy can be excluded by medical history incompatible with pregnancy or by serum or urine beta HCG levels.
* Patients who are hemodynamically unstable and thus may require immediate cardioversion.
* Weight less than 40 kg (88 pounds) or more than 125 kg (275 pounds)
* History of gastrointestinal bleeding disorder and/or endoscopically verified ulcer disease within the last year
* History of intracranial or retinal bleeding, or other known disorders with an increased risk of bleeding
* Ischemic stroke in the previous three months
* Uncontrolled hypertension (systolic blood pressure greater than 180 mm Hg or diastolic blood pressure greater than 100 mm Hg)
* Malignancy currently under active treatment, including melanoma
* Patients with renal insufficiency (creatinine \> 2.0 mg/dL) or are renal transplant subjects
* Patients with anemia (Hgb less than 10 gm/dL)
* Patients with thrombocytopenia (platelet count less than 100 x 10\^9/L)
* Positive fecal hemoglobin test
* Life expectancy of less than 6 months
* History of drug and/or alcohol abuse within the last two years
* Patients unable or unwilling to give informed consent
* Patients unable or unwilling to return for follow-up
* Prisoners or wards of the state
* Patients with psychological problems that may decrease compliance with the protocol
* Not willing to complete the Quality of Life Questionnaires x 3
* Participating in another clinical trial and/or taking an investigational medication in the past 30 days
* Patient language, learning skills, or home environment unconducive to self-management
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sanofi

INDUSTRY

Sponsor Role collaborator

The Cleveland Clinic

OTHER

Sponsor Role lead

Principal Investigators

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Allan L. Klein, MD

Role: PRINCIPAL_INVESTIGATOR

The Cleveland Clinic

Locations

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Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Countries

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United States

References

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Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, Davidoff R, Erbel R, Halperin JL, Orsinelli DA, Porter TR, Stoddard MF; Assessment of Cardioversion Using Transesophageal Echocardiography Investigators. Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med. 2001 May 10;344(19):1411-20. doi: 10.1056/NEJM200105103441901.

Reference Type BACKGROUND
PMID: 11346805 (View on PubMed)

Murray RD, Deitcher SR, Shah A, Jasper SE, Bashir M, Grimm RA, Klein AL. Potential clinical efficacy and cost benefit of a transesophageal echocardiography-guided low-molecular-weight heparin (enoxaparin) approach to antithrombotic therapy in patients undergoing immediate cardioversion from atrial fibrillation. J Am Soc Echocardiogr. 2001 Mar;14(3):200-8. doi: 10.1067/mje.2001.109505.

Reference Type BACKGROUND
PMID: 11241016 (View on PubMed)

Murray RD, Shah A, Jasper SE, Goodman A, Deitcher SR, Katz WE, Malouf JF, Stoddard MF, Grimm RA, Klein AL; ACUTE II pilot study. Transesophageal echocardiography guided enoxaparin antithrombotic strategy for cardioversion of atrial fibrillation: the ACUTE II pilot study. Am Heart J. 2000 Jun;139(6):E1-7. doi: 10.1067/mhj.2000.106628.

Reference Type BACKGROUND
PMID: 10827367 (View on PubMed)

Elliott DJ, Zhao L, Jasper SE, Lieber EA, Klein AL, Weintraub WS. Health status outcomes after cardioversion for atrial fibrillation: results from the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) II Trial. Am Heart J. 2008 Aug;156(2):374.e1-6. doi: 10.1016/j.ahj.2008.05.008.

Reference Type DERIVED
PMID: 18657673 (View on PubMed)

Other Identifiers

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IRB 2879

Identifier Type: -

Identifier Source: org_study_id