- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02091479
Early Versus Late Resumption of Anticoagulation in Patients With Both High Thrombosis Risk and Major HEmoRrhage (RATHER)
Randomized Assay Evaluating the Risk/Benefit of Early Versus Late Resumption of Anticoagulation in Patients With Major, Non-trauma Related Hemorrhage Occurring While on Anticoagulant Treatment for a High Risk of Thrombosis.
In patients with a high thromboembolic risk, withdrawing anticoagulant treatment is recommended in some situations, including when major hæmorrhage occurs. But withdrawing treatment can be risky. In patients on a curative dose of anticoagulant medicine, treatment withdrawal heightens the risk of thromboembolic events occurring, with potentially major consequences. For instance, mechanical valve thrombosis is fatal in 15% of patients. Resumption of anticoagulation is therefore critical in patients at high risk for thromboembolic events.
However, in these patients having presented major hæmorrhage, resumption of anticoagulation heightens the risk of hæmorrhage recurrence. This risk is even higher when the original hæmorrhage was not accessible via surgical, endoscopic or endoluminal hemostasis.
As far as investigators know, there is no data in the literature to rely on when the major hæmorrhage is not accessible via hemostatic intervention and the risk of thrombosis is high. When confronted with patients who need anticoagulation but have a high risk of hæmorrhage recurrence, the question of when treatment should be resumed has not been resolved. This is why investigators propose to conduct a randomised comparative study to evaluate two treatment strategies - early resumption (H48 to H72) versus late resumption (H120 to H144) of anticoagulation.
MAIN OBJECTIVE: The main objective of the present study is to evaluate in terms of bleeding risk, thrombosis risk and mortality at one month, the effect of early vs. late resumption of anticoagulation in patients having presented with serious hæmorrhage while on curative-dose anticoagulants and facing a high thromboembolic risk.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
STUDY DESIGN: This is a comparative, randomised, open study assessing after 1 month and 3 months the effect of early (H48 to 72) versus late (H120 to 144) resumption of anticoagulation in patients presenting with serious bleeding while on anticoagulants (excluding intracerebral bleeding) and with a thromboembolic risk evaluated as high (except mitral prostheses). The accumulated frequency of major hæmorrhage, thromboembolic events and deaths should be 26% in case of early resumption and 15% in case of late resumption, i.e. a relative risk reduction of 43%. Based on this hypothesis, to obtain 80% power with two-sided α being 5%, each group should include 208 patients, for a total of 416 patients.
EVALUATION CRITERIA: The main criteria in this study will be the accumulated one-month incidence of hæmorrhage recurrence, thromboembolic complications and deaths. It is a combined criterion associating:
- Fatal hæmorrhage proven by autopsy or sudden deaths in a clinical context strongly suggestive of hæmorrhage
- Fatal thromboembolic events proven by autopsy or imagery or sudden deaths in a clinical context strongly suggestive of thrombosis
- Any clinically significant hæmorrhage leading to temporary (> 24 hours) or permanent withdrawal of anticoagulant treatment
- Any symptomatic thromboembolic event in any territory, proven by imagery or surgery
These events will be validated by a committee for the validation of critical events blind to the date of anticoagulant treatment resumption. The secondary evaluation criteria will be symptomatic hæmorrhages, fatal or not, symptomatic thromboembolic incidents, fatal or not, and mortality at 1 month and 3 mont
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Saint-Etienne, France, 42055
- Service d'Urgences et de Réanimation Medicale, CHU de Saint-Etienne
-
Saint-etienne, France, 42000
- CHU de SAINT-ETIENNE
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:affiliated with or a beneficiary of a social security category
- age > 18 years old
- with major bleeding (ISTH) and highs thrombosis risk (ACCP 2008)
- having signed the inform consent form
Exclusion Criteria:
- intracranial bleeding
- artificial heart valves
- bleeding with hemostatic surgical
- low and moderate thrombosis risk
- INR>1.2
- hemodynamic instability contra-indication to HBPM or HNF treatment
- With previous history of HIT (heparin Inducted thrombopenia)
- patient who need antiaggregant treatment before anticoagulant treatment
- Hæmoglobin count < 8 g/dl or patients with hæmoglobin count < 10 g/dl combined with acute coronary syndrome or proven heart failure
- pregnant
- Polytraumatism
- with curatif heparin before randomisation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: UFH Early group
anticoagulant (UFH or LMWH) reintroduction at 48h to 72h after hemorrhage
|
Either curative dose, intravenous unfractionated heparin (UFH) so as to reach an anti-Xa activity between 0.3 and 0.7 IU/mL, lengthening the activated prothrombin time as determined by each centre according to the treatment area (depending on the coagulometer and reactants). Or low-molecular-weight, curative dose, subcutaneous heparin (LMWH) so as to reach an anti-Xa activity corresponding to treatment areas as determined for each type of molecule (about 0.5 to 1 anti-Xa IU for most LMWHs, administered via 2 daily injections, and about 0.5 to 1.5 anti-Xa IU for tinzaparin, 1 injection daily). |
Active Comparator: UFH Late group
anticoagulant (UFH or LMWH) réintroduction 120h to 144h after hemorrhage
|
Either curative dose, intravenous unfractionated heparin (UFH) so as to reach an anti-Xa activity between 0.3 and 0.7 IU/mL, lengthening the activated prothrombin time as determined by each centre according to the treatment area (depending on the coagulometer and reactants). Or low-molecular-weight, curative dose, subcutaneous heparin (LMWH) so as to reach an anti-Xa activity corresponding to treatment areas as determined for each type of molecule (about 0.5 to 1 anti-Xa IU for most LMWHs, administered via 2 daily injections, and about 0.5 to 1.5 anti-Xa IU for tinzaparin, 1 injection daily). |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The main criterion in this study is the cumulated incidence of mortality, hæmorrhage recurrence and thromboembolic complications at 1 month
Time Frame: The main criterion in this study is the cumulated incidence of mortality, hæmorrhage recurrence and thromboembolic complications at 1 month
|
Fatal hæmorrhage proven by autopsy or sudden deaths in a clinical context strongly suggestive of hæmorrhage,
|
The main criterion in this study is the cumulated incidence of mortality, hæmorrhage recurrence and thromboembolic complications at 1 month
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
-We will evaluate the risk/benefit balance of early versus late resumption of anticoagulant treatment,
Time Frame: We will evaluate at 1 month and at 3 monthsthe risk/benefit balance of early versus late resumption of anticoagulant treatment
|
|
We will evaluate at 1 month and at 3 monthsthe risk/benefit balance of early versus late resumption of anticoagulant treatment
|
Collaborators and Investigators
Investigators
- Principal Investigator: Bernard Tardy, MD phD, CHU Saint Etienne
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1108097
- 2012-000286-21 (EudraCT Number)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Major hæmorrhage
-
Stanford UniversityTerminatedMajor Depressive Disorder | Major Depressive Episode | Major Depressive Disorder, Recurrent | Major Depression Mild | Major Depression Moderate | Major Depression SevereUnited States
-
University of British ColumbiaMichael Smith Foundation for Health ResearchRecruiting
-
Shalvata Mental Health CenterUnknownMAjor Depressive DisorderIsrael
-
Dr Gerard O'ReillyAll India Institute of Medical Sciences, New Delhi; Monash University; The Alfred and other collaboratorsCompletedMajor Trauma | Injuries MajorIndia
-
SanofiCompletedMajor DepressionBelgium, Canada, Chile, Estonia, Finland, France, Germany, Netherlands, Russian Federation, Slovakia, South Africa, Sweden
-
Seasons Biotechnology (Taizhou) Co., Ltd.CompletedMajor Depressive Disorder (MDDIndia
-
Gangnam Severance HospitalCompletedMajor Depressive Disorder(MDD)Korea, Republic of
-
University College, LondonCompletedUnipolar Major Depressive DisorderUnited Kingdom
-
Fundació Institut de Recerca de l'Hospital de la...Fondo de Investigacion SanitariaUnknown
-
University Hospital, MontpellierCompletedMajor Depressive Disorders
Clinical Trials on UFH Early group
-
Population Health Research InstituteRecruitingCardiovascular Diseases | Percutaneous Coronary InterventionCanada
-
University of AarhusCompleted
-
Dayanand Medical College and HospitalCompletedAcute Gastroesophageal Variceal BleedingIndia
-
Peking Union Medical College HospitalUnknown
-
Changhai HospitalFirst People's Hospital of Hangzhou; LanZhou University; Ruijin Hospital; The Second... and other collaboratorsNot yet recruitingFasting | Pancreatic Duct Stone | ESWLChina
-
University Hospital Inselspital, BerneCompletedMultiple SclerosisSwitzerland
-
Colorado State UniversityCompletedChronic InsomniaUnited States
-
Mansoura UniversityUnknownAcute Cholecystitis: Early Versus Delayed Laparoscopic Cholecystectomy; Randomized Prospective StudyAcute CholecystitisEgypt
-
HealthPartners InstituteNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Completed
-
Hongwei ShiNot yet recruitingPostoperative Recovery | Unilateral Knee Arthroplasty | Postoperative Oral Carbohydrates