Can Patients With Atrial Fibrillation Safely Discontinue Anticoagulant Therapy After Cardiac Surgery? (ATLAAC)

NCT ID: NCT06401616

Last Updated: 2024-05-23

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

1220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-21

Study Completion Date

2028-03-31

Brief Summary

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Left atrial appendage (LAA) closure has become a frequent addition to oral anticoagulation in patients with atrial fibrillation who undergo cardiac surgery. The procedure significantly reduces the risk of stroke and systemic embolism, which may render anticoagulation unnecessary or even harmful when considering the associated increased risk of bleeding. A clinical trial to address the need for anticoagulation after LAA closure is needed.

The ATLAAC trial will enroll 1220 patients with atrial fibrillation who have previously undergone surgical LAA closure. Patients will undergo a cardiac CT-scan to determine if LAA closure was successful and patients with successful closure will be randomized to continue or discontinue anticoagulation. The trial will assess the risk of ischemic stroke, peripheral arterial embolism, and major bleeding during the randomized intervention

Detailed Description

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Conditions

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Atrial Fibrillation Left Atrial Appendage Absent Anticoagulant Adverse Reaction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients will be randomized to either continue or discontinue oral anticoagulant therapy
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Blinding of patients and physicians is not possible due to different types of oral anticoagulant therapy within the same interventional arm and the need for continuous monitoring of treatment with warfarin.However, since the primary outcome is not a subjectively reported outcome, lack of blinding presents less risk of bias.

The investigators responsible for data collection and the Endpoint Adjudication Committee will be blinded to the randomization.

Study Groups

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Discontinue OAC

OAC stopped for the duration of the trial

Group Type EXPERIMENTAL

OAC will be discontinued for the duration of the trial

Intervention Type DRUG

Discontinuation of warfarin, dabigatran, rivaroxaban, apixaban or edoxaban

Continue OAC

OAC continued for the duration of the trial

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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OAC will be discontinued for the duration of the trial

Discontinuation of warfarin, dabigatran, rivaroxaban, apixaban or edoxaban

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age \> 18 years
* Previously undergone any type of cardiac surgical procedure including any type of surgical LAA closure (use of any of the following techniques; amputation and suture closure, stapler closure, non-amputating suture closure or closure with an approved surgical occlusion device (e.g. AtriClip)) according to the NationalPatient Register (NPR), the Danish Heart Registry (DHR) or the Western Danish Heart Registry (WDHR) from January 1st 2010 til 3 months prior to inclusion in the project.
* Documented history of paroxysmal, persistent, or permanent atrial fibrillation or atrial flutter according to the electronic patient record
* Informed consent

Exclusion Criteria

* Not receiving OAC (warfarin/DOAC)
* Patient specific conditions requiring OAC (e.g.mechanical valve, previous pulmonary embolism)
* Renal impairment (estimated glomerular filtration rate \< 30)
* Allergy to contrast media
* Pregnancy or breastfeeding
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rigshospitalet, Denmark

OTHER

Sponsor Role collaborator

Gødstrup Hospital

OTHER

Sponsor Role collaborator

Aarhus University Hospital

OTHER

Sponsor Role collaborator

Aalborg University Hospital

OTHER

Sponsor Role collaborator

Population Health Research Institute

OTHER

Sponsor Role collaborator

Region of Southern Denmark

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lars Peter Riber, DMSc

Role: PRINCIPAL_INVESTIGATOR

Odense University Hospital

Locations

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Rigshospitalet

Copenhagen, Capital Region, Denmark

Site Status NOT_YET_RECRUITING

Gentofte Hospital

Gentofte Municipality, Capital Region, Denmark

Site Status RECRUITING

Regionshospital Gødstrup

Herning, Central Jutland, Denmark

Site Status NOT_YET_RECRUITING

Aalborg university hospital

Aalborg, North Denmark, Denmark

Site Status NOT_YET_RECRUITING

Århus Universitetshospital

Aarhus, Region Midt, Denmark

Site Status RECRUITING

Odense University Hospital

Odense, Region Syddanmark, Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Kristina Gosvig, M.D.

Role: CONTACT

+4551520696

Julie Goller, M.D.

Role: CONTACT

Facility Contacts

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Christian Carranza, M.D.

Role: primary

Kristian Eskesen, MD

Role: primary

Morten Böttcher, M.D.

Role: primary

Louise Rasmussen, M.D.

Role: primary

Ivy Modrau, MD

Role: primary

Kristina Gosvig, M.D.

Role: primary

+4551520696

References

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Gosvig K, Goller J, Hansson NH, Brandes A, Modrau I, Rasmussen LF, Eskesen K, Jensen AKG, Belley-Cote E, Whitlock R, Riber LPS. Rationale and design of the anticoagulant therapy after left atrial appendage closure (ATLAAC) trial. Am Heart J. 2025 Sep;287:86-93. doi: 10.1016/j.ahj.2025.04.015. Epub 2025 Apr 15.

Reference Type DERIVED
PMID: 40246048 (View on PubMed)

Other Identifiers

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2022-502986-92-00

Identifier Type: OTHER

Identifier Source: secondary_id

2022-502986-92-00

Identifier Type: -

Identifier Source: org_study_id

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