Comparison of LAA-Closure vs Oral Anticoagulation in Patients With NVAF and Status Post Intracranial Bleeding.

NCT ID: NCT04298723

Last Updated: 2025-09-02

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

NA

Total Enrollment

530 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-16

Study Completion Date

2029-12-31

Brief Summary

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Atrial fibrillation is the most common cardiac arrhythmia. In atrial fibrillation, there is a risk that clots can form in the heart, especially in the left atrium. If these clots come loose, there is a risk of stroke. To prevent strokes, patients with atrial fibrillation and status post ICB can be treated with anticoagulants. This medication therapy prevents blood clots from forming in the heart, but can also cause bleeding. Another therapy option is the occlusion of the left atrium. After closure of the left atrium, only a short anticoagulation therapy is necessary until the occluder has healed. The aim of the study is to compare these two treatment approaches. In this study only already approved drugs and occlusion systems will be used.

Detailed Description

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Within the current trial, two novel strategies are tested in a randomized fashion in patients with atrial fibrillation and status post intracranial bleeding. Patients with ICH were usually excluded from the large NOAC trials and were also not representatively included in the large Watchman device trials. On the other hand, registries show that there is a significant proportion of patients with status post ICH that were implanted with a LAA closure device in clinical routine, and also there are those patients treated with NOAC due to their high stroke risk, despite the risk of recurrent ICH.

Both therapies, NOAC and LAA closure are effective in preventing stroke in patients with AF at high risk for stroke. Also, for both therapies there is evidence for prevention of bleedings, especially intracranial bleeding events.

Patients within the LAA closure group will have the chance after successful closure of the LAA to quit oral anticoagulation medication and therefore reduce their lifetime risk for bleeding and recurrent bleeding. Patients in the NOAC group are provided with an excellent protection against stroke and a significant reduced bleeding risk compared to Vitamin K antagonist therapy.

The trial will help to develop data and hopefully guidelines for management of patients with AF and status post intracranial bleedings. It may help to give physicians data to therapy patients post ICH adequately and help to reduce mortality rates in those patients.

Conditions

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Intracranial Hemorrhages Atrial Fibrillation (AF) Atrial Flutter

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

multicenter, prospective, randomized, controlled, non-blinded clinical trial with a two-arm parallel group design
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors
CEC blinded DSMB blinded

Study Groups

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Left Atrial Appendage Occlusion

Percutaneous closure of the LAA by use of CE-mark approved LAA occlusion device Watchman / Watchman FLX

Group Type EXPERIMENTAL

Percutaneous closure of the LAA (Watchman / Watchman FLX)

Intervention Type DEVICE

LAA closure procedure will be done by experienced operators according to the local SOP. LAA closure will be performed under fluoroscopic and TEE guidance within conscious sedation or general anesthesia. Antibiotic single-shot prophylaxis should be administered peri-procedurally (i.e., cefazolin 2 g). The specific anatomy of the LAA is evaluated and an appropriately sized CE-marked device (Watchman or Watchman FLX) is deployed. LAA angiography and TEE imaging is performed to identify optimal positioning of the device and to exclude a relevant leak. Following device deployment, patients will receive a therapy according to the manufacturers IFU, currently Aspirin and clopidogrel for 3 months followed by single Aspirin up to 12 months. Alternatively, 3 months of NOAC followed by Aspirin monotherapy up to 12 months are possible.

Best Medical Therapy for Anticoagulation

Standard of care (according to current guidelines)

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Percutaneous closure of the LAA (Watchman / Watchman FLX)

LAA closure procedure will be done by experienced operators according to the local SOP. LAA closure will be performed under fluoroscopic and TEE guidance within conscious sedation or general anesthesia. Antibiotic single-shot prophylaxis should be administered peri-procedurally (i.e., cefazolin 2 g). The specific anatomy of the LAA is evaluated and an appropriately sized CE-marked device (Watchman or Watchman FLX) is deployed. LAA angiography and TEE imaging is performed to identify optimal positioning of the device and to exclude a relevant leak. Following device deployment, patients will receive a therapy according to the manufacturers IFU, currently Aspirin and clopidogrel for 3 months followed by single Aspirin up to 12 months. Alternatively, 3 months of NOAC followed by Aspirin monotherapy up to 12 months are possible.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Signed written informed consent
* Documented atrial fibrillation (paroxysmal, persistent, long-standing persistent or permanent)
* CHA2DS2VASc-Score ≥2
* Status post intracranial bleeding \>6 weeks
* Favorable LAA anatomy
* Subject eligible for a LAA occluder device
* Age ≥18 years

Exclusion Criteria

* Comorbidities other than AF requiring chronic (N)OAC therapy, e.g. mechanical heart valve prosthesis, hereditary thrombophilia requiring livelong OAC - recurrent thrombosis
* Symptomatic carotid disease (if not treated)
* Thrombus in the left atrium or left atrial appendage
* Active infection or active endocarditis or other infections resulting in bacteremia
* Functional Impairment (modified ranking scale ≥4 )
* Severe liver failure (Child-Pugh class C or liver failure with coagulopathy)
* Pregnancy or breastfeeding
* Subject with participation in another interventional clinical trial during this study or within 30 days before entry into this trial.
* Known terminating disease with life expectancy \<1 year (including those with end-stage heart failure)
* Subjects, who are committed to an institution due to binding official or court order
* Subjects with planned cardiac or non-cardiac surgery or intervention. (These subjects can be included 30 days after intervention / surgery
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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KCRI

OTHER

Sponsor Role collaborator

Jena University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Sven Möbius-Winkler

Principal Investigator, Debuty director cardiology departement

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sven Möbius-Winkler, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Internal Medicine I, Jena University Hospital

Albrecht Günther, Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Neurology, Jena University Hospital

Christian Senft, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Neurosurgery, Jena University Hospital

P. Christian Schulze, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Internal Medicine I, Jena University Hospital

Locations

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University Hospital Mannheim

Mannheim, Baden-Wurttemberg, Germany

Site Status RECRUITING

RHÖN-KLINIKUM Campus Bad Neustadt

Bad Neustadt an der Saale, Bavaria, Germany

Site Status ACTIVE_NOT_RECRUITING

Therapiezentrum Burgau

Burgau, Bavaria, Germany

Site Status ACTIVE_NOT_RECRUITING

REGIOMED Klinikum Coburg

Coburg, Bavaria, Germany

Site Status RECRUITING

Universitätsklinikum Erlangen

Erlangen, Bavaria, Germany

Site Status RECRUITING

Klinikum Ingolstadt

Ingolstadt, Bavaria, Germany

Site Status RECRUITING

RoMed Klinikum

Rosenheim, Bavaria, Germany

Site Status ACTIVE_NOT_RECRUITING

Cardiologicum Hamburg

Hamburg, City state of Hamburg, Germany

Site Status RECRUITING

Asklepios Klinik Wandsbek

Hamburg, City state of Hamburg, Germany

Site Status RECRUITING

Asklepios Klinik Nord Heidberg

Hamburg, City state of Hamburg, Germany

Site Status RECRUITING

Asklepios Klinik Altona

Hamburg, City state of Hamburg, Germany

Site Status RECRUITING

Herz-Kreislauf-Zentrum

Rotenburg an der Fulda, Hesse, Germany

Site Status ACTIVE_NOT_RECRUITING

Evangelisches Klinikum Bethel

Bielefeld, North Rhine-Westphalia, Germany

Site Status RECRUITING

Klinikum Dortmund

Dortmund, North Rhine-Westphalia, Germany

Site Status ACTIVE_NOT_RECRUITING

Knappschaft Kliniken

Dortmund, North Rhine-Westphalia, Germany

Site Status RECRUITING

Westpfalz-Klinikum

Kaiserslautern, Rhineland-Palatinate, Germany

Site Status RECRUITING

Katholisches Klinikum Koblenz • Montabaur

Koblenz, Rhineland-Palatinate, Germany

Site Status RECRUITING

Klinikum Chemnitz

Chemnitz, Saxony, Germany

Site Status RECRUITING

Dresden Heart Center

Dresden, Saxony, Germany

Site Status RECRUITING

University Hospital Leipzig

Leipzig, Saxony, Germany

Site Status RECRUITING

Klinikum St. Georg

Leipzig, Saxony, Germany

Site Status RECRUITING

Heart Center Leipzig

Leipzig, Saxony, Germany

Site Status RECRUITING

Helios Klinikum Pirna

Pirna, Saxony, Germany

Site Status RECRUITING

Heinrich-Braun-Klinikum (HBK)

Zwickau, Saxony, Germany

Site Status RECRUITING

University Hospital Magdeburg

Magdeburg, Saxony-Anhalt, Germany

Site Status RECRUITING

Universitätsklinikum Schleswig-Holstein (UKSH)

Lübeck, Schleswig-Holstein, Germany

Site Status RECRUITING

Charité - Universitätsmedizin Berlin (CBF)

Berlin, State of Berlin, Germany

Site Status RECRUITING

Charité - Universitätsmedizin Berlin (CVK

Berlin, State of Berlin, Germany

Site Status ACTIVE_NOT_RECRUITING

Helios Klinikum Erfurt

Erfurt, Thuringia, Germany

Site Status RECRUITING

University Hospital Jena

Jena, Thuringia, Germany

Site Status RECRUITING

Uniwersytecki Szpital Kliniczny w Poznaniu

Poznan, Greater Poland Voivodeship, Poland

Site Status NOT_YET_RECRUITING

Polsko-Amerykańskie Kliniki Serca

Bielsko-Biala, Silesian Voivodeship, Poland

Site Status NOT_YET_RECRUITING

Górnośląskim Centrum Medycznym

Katowice, Silesian Voivodeship, Poland

Site Status RECRUITING

Countries

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Germany Poland

Central Contacts

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Sven Möbius-Winkler, Prof. Dr.

Role: CONTACT

+4936419324503

Marcus Winter

Role: CONTACT

+4936419396648

Facility Contacts

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Ibrahim Akin, Prof. Dr.

Role: primary

+496213835229

Steffen Schnupp, Dr.

Role: primary

+4995612233201

Bernd Kallmünzer, Prof. Dr.

Role: primary

+4991318534306

Blerim Luani, PD Dr.

Role: primary

+498418802101

Martin Bergmann, Prof. Dr.

Role: primary

+49401818811221

Tudor C Pörner, PD Dr.

Role: primary

+49401818831051

Alexander Ghanem, Prof. Dr.

Role: primary

+49401818873286

Felix Meincke, Dr.

Role: primary

+49401818818902

Wladimir Tschichow, Dr.

Role: primary

+4952177277672

Burghard Schumacher, Prof. Dr.

Role: primary

+496312031255

Jiangtao Yu, PD Dr.

Role: primary

+492614963132

Karim Ibrahim, Prof. Dr.

Role: primary

+4937133342211

Norman Mangner, Prof. Dr.

Role: primary

+493514501701

Karsten Lenk, PD Dr.

Role: primary

+493419720956

Norbert Klein, PD Dr.

Role: primary

+493419092300

Marcus Sandri, PD Dr.

Role: primary

+49341865252035

Steffen Schön, Prof. Dr.

Role: primary

+49350171185211

Holger H Sigusch, PD Dr.

Role: primary

+49375512219

Rüdiger Braun-Dullaeus, Prof. Dr.

Role: primary

+493916713203

Ingo Eitel, Prof. Dr.

Role: primary

+4945150044504

Carsten Skurk, Prof. Dr.

Role: primary

+4930450513725

Frank Steinborn, Dr.

Role: primary

+493617812481

Sven Möbius-Winkler, Prof. Dr.

Role: primary

+4936419324503

Sissy Grund

Role: backup

Marek Grygier, Prof. Dr.

Role: primary

Krzysztof Milewski, Prof. Dr.

Role: primary

Wojciech Wojakowski, Prof. Dr.

Role: primary

+48604188669

Other Identifiers

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ZKSJ0123_Clearance

Identifier Type: -

Identifier Source: org_study_id

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