VTE Prevention Following Total Hip and Knee Arthroplasty

NCT ID: NCT04075240

Last Updated: 2024-02-07

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

PHASE3

Total Enrollment

5400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-04

Study Completion Date

2026-04-30

Brief Summary

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Consented patients undergoing elective total hip and total knee arthroplasty will be randomized to receive either aspirin alone or aspirin and rivaroxaban for prevention of venous thromboembolism.

Detailed Description

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Aspirin and rivaroxaban prevent venous thromboembolism (VTE) via different mechanisms. Aspirin is significantly cheaper than rivaroxaban. Aspirin in combination with rivaroxaban was shown to be safe and efficacious in a non-inferiority trial (EPCATII) when compared to rivaroxaban alone.

This study will assess if aspirin alone is non-inferior to rivaroxaban and aspirin in the prevention of venous thromboembolism.

Conditions

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Venous Thromboembolism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

randomized, controlled, double-blind
Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
over-encapsulated rivaroxaban/ASA

Study Groups

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THA-control arm

Total Hip Arthroplasty: 5 days of rivaroxaban, followed by 30 days of aspirin

Group Type ACTIVE_COMPARATOR

Rivaroxaban 10 MG and acetylsalicylic acid 81 mg

Intervention Type DRUG

Starting post op, rivaroxaban (5 days) followed by aspirin (9 days for TKA; 30 days for THA)

THA-study arm

Total Hip Arthroplasty: 35 days of aspirin

Group Type EXPERIMENTAL

acetylsalicylic acid 81 mg

Intervention Type DRUG

Starting post op, aspirin for 9 days for TKA and 30 days for THA

TKA-control arm

Total Knee Arthroplasty: 5 days of rivaroxaban, followed by 9 days of aspirin

Group Type ACTIVE_COMPARATOR

Rivaroxaban 10 MG and acetylsalicylic acid 81 mg

Intervention Type DRUG

Starting post op, rivaroxaban (5 days) followed by aspirin (9 days for TKA; 30 days for THA)

TKA-study arm

Total Knee Arthroplasty: 14 days of aspirin

Group Type EXPERIMENTAL

acetylsalicylic acid 81 mg

Intervention Type DRUG

Starting post op, aspirin for 9 days for TKA and 30 days for THA

Interventions

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Rivaroxaban 10 MG and acetylsalicylic acid 81 mg

Starting post op, rivaroxaban (5 days) followed by aspirin (9 days for TKA; 30 days for THA)

Intervention Type DRUG

acetylsalicylic acid 81 mg

Starting post op, aspirin for 9 days for TKA and 30 days for THA

Intervention Type DRUG

Other Intervention Names

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Xarelto 10mg and aspirin 81mg aspirin 81mg

Eligibility Criteria

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Inclusion Criteria

1. Patients undergoing elective THA/TKA at the participating institutions will be potentially eligible for this study
2. Written informed consent in accordance with federal, local and institutional guidelines

Exclusion Criteria

1. Previous documented VTE (proximal DVT or any PE)
2. Hip or lower limb fracture in the previous three months, not related to present surgery
3. Metastatic cancer
4. Life expectancy less than 6 months
5. History of major bleeding that in the judgment of the investigator precludes use of anticoagulant prophylaxis
6. History of aspirin allergy, active peptic ulcer disease or gastritis that in the judgment of investigator precludes use of aspirin
7. History of significant hepatic disease or any other condition that in the judgment of the investigator precludes the use of rivaroxaban
8. Creatinine clearance less than 15 ml per minute
9. Pre-operative platelet count less than 100 x 109 /L
10. Need for long-term anticoagulation due to a pre-existing co-morbid condition or due to the development of VTE following surgery but prior to randomization
11. Received anticoagulation post operatively
12. Bilateral THA/TKA or simultaneous hip and knee arthroplasty
13. Major surgical procedure within the previous 3 months
14. Requirement for major surgery post arthroplasty within a 90 day period
15. Chronic daily aspirin use with dose greater than 100 mg a day
16. Women of childbearing potential who are not abstinent or do not use effective contraception or are breast-feeding throughout the study drug period
17. Unwilling or unable to give consent
18. Previous participation in the EPCAT III study
19. Under 18 years of age
20. Concomitant use of drugs that are strong inhibitors of P-gp AND CYP3A4 (e.g., systemic treatment with ketoconazole, itraconazole, or ritonavir) or strong inducers of P-gp AND CYP3A4 (e.g., rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's Wort)
21. Known allergy to food dye
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

Nova Scotia Health Authority

OTHER

Sponsor Role collaborator

Canadian Venous Thromboembolism Clinical Trials and Outcomes Research (CanVECTOR) Network

NETWORK

Sponsor Role collaborator

Sudeep Shivakumar

OTHER

Sponsor Role lead

Responsible Party

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Sudeep Shivakumar

Head, Division of Hematology

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Sudeep P Shivakumar, MD

Role: PRINCIPAL_INVESTIGATOR

Dalhousie University/Nova Scotia Health Authority

Locations

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Queen Elizabeth II HSC

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Susan L Pleasance, BScN

Role: CONTACT

902-719-5203

Facility Contacts

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Joanne Douglas, BSc

Role: primary

902-473-7339

Other Identifiers

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EPCATIII.001

Identifier Type: -

Identifier Source: org_study_id

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