Low Molecular Weight Heparin for 72 Hours Followed by Dabigatran for Acute Intermediate-Risk Pulmonary Embolism.

NCT ID: NCT02596555

Last Updated: 2020-02-17

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE4
• Total Enrollment: 400 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-01-31
• Study Completion Date: 2020-02-29

Brief Summary

This prospective, multicenter, multinational, phase IV, interventional single-armed (management) trial will focus on the safety, efficacy and cost-effectiveness of a new oral anticoagulant in the treatment of patients with acute intermediate-risk PE based on validated imaging (echocardiographic or CT angiographic) and laboratory biomarker (circulating levels of cardiac troponins and natriuretic peptides) parameters and their combinations.

Conditions

Pulmonary Embolism

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Dabigatran treatment

Low molecular weight heparin for 72 hours followed by 6 months of dabigatran

Group Type: EXPERIMENTAL

Dabigatran

Intervention Type: DRUG

Low molecular weight heparin for 72 hours followed by 6 months of dabigatran

Interventions

Dabigatran

Low molecular weight heparin for 72 hours followed by 6 months of dabigatran

Intervention Type: DRUG

Other Intervention Names

Pradaxa

Eligibility Criteria

Inclusion Criteria

1. Age ≥18 years

2. Objectively confirmed diagnosis of acute PE by multidetector CT angiography, ventilation/perfusion lung scan, or selective invasive pulmonary angiography, according to established diagnostic criteria, with or without symptomatic deep vein thrombosis

3. Absence of hemodynamic collapse, or decompensation, at presentation; Hemodynamic collapse or decompensation

4. Intermediate-risk category of PE severity indicated by a positive (score ≥1) simplified pulmonary embolism severity index (sPESI), in combination with the presence of at least one of the following criteria at presentation:

• At least one sign of RV pressure overload/dysfunction on CT angiography or echocardiography
• Signs of myocardial injury as indicated by elevated troponin levels
• Signs of (RV) failure as indicated by NT-proBNP levels >600 pg/ml at baseline.

5. Ability of the subject to understand the character and individual consequences of the clinical trial; signed and dated informed consent of the subject available before the start of any specific trial procedures

Exclusion Criteria

1. Pregnancy (a negative serum or urine pregnancy test should be available for women of child-bearing potential before study inclusion) or lactation

2. Women of childbearing potential who do not practice a medically accepted highly effective contraception during the trial and one month beyond

3. History of hypersensitivity to the investigational medicinal product or to any drug with similar chemical structure or to any excipient present in the pharmaceutical form of the investigational medicinal product

4. Participation in another clinical trial during the present clinical trial or within the last three months

5. Medical or psychological condition that would not permit completion of the trial or signing of informed consent

6. Use of a fibrinolytic agent, surgical thrombectomy, interventional (catheter-directed) thrombus aspiration or lysis, or use of a cava filter to treat the index episode of PE

7. Treatment with any therapeutically dosed anticoagulant for more than 48 hours prior to enrolment

8. Need for long-term treatment with a low molecular weight heparin, vitamin K antagonists or NOAC, for an indication other than the index PE episode, or for antiplatelet agents except acetylsalicylic acid at a dosage ≤100 mg/day;

9. Active bleeding or known significant bleeding risk (e.g., gastrointestinal ulcer, malignant neoplasms, injuries or recent surgeries of the brain, spinal cord or eyes, recent intracranial bleedings, known or suspected esophagus varices, aneurysms or intraspinal or intracranial vascular abnormalities)

10. Artificial heart valves requiring treatment with an anticoagulant

11. Renal insufficiency with estimated creatinine clearance <30 ml/min/1.73m2

12. Chronic liver disease with aminotransferase levels two times or more above the local upper limit of normal range

13. Concomitant administration of strong inhibitors of P-glycoprotein like ketoconazole, cyclosporin, itraconazole or dronedarone

14. Unwillingness or inability to adhere to treatment or to the follow-up visits

15. Life expectancy less than 6 months

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

European Georges Pompidou Hospital

OTHER

Sponsor Role: collaborator

Prof. Stavros Konstantinides, MD

OTHER

Sponsor Role: lead

Responsible Party

Prof. Stavros Konstantinides, MD

Medical Director of Center for Thrombosis and Hemostasis, University Medical Center Mainz

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Stavros Konstantinides, Prof., MD

Role: PRINCIPAL_INVESTIGATOR

Center for Thrombosis and Hemostasis, University Medical Center Mainz

Locations

Center for Thrombosis and Hemostasis, University Medical Center Mainz

Mainz, , Germany

Countries

Germany

References

Klok FA, Toenges G, Mavromanoli AC, Barco S, Ageno W, Bouvaist H, Brodmann M, Cuccia C, Couturaud F, Dellas C, Dimopoulos K, Duerschmied D, Empen K, Faggiano P, Ferrari E, Galie N, Galvani M, Ghuysen A, Giannakoulas G, Huisman MV, Jimenez D, Kozak M, Lang IM, Lankeit M, Meneveau N, Munzel T, Palazzini M, Petris AO, Piovaccari G, Salvi A, Schellong S, Schmidt KH, Verschuren F, Schmidtmann I, Meyer G, Konstantinides SV; PEITHO-2 investigators. Early switch to oral anticoagulation in patients with acute intermediate-risk pulmonary embolism (PEITHO-2): a multinational, multicentre, single-arm, phase 4 trial. Lancet Haematol. 2021 Sep;8(9):e627-e636. doi: 10.1016/S2352-3026(21)00203-9. Epub 2021 Aug 4.

Reference Type: DERIVED

PMID: 34363769 (View on PubMed)

Other Identifiers

PEITHO-2

Identifier Type: -

Identifier Source: org_study_id