Prevention of Stroke by Left Atrial Appendage Closure in Atrial Fibrillation Patients After Intracerebral Hemorrhage

NCT ID: NCT02830152

Last Updated: 2024-06-12

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

750 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-03

Study Completion Date

2028-12-31

Brief Summary

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Intracerebral hemorrhage (ICH) in patients with non-valvular atrial fibrillation (NVAF) poses a particular dilemma for thromboprophylaxis. Left atrial appendage occlusion (LAAO) is a non-pharmacological approach to prevent cardiac embolism in NVAF. The risk-benefit ratio of LAAO in patients with NVAF after ICH is unknown. The aim of STROKECLOSE is to assess the effect of LAAO to reduce the incidence stroke, bleeding and cardiovascular mortality in patients with NVAF and prior ICH.

Detailed Description

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Methods/design: A multicenter prospective randomized open-label clinical trial with blinded outcome evaluation (PROBE design) and blinded safety outcome assessment. The active comparison LAAO is tested against medical therapy in a 2:1 stratified randomization.

Study population: Patients should have had an ICH within 12 months prior to enrollment and have NVAF with increased risk of stroke or systemic embolism, as indicated by a CHA2DS2VASc score \>2. In total 750 patients will be included. Active enrollment ensues over 3 years followed by 5 years follow-up and a long-term follow-up at 10 years.

Intervention and control: The intervention group will be treated by LAAO, using the Amplatzer Amulet device. Implantation requires a catheterization procedure using venous access and transseptal puncture and is guided by angiography, fluoroscopy and transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE). Recommended post-implant antithrombotic therapy includes aspirin (ASA) therapy for at least 6 months, with or without clopidogrel for the first 45 days after implantation. The control group will receive medical therapy, delivered according to national standards and guidelines at the treating physicians' discretion. This may include oral anticoagulation (OAC) (vitamin-K antagonists, VKA), non-VKA OAC, antiplatelet therapy or no antithrombotic therapy at all.

Main study outcomes: The primary outcome is the composite endpoint of stroke (ischemic and hemorrhagic), systemic embolism, life-threatening or major bleeding and all-cause mortality, assessed over at least two years. Secondary outcome examines various early and late safety outcome parameters.

Conditions

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Atrial Fibrillation Stroke Intracerebral Hemorrhage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Left Atrial Appendage Occlusion (LAAO)

The intervention is implantation of Amplatzer Amulet LAAO device within two months after randomization. Device implantation comprises a catheterization procedure using venous access and a transseptal puncture to obtain access to the left atrium (LA). Procedural imaging guidance is left to the physician's discretion and may include several techniques such as angiography/fluoroscopy, transesophageal echocardiography (TEE) and/or intracardiac echocardiography (ICE). Recommended post-implant antithrombotic therapy includes ASA therapy for at least 6 months, which may be combined with clopidogrel for the first 45 days after implantation.

Group Type EXPERIMENTAL

LAAO

Intervention Type DEVICE

The left atrial appendage is occluded with the AMPLATZER™ Amulet™ device, which offers a conformable disc and lobe designed for complete occlusion of the left atrial appendage.

Medical Therapy

The optimal medical therapy of stroke prevention in non-valvular atrial fibrillation (NVAF) after intracerebral hemorrhage (ICH) is not known. Therefore, it will be left to the discretion of the treating physician to decide if, when, and which pharmacological therapy will be prescribed. Available options include anticoagulation with oral anticoagulation (OAC) or novel oral anticoagulants (NOAC), antiplatelet therapy (including monotherapy and dual antiplatelet therapy) and no pharmacological antithrombotic therapy.

Group Type ACTIVE_COMPARATOR

Medical Therapy

Intervention Type DRUG

Available options included in Medical therapy are: anticoagulation with OAC or NOAC, antiplatelet therapy (including monotherapy and dual antiplatelet therapy) and no pharmacological antithrombotic therapy.

Interventions

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LAAO

The left atrial appendage is occluded with the AMPLATZER™ Amulet™ device, which offers a conformable disc and lobe designed for complete occlusion of the left atrial appendage.

Intervention Type DEVICE

Medical Therapy

Available options included in Medical therapy are: anticoagulation with OAC or NOAC, antiplatelet therapy (including monotherapy and dual antiplatelet therapy) and no pharmacological antithrombotic therapy.

Intervention Type DRUG

Other Intervention Names

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AMPLATZER™ Amulet™ (St. Jude Medical) Antiplatelet Therapy

Eligibility Criteria

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Inclusion Criteria

* A diagnosis of paroxysmal, persistent or long-standing NVAF with CHA2DS2VASc score \>2.
* Clinical and CT/MRI evidence of ICH within 12 months but not less than 4 weeks prior to enrollment.
* Age \> 18 years.
* Signed informed consent.

Exclusion Criteria

* ICH secondary to vascular malformation or tumors
* Estimated life expectancy of less than 1 year at eligibility assessment
* mRS \> 3 at enrollment
* Prior surgical LAA excision
* Planned combined interventional procedures at the time of enrollment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Abbott Medical Devices

INDUSTRY

Sponsor Role collaborator

Karolinska Institutet

OTHER

Sponsor Role lead

Responsible Party

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Per Wester

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Per Wester, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Clinical Sciences, Karolinska Institute, Danderyds hospital

Locations

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Aarhus University Hospital

Aarhus, , Denmark

Site Status

Bispebjerg University Hospital

Bispebjerg, , Denmark

Site Status

Rikshospitalet Glostrup

Glostrup Municipality, , Denmark

Site Status

Herlev sjukhus

Herlev, , Denmark

Site Status

Odenses Universitetssjukhus

Odense, , Denmark

Site Status

Helsinki University Hospital

Helsinki, , Finland

Site Status

North Karelia Central Hospital

Joensuu, , Finland

Site Status

Kuopio University Hospital

Kuopio, , Finland

Site Status

Turku University Hospital

Turku, , Finland

Site Status

Vaasa Centralsjukhus

Vaasa, , Finland

Site Status

Haukeland Universitetssjukhus

Bergen, , Norway

Site Status

Oslo University Hospital

Oslo, , Norway

Site Status

Sahlgrenska University Hospital

Gothenburg, , Sweden

Site Status

Universitetssjukhuset Skåne

Lund, , Sweden

Site Status

Universitetssjukhuset

Örebro, , Sweden

Site Status

Danderyd Hospital

Stockholm, , Sweden

Site Status

Akademiska sjukhuset

Uppsala, , Sweden

Site Status

Countries

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Denmark Finland Norway Sweden

Other Identifiers

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STROKECLOSE

Identifier Type: -

Identifier Source: org_study_id

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