Perioperative Anticoagulant Use for Surgery Evaluation Study

NCT ID: NCT02228798

Last Updated: 2019-06-28

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

Total Enrollment

3135 participants

Study Classification

OBSERVATIONAL

Study Start Date

2014-08-01

Study Completion Date

2018-08-31

Brief Summary

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The aim of the Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study, is to establish a safe, standardized protocol for the perioperative management of patients with atrial fibrillation (AF) who are receiving a novel oral anticoagulant (DOAC) drug, either dabigatran, rivaroxaban or apixaban, and require an elective surgery/procedure.

Detailed Description

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The primary aim is to demonstrate that a standardized but patient-focused protocol for the perioperative management of each DOAC is safe, with acceptably low rates of perioperative major bleeding (MB) and arterial thromboembolism (ATE). The perioperative protocol is adjusted based on patient renal function and surgery/procedure-related bleed risk, to optimize patient safety, and does not involve heparin bridging anticoagulation.

The secondary aim of the PAUSE Study is to determine the effect of the pre-operative DOAC interruption protocol on the level of residual anticoagulation, when measured by 'everyday' coagulation tests that are not DOAC-specific (e.g., activated partial thromboplastin time \[aPTT\]) and 'specialized' coagulation tests that are DOAC-specific (dilute thrombin time \[TT\] - HemoclotTM, and anti-factor Xa assays).

Approximately 3,300 patients from 15 to 25 centres over a 3.5 year period will be recruited across Canada for the PAUSE Study.

Patients with Atrial Fibrillation and are currently taking dabigatran, rivaroxaban and apixaban (DOACs) and require elective surgery/procedure will follow a standardized management perioperative protocol for discontinuation of their DOAC prior to surgery. Patients will be discontinuing the DOAC they are currently receiving from 1 to 4 days prior to surgery or procedure, depending on bleed risk, type of DOAC, and creatinine clearance rate.

A blood sample will be taken on the day of the surgery or procedure for measurement of laboratory outcomes (residual level of anticoagulant on day of surgery).

Patients will be followed up weekly up to a month for primary outcome assessments.

Conditions

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Atrial Fibrillation

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Rivaroxaban

Patients currently taking rivaroxaban that have atrial fibrillation and require surgery or a procedure.

No interventions assigned to this group

Dabigatran

Patients currently taking dabigatran that have atrial fibrillation and require surgery or a procedure.

No interventions assigned to this group

Apixaban

Patients currently taking apixaban that have atrial fibrillation and require surgery or a procedure.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. Age 18 years or older
2. Receiving a DOAC (dabigatran or rivaroxaban or apixaban) for Atrial Fibrillation
3. Ability to assess patient at lease one day prior to DOAC discontinuation

Exclusion Criteria

1. CrCl less than 30 mL per min for dabigatran- and rivaroxaban-treated patients ( less than 25 mL per min for apixaban-treated patients) as estimated by Cockroft-Gault formula
2. Cognitive impairment or psychiatric illness that precludes collection of followup data
3. Inability or unwillingness to provide informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Heart and Stroke Foundation of Canada

OTHER

Sponsor Role collaborator

McMaster University

OTHER

Sponsor Role lead

Responsible Party

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James Douketis

Dr. James Douketis-Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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James Douketis, MD

Role: PRINCIPAL_INVESTIGATOR

McMaster University/St. Joseph's Healthcare

Locations

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Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA

Aurora, Colorado, United States

Site Status

NorthShore University HealthSystem

Evanston, Illinois, United States

Site Status

Henry Ford Health System

Detroit, Michigan, United States

Site Status

Department of Cardiovascular Sciences, University of Leuven

Leuven, , Belgium

Site Status

University of Alberta

Edmonton, Alberta, Canada

Site Status

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status

QEII Hospital

Halifax, Nova Scotia, Canada

Site Status

Hamilton General Hospital

Hamilton, Ontario, Canada

Site Status

Juravinski Hospital

Hamilton, Ontario, Canada

Site Status

McMaster University Medical Centre

Hamilton, Ontario, Canada

Site Status

St. Joseph's Healthcare

Hamilton, Ontario, Canada

Site Status

The Ottawa Hospital

Ottawa, Ontario, Canada

Site Status

North York General

Toronto, Ontario, Canada

Site Status

Toronto General Hospital

Toronto, Ontario, Canada

Site Status

University of Manitoba

Winnipeg, Ontario, Canada

Site Status

Maisonneuve-Rosemont

Montreal, Quebec, Canada

Site Status

Montreal General Hospital

Montreal, Quebec, Canada

Site Status

Montreal Jewish General Hospital

Montreal, Quebec, Canada

Site Status

St. Mary's Hospital

Montreal, Quebec, Canada

Site Status

Department of Anesthesiology, University of Thessaly

Larissa, , Greece

Site Status

Department of Vascular Medicine, Amsterdam Cardiovascular Sciences

Amsterdam, , Netherlands

Site Status

Countries

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United States Belgium Canada Greece Netherlands

References

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Shaw JR, Li N, Vanassche T, Coppens M, Spyropoulos AC, Syed S, Radwi M, Duncan J, Schulman S, Douketis JD. Predictors of preprocedural direct oral anticoagulant levels in patients having an elective surgery or procedure. Blood Adv. 2020 Aug 11;4(15):3520-3527. doi: 10.1182/bloodadvances.2020002335.

Reference Type DERIVED
PMID: 32756938 (View on PubMed)

Other Identifiers

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CIHR313156 HSFG-14-0006163

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

CIHR-PAUSE-2014

Identifier Type: -

Identifier Source: org_study_id

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