Oral Anticoagulation in Haemodialysis Patients

NCT ID: NCT02886962

Last Updated: 2024-08-20

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

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-07-12

Study Completion Date

2023-12-01

Brief Summary

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Guidelines recommend oral anticoagulation with vitamin K antagonists for atrial fibrillation whenever the CHADS2VASC score is superior or equal to 2. As there are no specific guidelines for the hemodialysis patients with atrial fibrillation, the general guidelines apply. However, several retrospective studies suggest that these patients do not benefit from the oral anticoagulation regarding the risk of stroke and may even experience more bleedings and deaths.

The aim of this prospective study is to prospectively compare the hemorrhagic and thrombotic risks of oral anticoagulation in comparison with no anticoagulation in hemodialysis patients with atrial fibrillation.

Detailed Description

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Conditions

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Kidney Failure, Chronic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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No anticoagulation

No oral anticoagulation, and no monitoring of the INR.

Group Type EXPERIMENTAL

No oral anticoagulation

Intervention Type BIOLOGICAL

No oral anticoagulation, and no monitoring of the INR.

Oral anticoagulation with vitamin K antagonists

VKA use as recommended in the guidelines with INR target range between 2 and 3. Daily administration or thrice weekly at the end of dialysis sessions upon Nephrologist's choice.

Antiplatelet therapy will be provided only if recent acute coronary syndrome (\< 6 months) or active coronary stent. Aspirin should be preferred in dialysis patients as clopidogrel has an unpredictable reduced activity and there is no safety data on combination of VKA with prasugrel or ticagrelor in this population.

Group Type ACTIVE_COMPARATOR

Oral anticoagulation with vitamin K antagonists

Intervention Type DRUG

Vitamin K antagonist prescription with INR target between 2 and 3 as recommended in the guidelines.

Administration once daily or at the end of each dialysis session, according to the nephrologist choice.

INR monitoring at least once per week

Interventions

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No oral anticoagulation

No oral anticoagulation, and no monitoring of the INR.

Intervention Type BIOLOGICAL

Oral anticoagulation with vitamin K antagonists

Vitamin K antagonist prescription with INR target between 2 and 3 as recommended in the guidelines.

Administration once daily or at the end of each dialysis session, according to the nephrologist choice.

INR monitoring at least once per week

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Adult patients (≥ 18 years)
* Patient on hemodialysis treatment for at least 1 month
* Patient with a history of, or presenting a new episode of atrial fibrillation (either permanent or paroxysmal).
* Patient with a CHADS2VASC score ≥2
* Patient with high risk of bleeding as defined by (1) HASBLED score ≥3 OR (2) HASBLED ≥ CHADS2VASC score, OR (3) recent history of severe bleeding (type 3a, 3b, 3c), particularly cerebral or gastrointestinal, OR (4) prior recurrent (\>2) history of falls.
* Patient capable of understanding information about the study and of giving his/her consent
* Patient informed of the preliminary medical exam results
* Patient with healthcare insurance
* Written consent signed

Exclusion Criteria

* Formal indication to oral anticoagulation beside atrial fibrillation (mechanic heart valves, recurrent thrombophlebitis, antiphospholipid syndrome)
* Life expectancy \< 6 months (e.g., terminal cancer)
* Live donor transplantation scheduled within 6 months
* Pregnancy (β-HCG blood-based assay)or nursing (lactating) women
* Women of child bearing potential, unless they are using an effective method of birth control
* Patient under legal guardianship
* Patients under law protection
* Known hypersensibility to coumadin or indoine derivatives or to any excipients (CI to oral AVK)
* Severe liver failure (CI to oral AVK)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Strasbourg, France

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Service de Néphrologie et médecine interne

Amiens, , France

Site Status

CHRU d'Angers - Service de Néphrologie

Angers, , France

Site Status

Service Néphrologie, Dialyse, Transplantation

Caen, , France

Site Status

Pathologie Rénale

Chambéry, , France

Site Status

Service de Néphrologie

Cherbourg-Octeville, , France

Site Status

Aural Colmar

Colmar, , France

Site Status

Service de néphrologie

Colmar, , France

Site Status

Service de néphrologie

Dijon, , France

Site Status

Aurad Aquitaine

Gradignan, , France

Site Status

Centre Hospitalier de Haguenau - service de Néphrologie

Haguenau, , France

Site Status

AURAL Haguenau

Haguenau, , France

Site Status

Centre Hospitalier Emile Roux

Le Puy-en-Velay, , France

Site Status

Clinique Bouchard

Marseille, , France

Site Status

Service de Néphrologie

Nancy, , France

Site Status

ECHO de Nantes

Nantes, , France

Site Status

Service de Néphrologie

Nantes, , France

Site Status

AURA Paris Plaisance

Paris, , France

Site Status

Hôpital Tenon - Service de Néphrologie

Paris, , France

Site Status

Service de néphrologie

Rennes, , France

Site Status

ECHO CA Laennec

Saint-Herblain, , France

Site Status

NéphroCare Tassin-Charcot

Sainte-Foy-lès-Lyon, , France

Site Status

AURAL st Anne

Strasbourg, , France

Site Status

Service de Néphrologie

Strasbourg, , France

Site Status

Centre Hospitalier Bretagne-Atlantique

Vannes, , France

Site Status

Calydial CH Lucien Hussel

Vienne, , France

Site Status

Countries

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France

Other Identifiers

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6396

Identifier Type: -

Identifier Source: org_study_id

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