Strategies for the Management of Atrial Fibrillation in patiEnts Receiving Dialysis

NCT ID: NCT03987711

Last Updated: 2023-06-22

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

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

151 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-10

Study Completion Date

2022-12-31

Brief Summary

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The prevention of atrial fibrillation related thromboembolism in the dialysis population is unclear. While the practice of anticoagulation appears favorable in patients with mild-to-moderate chronic kidney disease, no patients with severe chronic kidney disease (estimated glomerular filtration rate \<25 ml/min), and specifically those receiving dialysis, have been included in randomized trials.Moreover, the effect of anticoagulation in the dialysis population may fundamentally differ from those studied in clinical trials. Accordingly, characterization of the optimal management strategy to reduce the risk of stroke and systemic embolism in patients with atrial fibrillation receiving dialysis is a priority. The overall goal of this pilot trial is to evaluate the feasibility of conducting a randomized controlled trial comparing anticoagulation strategies in patients with atrial fibrillation receiving dialysis (either hemodialysis or peritoneal dialysis).

Detailed Description

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Conditions

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Atrial Fibrillation End Stage Renal Failure on Dialysis

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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Warfarin

Individuals randomized to this arm will be exposed to dose-adjusted daily warfarin targeting an international normalized ratio (INR) of 2.0-3.0.

Group Type EXPERIMENTAL

Warfarin

Intervention Type DRUG

Individuals randomized to this arm will be exposed to dose-adjusted daily warfarin targeting an international normalized ratio (INR) of 2.0-3.0.

Apixaban

Individuals randomized to this arm will receive apixaban 5 mg twice daily (a reduced dose of 2.5 mg twice daily will be given to selected participants).

Group Type ACTIVE_COMPARATOR

Apixaban

Intervention Type DRUG

Individuals randomized to this arm will receive apixaban 5 mg twice daily (a reduced dose of 2.5 mg twice daily will be given to selected participants).

No oral anticoagulation

Individuals in this arm will be exposed to a treatment strategy in which no oral anticoagulation is prescribed.

Group Type ACTIVE_COMPARATOR

No oral anticoagulation

Intervention Type OTHER

No oral anticoagulation

Interventions

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Warfarin

Individuals randomized to this arm will be exposed to dose-adjusted daily warfarin targeting an international normalized ratio (INR) of 2.0-3.0.

Intervention Type DRUG

Apixaban

Individuals randomized to this arm will receive apixaban 5 mg twice daily (a reduced dose of 2.5 mg twice daily will be given to selected participants).

Intervention Type DRUG

No oral anticoagulation

No oral anticoagulation

Intervention Type OTHER

Other Intervention Names

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Coumadin Eliquis

Eligibility Criteria

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Inclusion Criteria

1. Age ≥ 18 years.
2. Receiving maintenance hemodialysis or peritoneal dialysis for \> 90 days.
3. History of AF or atrial flutter as defined by:

(i) AF or atrial flutter on a 12 lead ECG at enrollment, and not due to a reversible cause, or (ii) AF or atrial flutter documented on two separate occasions, not due to a reversible cause, at least 1 day apart prior to enrollment. AF or atrial flutter may be documented by ECG, or as an episode lasting at least 30 seconds on a rhythm strip or Holter recording, or more than 30 minutes if using pacemaker or implantable cardioverter defibrillator (ICD) recordings, or (iii) AF or atrial flutter documented on one occasion, not due to a reversible cause, prior to enrollment and being treated with an oral anticoagulant for AF or atrial flutter at enrollment. \[AF or atrial flutter may be documented by ECG, or as an episode lasting at least 30 seconds on a rhythm strip or Holter recording, or more than 30 minutes if using pacemaker or implantable cardioverter defibrillator (ICD) recordings, or mentioned in the medical record\], or (iv) AF or atrial flutter documented on one occasion on ECG, not due to a reversible cause, prior to enrollment and at least one more episode of AF or atrial flutter mentioned in the medical record, or (v) AF or atrial flutter documented on one occasion in a cardiologist report, not due to a reversible condition, prior to enrollment.
4. Satisfying CHADS-65 criteria: i) Age ≥65 or ii) Age \<65 and one of: hypertension, diabetes mellitus, congestive heart failure, stroke/transient ischemic attack or peripheral embolism.

Exclusion Criteria

1. Moderate or severe mitral stenosis.
2. Conditions other than non-valvular atrial fibrillation that require oral anticoagulation, such as mechanical prosthetic valve, deep venous thrombosis, or pulmonary embolism.
3. Need for aspirin at a dose \> 165 mg a day, or need for aspirin in combination with P2Y12 antagonist therapy.
4. Need for an interacting drug which precludes the safe use of apixaban.
5. Life expectancy \< 6 months.
6. Scheduled live-donor kidney transplant in the next 6 months.
7. A woman who is pregnant or breastfeeding or unwilling to pursue methods of contraception if \< 12 months since the last menstrual period.
8. Co-enrollment in a clinical trial where the intervention is deemed to interfere with the adherence, safety or efficacy of the intervention provided herein.
9. Patient's attending physician(s) (e.g., nephrologist and/or cardiologist and/or neurologist) believes that oral anticoagulation is absolutely mandated.
10. Patient's attending physician(s) (e.g., nephrologist and/or cardiologist and/or neurologist) believes that oral anticoagulation is absolutely contraindicated.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

The George Institute for Global Health (Sydney, Australia)

UNKNOWN

Sponsor Role collaborator

Unity Health Toronto

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ziv Harel

Role: PRINCIPAL_INVESTIGATOR

Unity Health Toronto

Ron Wald

Role: PRINCIPAL_INVESTIGATOR

Unity Health Toronto

Locations

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Nepean Hospital

Kingswood, New South Wales, Australia

Site Status

Prince of Wales Hospital

Randwick, New South Wales, Australia

Site Status

Royal North Shore Hospital

Saint Leonards, New South Wales, Australia

Site Status

St. George Hospital

Sydney, , Australia

Site Status

Surrey Memorial Hospital

Surrey, British Columbia, Canada

Site Status

St. Paul's Hospital

Vancouver, British Columbia, Canada

Site Status

Seven Oaks General Hospital

Winnipeg, Manitoba, Canada

Site Status

Nova Scotia Health Authority, QEII Health Sciences Centre

Halifax, Nova Scotia, Canada

Site Status

Royal Victoria Regional Health Centre

Barrie, Ontario, Canada

Site Status

Health Sciences North

Greater Sudbury, Ontario, Canada

Site Status

St. Joseph's Healthcare Hamilton

Hamilton, Ontario, Canada

Site Status

Kingston Health Sciences Centre - Kingston General Hospital

Kingston, Ontario, Canada

Site Status

London Health Sciences Centre

London, Ontario, Canada

Site Status

Halton Healthcare - Oakville Trafalgar Memorial Hospital

Oakville, Ontario, Canada

Site Status

Lakeridge Health Oshawa

Oshawa, Ontario, Canada

Site Status

The Ottawa Hospital - Riverside Campus

Ottawa, Ontario, Canada

Site Status

Thunder Bay Regional Health Sciences Centre

Thunder Bay, Ontario, Canada

Site Status

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status

Unity Health Toronto, at its St. Michael's Hospital site

Toronto, Ontario, Canada

Site Status

University Health Network - Toronto General Hospital

Toronto, Ontario, Canada

Site Status

St. Joseph's Health Centre Toronto

Toronto, Ontario, Canada

Site Status

Hôpital Maisonneuve-Rosemont

Montreal, Quebec, Canada

Site Status

Centre Hospitalier de l'Université de Montréal

Montreal, Quebec, Canada

Site Status

Jewish General Hospital

Montreal, Quebec, Canada

Site Status

Hôpital du Sacré-Cœur de Montréal

Montreal, Quebec, Canada

Site Status

McGill University Health Centre

Montreal, Quebec, Canada

Site Status

CHU de Québec - Université Laval

Québec, Quebec, Canada

Site Status

Regina General Hospital

Regina, Saskatchewan, Canada

Site Status

Countries

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Australia Canada

References

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Harel Z, Smyth B, Badve SV, Blum D, Beaubien-Souligny W, Silver SA, Clark E, Suri R, Mavrakanas TA, Sasal J, Prasad B, Eikelboom J, Tennankore K, Rigatto C, Prce I, Madore F, Mac-Way F, Steele A, Zeng Y, Sholzberg M, Dorian P, Yan AT, Sood MM, Gladstone DJ, Tseng E, Kitchlu A, Walsh M, Sapir D, Oliver MJ, Krishnan M, Kiaii M, Wong N, Kotwal S, Battistella M, Acedillo R, Lok C, Weir M, Wald R. Anticoagulation for Patients with Atrial Fibrillation Receiving Dialysis: A Pilot Randomized Controlled Trial. J Am Soc Nephrol. 2025 May 1;36(5):901-910. doi: 10.1681/ASN.0000000000000495. Epub 2024 Nov 4.

Reference Type DERIVED
PMID: 39495569 (View on PubMed)

Other Identifiers

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SAFE-D-01

Identifier Type: -

Identifier Source: org_study_id

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