Anticoagulation for Stroke Prevention In Patients With Recent Episodes of Atrial Fibrillation Occurring Transiently With Stress

NCT ID: NCT03968393

Last Updated: 2026-01-12

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

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

2270 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-06-14

Study Completion Date

2028-12-31

Brief Summary

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Multinational, investigator-initiated study of oral anticoagulation versus no anticoagulation for the prevention of stroke and other adverse cardiovascular events in patients with transient atrial fibrillation occurring transiently with stress and additional stroke risk factors.

Detailed Description

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ASPIRE-AF is a prospective, randomized, open-label trial of non-vitamin K oral anticoagulants (NOACs) versus no oral anticoagulation in patients with transient atrial fibrillation and additional stroke factors occurring transiently with stress. The primary objective is to assess the effects of NOACs versus no anticoagulation on the co-primary composite outcomes of 1. non-hemorrhagic stroke and systemic embolism, and 2. vascular mortality, and non-fatal non-hemorrhagic stroke, myocardial infarction, peripheral arterial thrombosis, amputation, and symptomatic venous thromboembolism over the duration of follow-up.

Conditions

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Stroke Atrial Fibrillation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective, randomized, open-label clinical trial with blinded outcome assessment
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Non-vitamin K oral anticoagulant (NOAC)

Participants randomized to the intervention arm will be prescribed one of the following NOACs for the duration of follow-up, unless they are undergoing a procedure with an increased risk of bleeding, have an adverse event or low calculated creatinine clearance, or decide to discontinue their use.

Group Type EXPERIMENTAL

Non-vitamin K oral anticoagulant (NOAC)

Intervention Type DRUG

Participants randomized to the intervention arm will be prescribed one of the following NOACs for the duration of follow-up: edoxaban 60 mg daily (dose reduction to 30 mg, if applicable), apixaban 5 mg twice daily (dose reduction to 2.5 mg, if applicable), dabigatran 110 mg twice daily, or rivaroxaban 20 mg daily (dose reduction to 15 mg, if applicable). The choice of NOAC will be left up to the participant's prescribing physician.

No anticoagulation

Participants randomized to the control arm will not be prescribed an oral anticoagulant unless they develop a clear indication for one during follow-up (e.g., recurrent nonoperative AF). They can be newly prescribed or continue taking low dose aspirin or another single antiplatelet agent as per the protocol. This will be decided by the participant's physician.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Non-vitamin K oral anticoagulant (NOAC)

Participants randomized to the intervention arm will be prescribed one of the following NOACs for the duration of follow-up: edoxaban 60 mg daily (dose reduction to 30 mg, if applicable), apixaban 5 mg twice daily (dose reduction to 2.5 mg, if applicable), dabigatran 110 mg twice daily, or rivaroxaban 20 mg daily (dose reduction to 15 mg, if applicable). The choice of NOAC will be left up to the participant's prescribing physician.

Intervention Type DRUG

Other Intervention Names

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Apixaban Dabigatran Edoxaban Rivaroxaban

Eligibility Criteria

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Inclusion Criteria

1. have ≥1 episode of clinically important AFOTS during any of the following conditions:

1. noncardiac surgery in the past 35 days, with at least an overnight hospital admission aftersurgery;
2. noncardiac day surgery resulting in a large enough physiological insult to be able to cause AFOTS, as judged by the local investigator; or
3. acute medical illness requiring hospital admission in the past 35 days and resulting in a large enough physiological insult to be able to cause AFOTS, as judged by the local investigator;
2. sinus rhythm at the time of randomization;
3. any of the following high-risk criteria:

1. age 55-64 years, and having either known cardiovascular disease, recent major vascular surgery, a CHA2DS2VASc score ≥3, or an elevated postoperative troponin level;
2. age 65-74 years, and having either known cardiovascular disease, recent major vascular surgery, a CHA2DS2VASc score ≥2, or an elevated postoperative troponin level; OR
3. age ≥75 years.;
4. provide written informed consent

Exclusion Criteria

1. any cardiac diagnosis as the primary reason for hospital admission;
2. history of documented chronic AF prior to noncardiac surgery;
3. need for long-term systemic anticoagulation;
4. ongoing need for long-term dual antiplatelet treatment;
5. contraindication to oral anticoagulation;
6. severe renal insufficiency (CrCl \<20 ml/min);
7. severe liver cirrhosis (i.e., Child-Pugh Class C)
8. acute stroke in the past 14 days;
9. underwent cardiac surgery in the past 35 days;
10. history of nontraumatic intracranial, intraocular, or spinal bleeding;
11. hemorrhagic disorder or bleeding diathesis;
12. expected to be non-compliant with follow-up and/or study medications;
13. known life expectancy less than 1 year due to concomitant disease;
14. women who are pregnant, breastfeeding, or of childbearing potential who are not taking effective contraception; OR
15. previously enrolled in the trial
Minimum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hamilton Health Sciences Corporation

OTHER

Sponsor Role collaborator

Population Health Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David Conen, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Population Health Research Institute

PJ Devereaux, MD, PhD

Role: STUDY_CHAIR

Population Health Research Institute

Locations

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Cedars-Sinai Medical Center

Los Angeles, California, United States

Site Status RECRUITING

Mcgovern Medical School at University of Texas

Houston, Texas, United States

Site Status RECRUITING

Clinica Coronel Suarez

Coronel Suárez, Buenos Aires, Argentina

Site Status RECRUITING

Instituto de Investigaciones Clinicas Rosario

Rosario, Santa Fe Province, Argentina

Site Status RECRUITING

Instituto Cardiovascular de Rosario

Rosario, Santa Fe Province, Argentina

Site Status RECRUITING

Centro Integral de Arritmias de Tucuman (CIAT)

San Miguel de Tucumán, Tucumán Province, Argentina

Site Status RECRUITING

Hospital Municipal Chivilcoy

Chivilcoy, , Argentina

Site Status RECRUITING

Sanatorio Cisma

San Miguel de Tucumán, , Argentina

Site Status RECRUITING

Hospital Privado de Rosario

Santa Fe, , Argentina

Site Status NOT_YET_RECRUITING

Canberra Hospital

Garran, Australian Capital Territory, Australia

Site Status RECRUITING

Bankstown Hospital

Bankstown, New South Wales, Australia

Site Status RECRUITING

Royal Prince Alfred Hospital

Camperdown, New South Wales, Australia

Site Status RECRUITING

Concord Repatriation General Hospital

Concord, New South Wales, Australia

Site Status RECRUITING

Liverpool Hospital

Liverpool, New South Wales, Australia

Site Status NOT_YET_RECRUITING

John Hunter Hospital

Newcastle, New South Wales, Australia

Site Status RECRUITING

Westmead Hospital

Westmead, New South Wales, Australia

Site Status RECRUITING

Sunshine Coast Hospital and Health Service

Birtinya, Queensland, Australia

Site Status RECRUITING

Royal Brisbane and Women's Hospital

Herston, Queensland, Australia

Site Status NOT_YET_RECRUITING

Redcliffe Hospital

Redcliffe, Queensland, Australia

Site Status RECRUITING

Royal Adelaide Hospital

Adelaide, South Australia, Australia

Site Status NOT_YET_RECRUITING

Box Hill Hospital

Box Hill, Victoria, Australia

Site Status RECRUITING

Northeast Health Wangaratta

Wangaratta, Victoria, Australia

Site Status RECRUITING

Royal Perth Hospital

Perth, Western Australia, Australia

Site Status RECRUITING

Instituto do Coração do Hospital das Clínicas da FMUSP

Cerqueira César, , Brazil

Site Status RECRUITING

Hospital de Clinicas de Porto Alegre

Porto Alegre, , Brazil

Site Status RECRUITING

Foothills Hospital

Calgary, Alberta, Canada

Site Status RECRUITING

University of Alberta Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Medicine Hat Regional Hospital

Medicine Hat, Alberta, Canada

Site Status RECRUITING

East Kootenay Regional Hospital

Cranbrook, British Columbia, Canada

Site Status NOT_YET_RECRUITING

Fraser Health Authority

Surrey, British Columbia, Canada

Site Status RECRUITING

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Health Sciences Centre Winnipeg

Winnipeg, Manitoba, Canada

Site Status RECRUITING

Dr.-Georges-L.-Dumont University Hospital Centre

Moncton, New Brunswick, Canada

Site Status NOT_YET_RECRUITING

Halifax Infirmary

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Cape Breton University

Sydney, Nova Scotia, Canada

Site Status RECRUITING

Cambridge Cardiac Care Centre

Cambridge, Ontario, Canada

Site Status NOT_YET_RECRUITING

Hamilton General Hospital

Hamilton, Ontario, Canada

Site Status RECRUITING

St. Joseph's Healthcare Hamilton

Hamilton, Ontario, Canada

Site Status RECRUITING

Juravinski Hospital

Hamilton, Ontario, Canada

Site Status RECRUITING

Kingston General Hospital

Kingston, Ontario, Canada

Site Status RECRUITING

London Health Sciences Centre - University Hospital

London, Ontario, Canada

Site Status RECRUITING

The Ottawa Hospital General Campus

Ottawa, Ontario, Canada

Site Status RECRUITING

Niagara Health System - St. Catharine's Site

St. Catharines, Ontario, Canada

Site Status RECRUITING

Cortelluci Vaughan Hospital

Vaughan, Ontario, Canada

Site Status RECRUITING

Centre Hospitalier de l'Université de Montréal

Montreal, Quebec, Canada

Site Status RECRUITING

CHU de Quebec Universite Laval

Québec, Quebec, Canada

Site Status NOT_YET_RECRUITING

Hôpital Fleurimont du Centre hospitalier universitaire de Sherbrooke

Sherbrooke, Quebec, Canada

Site Status RECRUITING

Regina General Hospital

Regina, Saskatchewan, Canada

Site Status RECRUITING

Royal University Hospital

Saskatoon, Saskatchewan, Canada

Site Status RECRUITING

Aarhus University Hospital

Aarhus, , Denmark

Site Status RECRUITING

Hospital South West Jutland - University Hospital of Southern Denmark

Esbjerg, , Denmark

Site Status RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

Southwest Finland Wellbeing County (VARHA)

Turku, , Finland

Site Status RECRUITING

Universitatsklinikum Leipzig

Leipzig, , Germany

Site Status RECRUITING

GNRC Medical

North Guwāhāti, Assam, India

Site Status NOT_YET_RECRUITING

Marengo CIMS Hospital

Ahmedabad, Gujarat, India

Site Status NOT_YET_RECRUITING

NU Hospitals

Bangalore, Karnataka, India

Site Status RECRUITING

Govt. T.D. Medical College

Alappuzha, Kerala, India

Site Status NOT_YET_RECRUITING

Amala Institute of Medical Sciences

Thrissur, Kerala, India

Site Status RECRUITING

Amala Institute

Thrissur, Kerala, India

Site Status NOT_YET_RECRUITING

St. John's Medical College Hospital

Bangalore, , India

Site Status RECRUITING

JIPMER

Puducherry, , India

Site Status RECRUITING

Ruby Hall Clinic

Pune, , India

Site Status NOT_YET_RECRUITING

Trivandrum Medical

Thiruvananthapuram, , India

Site Status RECRUITING

ASST Grande Ospedale Metropolitano Niguarda

Milan, Milan, Italy

Site Status RECRUITING

Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo

Alessandria, , Italy

Site Status RECRUITING

Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico

Milan, , Italy

Site Status RECRUITING

La Maddalena

Palermo, , Italy

Site Status RECRUITING

Piacenza Ospedale

Piacenza, , Italy

Site Status RECRUITING

Nobel Medical College Teaching Hospital

Biratnagar, , Nepal

Site Status RECRUITING

B.P. Koirala Institute of Health Sciences

Koshi, , Nepal

Site Status RECRUITING

B and B Hospital

Lalitpur, , Nepal

Site Status RECRUITING

Jeroen Bosch Hospital

's-Hertogenbosch, , Netherlands

Site Status RECRUITING

Noordwest Ziekenhuisgroep

Alkmaar, , Netherlands

Site Status RECRUITING

ZiekenhuisGroepTwente (ZGT)

Almelo, , Netherlands

Site Status RECRUITING

Ziekenhuis Amstelland

Amstelveen, , Netherlands

Site Status RECRUITING

Rijnstate Hospital

Arnhem, , Netherlands

Site Status RECRUITING

Amphia Ziekenhuis Breda

Breda, , Netherlands

Site Status RECRUITING

Deventer Ziekenhuis

Deventer, , Netherlands

Site Status RECRUITING

Hospital Gelderse Vallei

Ede, , Netherlands

Site Status RECRUITING

Martini Hospital

Groningen, , Netherlands

Site Status RECRUITING

Franciscus Gasthuis

Rotterdam, , Netherlands

Site Status RECRUITING

Ikazia Hospital

Rotterdam, , Netherlands

Site Status RECRUITING

ETZ Tilburg

Tilburg, , Netherlands

Site Status RECRUITING

Aga Khan University

Karachi, Sindh, Pakistan

Site Status RECRUITING

Maroof International Hospital

Islamabad, , Pakistan

Site Status RECRUITING

Shifa International Hospital

Islamabad, , Pakistan

Site Status RECRUITING

Dow Medical University

Karachi, , Pakistan

Site Status RECRUITING

Rehman Medical Institute

Peshawar, , Pakistan

Site Status RECRUITING

Korea Univesrity Anam Hospital

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Hospital

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Bundang Hospital

Seoul, , South Korea

Site Status RECRUITING

Hospital de Mar

Barcelona, Barcelona, Spain

Site Status NOT_YET_RECRUITING

Vall d'Hebron Hospital

Barcelona, Barcelona, Spain

Site Status NOT_YET_RECRUITING

Hospital de la Santa Creu i Sant Pau

Barcelona, , Spain

Site Status RECRUITING

Hospital Mutua de Terrassa

Barcelona, , Spain

Site Status RECRUITING

University Hospital Ramon y Cajal

Madrid, , Spain

Site Status RECRUITING

Hospital Universitario de Navarra

Pamplona, , Spain

Site Status RECRUITING

Karolinska Institutet Danderyd Hospital

Danderyd, , Sweden

Site Status RECRUITING

Uppsala University

Uppsala, , Sweden

Site Status RECRUITING

University Hospital Basel

Basel, Basel, Switzerland

Site Status RECRUITING

Kantonsspital St. Gallen

Sankt Gallen, , Switzerland

Site Status RECRUITING

Kantonsspital Winterthur

Winterthur, , Switzerland

Site Status RECRUITING

Liverpool Heart and Chest Hospital

Liverpool, , United Kingdom

Site Status RECRUITING

Southend Hospital

Westcliff-on-Sea, , United Kingdom

Site Status RECRUITING

Countries

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United States Argentina Australia Brazil Canada Denmark Finland Germany India Italy Nepal Netherlands Pakistan South Korea Spain Sweden Switzerland United Kingdom

Central Contacts

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Cassie McDonald

Role: CONTACT

1-905-594-0560

Other Identifiers

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2023-509142-35-00

Identifier Type: CTIS

Identifier Source: secondary_id

2019-001336-62

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

2019-ASPIREAF

Identifier Type: -

Identifier Source: org_study_id

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