The Danish Warfarin-Dialysis Study - Safety and Efficacy of Warfarin in Patients With Atrial Fibrillation on Dialysis

NCT ID: NCT03862859

Last Updated: 2024-02-26

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

718 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-09

Study Completion Date

2027-01-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The study aims to evaluate the appropriateness of initiating oral anticoagulation for stroke risk reduction in dialysis populations with atrial fibrillation. Specifically, the study will assess the overall safety, tolerability, and efficacy of initiating treatment with Warfarin in patients with end-stage renal disease on dialysis and atrial fibrillation.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Data pertaining to the tolerability, safety, and benefit of initiating anticoagulation for stroke risk reduction in patients with end-stage renal disease and atrial fibrillation remains conflicting and insufficient. Patients on dialysis continue to be routinely excluded from randomized controlled trials, and evidence from observational studies is plausibly biased. The main objective of the following parallel-group open randomized clinical trial presents a nationwide study aimed at investigating the benefit, tolerability, and safety of initiating warfarin versus no treatment in patients with atrial fibrillation on dialysis. The anticipated results from this project will provide conclusive evidence as to the appropriateness of initiating oral anticoagulation for stroke risk reduction in dialysis populations with atrial fibrillation with direct effects on clinical management and international guidelines pertaining to these patients.

The study is planned as a multicentre, randomized, open label, parallel group trial with planned inclusion of a total of 718 patients (359 patients per arm). Dialysis-treated patients with end-stage renal disease with paroxysmal, persistent, or permanent atrial fibrillation will be enrolled and randomized to either treatment with warfarin or no treatment. Randomization with be attained using a 1:1 allocation as per a computer-generated randomization schedule stratified by gender, age by decade, and center using permuted blocks of random sizes. Study participants will be allocated to treatment in accordance with the randomization for the full duration of the trial i.e. at a minimum one year following randomization, and followed with regular monitoring for the the primary efficacy outcome of ischemic stroke or death due to ischemic or unspecified stroke and the primary safety outcome of major bleeding defined in accordance with the International Society on Thrombosis and Hemostasis definition.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Atrial Fibrillation and Flutter Stroke Major Bleed End-stage Renal Disease

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A multicentre, randomized, open label, parallel group study.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

None (Open Label

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Treatment with Warfarin

Warfarin with dosing targeting an international normalized ratio of 2-3.

Group Type ACTIVE_COMPARATOR

Warfarin

Intervention Type DRUG

Dose adjusted Warfarin targeting an international normalized ratio of 2-3.

No treatment

No treatment

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Warfarin

Dose adjusted Warfarin targeting an international normalized ratio of 2-3.

Intervention Type DRUG

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Coumadin Marevan Jantoven

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Patients ≥18 years on chronic dialysis due to end-stage renal disease
* Non-valvular paroxysmal, persistent, or permanent atrial fibrillation OR non-treated (for \>2 months) prevalent paroxysmal, persistent or permanent atrial fibrillation as documented by an electrocardiogram or an episode of ≥30 seconds on Holter monitor, or episodes ≥ 6 minutes on event recorders or any other recording device.
* Competence to understand the study rationale, including potential risks and benefits associated with treatment, necessary for written informed consent.

Exclusion Criteria

* CHA2DS2-VASc Score ≤1
* Other indications for oral anticoagulation treatment (pulmonary embolism \< 6 months, deep vein thrombosis \<3 months, mechanical heart valve prosthesis) irrespective of whether treatment is implemented
* Ongoing dual antiplatelet treatment
* Malignancy (with exception of non-melanoma skin cancer) with recent \< 1 year, ongoing, or planned curative, or palliative chemo- , radiation-, and/or scheduled surgical therapy
* Endoscopy with gastrointestinal ulcer \<1 month
* Esophageal varices
* Autoimmune og genetic coagulation disorders
* Congenital alactasia, Lapp Lactase deficiency or glucose-galactose malabsorption
* Pending spinal tap
* Cerebrovascular malformations
* Arterial aneurysms
* Ulcers or wounds (Wagner grad \>1)
* Bacterial endocarditis \< 3 months
* Active bleeding contraindicating anticoagulation
* Any non-elective and/or non-ambulant surgery \<7 days
* Cerebral hemorrhage \<4 weeks
* Thrombocytopenia (platelet count \<100 × 109/L) \<30 days.
* Severe liver insufficiency (spontaneous international normalized ratio \>1.5) \<30 days.
* Known intolerance to warfarin
* Use of hypericum perforatum / St. John's Wort
* Uncontrolled hypertension (repeat blood pressure \>180/110 mmhg) \< 30 days
* Uncontrolled hyperthyroidism (thyroid-stimulating hormone \<0.1μIU/mL) \<30 days
* Pregnancy or lactation
* Participation in other ongoing intervention trials adjudged to influence study outcomes
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Danish Heart Foundation

OTHER

Sponsor Role collaborator

Nicholas Carlson

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Nicholas Carlson

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Nicholas Carlson, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Nephrology, Copenhagen University Hospital Rigshospitalet

Gunnar H Gislason, Prof MD PhD

Role: STUDY_CHAIR

Danish Heart Foundation

Anne-Lise Kamper, MD DMSc

Role: STUDY_CHAIR

Department of Nephrology, Copenhagen University Hospital Rigshospitalet

Christian Torp-Pedersen, Prof MD DMSc

Role: STUDY_CHAIR

Department of Cardiology, North Zealand Hospital

Jonas B Olesen, MD PhD

Role: STUDY_CHAIR

Department of Cardiology, Copenhagen University Hospital Gentofte

Casper Bang, MD PhD

Role: STUDY_CHAIR

Department of Cardiology, Frederiksberg and Bispebjerg Hospital

Thomas A Gerds, Prof

Role: STUDY_CHAIR

Danish Heart Foundation

Ditte Hansen, MD PhD

Role: STUDY_CHAIR

Department of Nephrology, Copenhagen University Hospital Herlev

Morten Schou, Prof MD PhD

Role: STUDY_CHAIR

Department of Cardiology, Copenhagen University Hospital Herlev

Mads Hornum, Prof MD PhD

Role: STUDY_CHAIR

Department of Nephrology, Copenhagen University Hospital Rigshospitalet

Erik Grove, MD PhD

Role: STUDY_CHAIR

Department of Cardiology, Aarhus University Hospital

Jens D Jensen, MD PhD

Role: STUDY_CHAIR

Department of Nephrology, Aarhus University Hospital

Ellen Linnea F Ballegaard, MD

Role: STUDY_CHAIR

Department of Nephrology, Copenhagen University Hospital Rigshospitalet

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Aalborg University Hosptial

Aalborg, , Denmark

Site Status RECRUITING

Aarhus University Hospital

Aarhus, , Denmark

Site Status RECRUITING

Department of Nephrology, Copenhagen University Hospital Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Esbjerg and Grindsted Hospital

Esbjerg, , Denmark

Site Status RECRUITING

Department of Nephrology, Herlev Hospital

Herlev, , Denmark

Site Status RECRUITING

Department of nephrology, Nordsjaellands Hospital

Hillerød, , Denmark

Site Status RECRUITING

Holbaek Hospital

Holbæk, , Denmark

Site Status RECRUITING

Holstebro Hospital

Holstebro, , Denmark

Site Status RECRUITING

Lillebælt Hospital

Kolding, , Denmark

Site Status RECRUITING

Zealand University Hospital

Roskilde, , Denmark

Site Status RECRUITING

Bornholms Hospital

Rønne, , Denmark

Site Status RECRUITING

Hospital Sønderjylland

Sønderborg, , Denmark

Site Status RECRUITING

Viborg Regional Hospital

Viborg, , Denmark

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Denmark

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Nicholas Carlson, MD PhD

Role: CONTACT

+45 35455827

Gunnar H Gislason, Prof MD PhD

Role: CONTACT

+45 70 25 00 00

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Jesper M Rantanen, MD PhD

Role: primary

Christian D Peters, MD PhD

Role: primary

Nicholas Carlson, MD PhD

Role: primary

+45 35455927

Alice S Nielsen, MD

Role: primary

Johanne K Breinholt, MD

Role: backup

Kristine Lindhard Rasmussen, MD

Role: primary

Marianne Bertelsen, MD

Role: primary

Morten Lindhardt, MD PhD

Role: primary

Frank H Mose, MD PhD

Role: primary

Donata Cibulskyte-Ninkovic, MD

Role: primary

Rikke Borg, MD PhD

Role: primary

Finn T Nielsen, MD

Role: primary

Jan D Kampmann, MD

Role: primary

Ida Tietze, MD PhD

Role: primary

References

Explore related publications, articles, or registry entries linked to this study.

Ballegaard ELF, Lindhard K, Lindhardt M, Peters CD, Thomsen Nielsen F, Tietze IN, Borg R, Boesby L, Bertelsen MC, Brosen JMB, Cibulskyte-Ninkovic D, Rantanen JM, Mose FH, Kampmann JD, Nielsen AS, Breinholt JK, Kofod DH, Bressendorff I, Clausen PV, Lange T, Kober L, Kamper AL, Bang CNF, Torp-Pedersen C, Hansen D, Grove EL, Gislason G, Dam Jensen J, Olesen JB, Hornum M, Rix M, Schou M, Carlson N. Protocol for a randomised controlled trial comparing warfarin with no oral anticoagulation in patients with atrial fibrillation on chronic dialysis: the Danish Warfarin-Dialysis (DANWARD) trial. BMJ Open. 2024 Feb 26;14(2):e081961. doi: 10.1136/bmjopen-2023-081961.

Reference Type DERIVED
PMID: 38413147 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

2018-000484-86

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

DANWARD 1.26

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Protocol for Improvement of Therapy With Warfarin
NCT06789588 ENROLLING_BY_INVITATION PHASE3