DOAC Versus VKA After Cardiac Surgery

NCT ID: NCT04002011

Last Updated: 2023-03-13

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

WITHDRAWN

Clinical Phase

PHASE2

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-09

Study Completion Date

2023-03-09

Brief Summary

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Postoperative management of oral anticoagulation is a frequent preoccupation in cardiac surgery, concerning about half of patients. Vitamin K antagonists are often recommended but their management is not easy due to the high dose-response patient variability. Pharmacologically more stable, direct oral anticoagulants have similar efficiency in preventing thromboembolic complications while they decrease the risk of bleeding in certain patient populations. The objective of study is to assess the safety and efficacy of direct oral anticoagulants in the postoperative period of cardiac surgical procedures.

Detailed Description

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This study will be composed by 2 groups of 103 participants, patients undergoing cardiac surgery and needing oral anticoagulation in the early postoperative period.

The control group will receive vitamin K antagonist and the study group will receive direct oral anticoagulant. The investigators will call back each participants at 3 months to report the ischemic and bleeding complications during this period and evaluated the quality of life of the oral anticoagulation.

Conditions

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Anticoagulant-induced Bleeding

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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Group VKA

103 patients. First intake at postoperative day 1 or later when anticoagulation is secondary indicated.

Dosage adapted to INR = \[2.0-3.0\], parenteral (subcoutaneous low-weight molecular or intravenous unfractionated heparin) until INR \> or = 2.0.

Daily INR during hospital stay, then management by familial doctor. Duration: 3 months

Group Type ACTIVE_COMPARATOR

Warfarin

Intervention Type DRUG

It will be started on postoperative day 1 or later when oral anticoagulation is secondary indicated. Daily dose will be adapted to obtain an international normalized ratio of \[2.0-3.0\]. Other anticoagulants will be not administrated.

Group DOAC

103 patients - One drug among the 4 DOAC according the morbidity of each patient (preoperative DOAC, oral nutrition recovery).

First intake at hospital discharge - parenteral (subcoutaneous low-weight molecular or intravenous unfractionated heparin) during hospital stay.

Regular daily dosages according the drug, its indication (atrial fibrillation/flutter or biological mitral replacement/repair or biological tricuspid replacement versus venous thromboembolism) and the morbidity of each patient (age, weight, creatinine ou its clearance).

Validation by one referent pharmacist. No biological monitoring. Duration: 3 months

Group Type ACTIVE_COMPARATOR

Dabigatran

Intervention Type DRUG

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Rivaroxaban

Intervention Type DRUG

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Apixaban

Intervention Type DRUG

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Edoxaban

Intervention Type DRUG

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Interventions

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Warfarin

It will be started on postoperative day 1 or later when oral anticoagulation is secondary indicated. Daily dose will be adapted to obtain an international normalized ratio of \[2.0-3.0\]. Other anticoagulants will be not administrated.

Intervention Type DRUG

Dabigatran

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Intervention Type DRUG

Rivaroxaban

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Intervention Type DRUG

Apixaban

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Intervention Type DRUG

Edoxaban

It will be started when patients will be discharged from our center. Our pharmacist referent will validated the drug and its daily dose. Other anticoagulants will be not administrated.

Intervention Type DRUG

Other Intervention Names

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Coumadin Pradaxa Xarelto Eliquis Lixiana

Eligibility Criteria

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Inclusion Criteria

* Cardiac surgery, with or without cardiopulmonary bypass
* Indication of postoperative oral anticoagulation: preoperative (atrial fibrillation/flutter of idiopathic venous thromboembolism disease), intraoperative (bioprosthetic mitral valve replacement/mitral valve repair or bioprosthetic tricuspid valve repair), postoperative (de novo persistent more than 24 hours or recurrent atrial fibrillation/flutter, venous thromboembolism)

Exclusion Criteria

* mechanical valvular prostheses or ventricular assist devices
* morbidly obesity (body mass index ≥ 40 kg/m²), prior biliopancreatic diversion or sleeve gastrectomy
* perioperative dysphagia needing naso-enteric tube or jejunostomy
* antiretroviral of antifungal oral therapy
* perioperative recent (less than 2 weeks) stroke
* perioperative severe renal failure (clearance of creatinine under 30 mL/min or dialysis)
* perioperative severe hepatic failure (elevated alanine aminotransferase more than 3 times the superior limit of normal range or cirrhosis)
* perioperative recent (less than 3 months) heparin-induced thrombocytopenia
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Laval University

OTHER

Sponsor Role lead

Responsible Party

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Pierre Voisine

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Pierre Voisine, M.D.

Role: PRINCIPAL_INVESTIGATOR

Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ)

Other Identifiers

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21755

Identifier Type: -

Identifier Source: org_study_id

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