Long-term Anticoagulation With Oral Factor Xa Inhibitor Versus Vitamin K Antagonist After Mechanical Aortic Valve Replacement

NCT ID: NCT04258488

Last Updated: 2025-12-29

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

1300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-21

Study Completion Date

2028-12-30

Brief Summary

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This study evaluates the long-term anticoagulation with oral factor Xa inhibitor versus vitamin K antagonist in patients receiving a mechanical aortic valve replacement.

Detailed Description

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Conditions

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AORTIC VALVE DISEASES Thromboembolism

Keywords

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Aortic valve replacement Mechanical valve

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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Oral Factor Xa inhibitor

Group Type EXPERIMENTAL

Rivaroxaban Oral Tablet

Intervention Type DRUG

For 12months, Rivaroxaban oral tablet 20mg once daily For renal disorder subjects\_creatinine clearance 15-49 mL/min, 15mg once daily

Vitamin K antagonist

Group Type ACTIVE_COMPARATOR

Vitamin K antagonist(warfarin)

Intervention Type DRUG

For 12months, keep the international normalized ratio (INR) 1.7-3.0

Interventions

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Rivaroxaban Oral Tablet

For 12months, Rivaroxaban oral tablet 20mg once daily For renal disorder subjects\_creatinine clearance 15-49 mL/min, 15mg once daily

Intervention Type DRUG

Vitamin K antagonist(warfarin)

For 12months, keep the international normalized ratio (INR) 1.7-3.0

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Age 19 and more
2. At least 3 months after mechanical aortic valve replacement
3. At least one of the conditions(as defined below) is met

* The New York Heart Association (NYHA) Functional Classification I or II; or
* According to the Valve Academic Research Consortium(VARC)2 criteria, confirmed proper valve function: no prosthesis-patient mismatch and mean aortic valve gradient \<20 mm Hg or peak velocity \<3 m/s, AND no moderate or severe prosthetic valve regurgitation
4. Voluntarily participated in the written agreement

Exclusion Criteria

1. Old-generation mechanical valve
2. History of mechanical valve implantation in the mitral valve, pulmonary valve, or tricuspid valve
3. Valvular atrial fibrillation(atrial fibrillation with moderate or severe mitral stenosis)
4. Moderate to severe mitral stenosis or regurgitation
5. History of hemorrhagic stroke
6. Clinically overt stroke within the last 3 months
7. Renal failure(creatinine clearance \<15mL/min) or on hemodialysis
8. Left ventricular dysfunction: Left ventricular ejection fraction (LVEF) ≤40%
9. Child-Pugh B and C hepatic impairment or any hepatic disease associated with coagulopathy
10. Clinically significant active bleeding
11. Bleeding or hemorrhagic disorder
12. The increased risk of bleeding due to the following reasons

1. History of gastrointestinal ulcers or active ulcerations within the last 6 months
2. History of intracranial or intracerebral hemorrhage within the last 6 months
3. Spinal cord vascular abnormalities or intracerebral vascular abnormalities
4. History of the brain, spinal cord, or ophthalmic surgery within the last 6 months
5. History of the brain or spinal cord injury within the last 6 months
6. History of the brain or spinal cord injury or spinal tap, major regional anesthesia, or spinal anesthesia within the last 6 months
7. Esophageal varices
8. Arteriovenous malformation
9. Vascular aneurysms
10. Malignant tumor with a high risk of bleeding
13. Bleeding tendencies associated with overt bleeding of

1. gastrointestinal, genitourinary, respiratory tract, or colorectal cancer
2. cerebrovascular hemorrhage
3. aneurysms- cerebral, dissecting aorta
4. pericarditis and pericardial effusions
5. bacterial endocarditis
14. Hemodynamically unstable or pulmonary embolism required thrombolysis or embolectomy
15. Combination therapy with other anticoagulants(Unfractionated heparin(UFH), enoxaparin, dalteparin, fondaparinux, etc.) However, the following cases are permitted

* Switching anticoagulants
* Intravenous UFH to keep central/arterial lines open
16. Uncontrolled moderate or severe hypertension
17. Anemia at least one among the conditions(as defined below) is met 1) Hemoglobin level \<10.0 g/dL or platelet count \< 100 x 10x9/L within the last 6 months 2) Diagnosed and documented ongoing anemia
18. Infective endocarditis
19. Hypersensitivity to the main component or constituents of Rivaroxaban or Vitamin K antagonist
20. Positive pregnancy test results (all pregnant women should undergo urinary human chorionic gonadotropin (hCG) testing within 7 days before screening and/or randomization) or during pregnancy or lactation
21. A genetic problem with galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption
22. The unsuitable condition of the protocol
23. Actively participating in another drug or device investigational study, which has not completed the primary endpoint follow-up period
24. Terminal illness with life expectancy \<12 months
25. Vitamin K deficiency
26. Alcoholic or psychical disorder
27. Threatened abortion, eclampsia, or preeclampsia
28. Concomitant use with antiplatelet in patients with a history of stroke or transient ischemic attack for the treatment of the acute coronary syndrome
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Joon Bum Kim

OTHER

Sponsor Role lead

Responsible Party

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Joon Bum Kim

Professor, Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Jung-min Ahn, MD

Role: PRINCIPAL_INVESTIGATOR

[email protected]

Locations

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Buchen Sejong Hospital

Bucheon-si, , South Korea

Site Status RECRUITING

Seoul National University Bundang Hospital

Bundang, , South Korea

Site Status NOT_YET_RECRUITING

Dong-A University Hospital

Busan, , South Korea

Site Status RECRUITING

Keimyung University Dongsan Hospital

Daegu, , South Korea

Site Status RECRUITING

GangNeung Asan Hospital

Gangneung, , South Korea

Site Status RECRUITING

Chonnam National University Hospital

Gwangju, , South Korea

Site Status RECRUITING

Asan Medical Center

Seoul, , South Korea

Site Status RECRUITING

Korea University Anam Hospital

Seoul, , South Korea

Site Status RECRUITING

Samsung Medical Center

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Hospital

Seoul, , South Korea

Site Status RECRUITING

Ajou University Hospital

Suwon, , South Korea

Site Status RECRUITING

St. Vincent's Hospital, Catholic University of Korea

Suwon, , South Korea

Site Status NOT_YET_RECRUITING

Eulji University Uijeongbu Hospital

Uijeongbu-si, , South Korea

Site Status NOT_YET_RECRUITING

Ulsan University Hospital

Ulsan, , South Korea

Site Status NOT_YET_RECRUITING

Pusan National University Yangsan Hospital

Yangsan, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Jung-hee Ham, RN

Role: CONTACT

Phone: 82230104728

Email: [email protected]

Facility Contacts

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Hee-moon Lee, MD

Role: primary

Hyung Gon Je, MD

Role: primary

Yong-rak Cho, MD

Role: primary

Yoon-suk Kim, MD

Role: primary

Hanbit Park

Role: primary

Kyo-sun Lee, MD

Role: primary

Joon-bum Kim, MD

Role: primary

Ho-Sung Son, MD

Role: primary

Dong-sub Jung, MD

Role: primary

Jae-woong Choi, MD

Role: primary

Soo Jin Park, MD

Role: primary

Jin Won Shin, MD

Role: primary

Joon Lee

Role: primary

Kwan-sik Kim, MD

Role: primary

mi-hee Lim, MD

Role: primary

Other Identifiers

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AMCCV2020-01

Identifier Type: -

Identifier Source: org_study_id