Apixaban for Early Prevention of Recurrent Embolic Stroke and Hemorrhagic Transformation (AREST)

November 3, 2021 updated by: University of South Florida
The purpose of this study is to evaluate if Apixaban will decrease the complication of having another stroke for people who have atrial fibrillation if initiated earlier than standard of care.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This is an Open label, randomized, active control, parallel-group pilot trial to examine the effect of initiation of APIXABAN at days 0-3 (TIA), days 3-5 (small stroke) and days 7-9 (medium stroke) to decrease fatal and/or recurrent stroke/TIA in 120 subjects who have suffered a recent( 0 to 48 hours from symptoms) TIA, or small to medium ischemic stroke compared to standard of care warfarin treatment regimen. Subjects will be randomly assigned in a 1:1 ratio to one of two treatment arms (apixaban or warfarin). Subjects will be followed for a total of 180 days during from screening through monthly follow-up visits.

Study Type

Interventional

Enrollment (Actual)

91

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Torrance, California, United States, 90502
        • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
    • Florida
      • Saint Petersburg, Florida, United States, 33701
        • Bayfront Health St Petersburg
      • Tampa, Florida, United States, 33602
        • Tampa General Hospital
      • Tampa, Florida, United States, 33602
        • University of South Florida
    • Kentucky
      • Louisville, Kentucky, United States, 40202
        • University of Louisville

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Signed Written Informed Consent
  2. Males and Females over 18 years of age.
  3. History of Nonvalvular Atrial Fibrillation (NVAF) by documentation in the medical history or newly diagnosed nonvalvular Atrial Fibrillation at time of study randomization by ECG, device or telemetry .
  4. Diagnosis of TIA or small or medium ischemic stroke 0 to 48 hours from signs or symptoms.
  5. Women of child-bearing potential must use a reliable method of contraception and must provide a negative pregnancy test at entry into the study and within 24 hours of study treatment initiation.
  6. WOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment with study drug Apixaban plus 5 half-lives (approximately 3 days) plus 30 days (duration of ovulatory cycle) for a total of 33 days post-treatment completion.
  7. Males who are sexually active with WOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment with Apixaban plus 5 half-lives (approximately 3 days) plus 90 days (duration of sperm turnover) for a total of 93 days post-treatment completion.
  8. Azoospermic males and WOCBP who are continuously not heterosexually active are exempt from contraceptive requirements. However they must still undergo pregnancy testing as described in this section.

Investigators shall counsel WOCBP and male subjects who are sexually active with WOCBP on the importance of pregnancy prevention and the implications of an unexpected pregnancy Investigators shall advise WOCBP and male subjects who are sexually active with WOCBP on the use of highly effective methods of contraception. Highly effective methods of contraception have a failure rate of < 1% when used consistently and correctly.

At a minimum, subjects must agree to the use of one method of highly effective contraception as listed below:

HIGHLY EFFECTIVE METHODS OF CONTRACEPTION

  • Male condoms with spermicide
  • Hormonal methods of contraception including combined oral contraceptive pills, vaginal ring, injectables, implants and intrauterine devices (IUDs) such as Mirena by WOCBP subject or male subject's WOCBP partner. Female partners of male subjects participating in the study may use hormone based contraceptives as one of the acceptable methods of contraception since they will not be receiving study drug
  • IUDs, such as ParaGard™
  • Tubal ligation
  • Vasectomy.
  • Complete Abstinence

Exclusion Criteria:

  1. Hemorrhagic stroke
  2. Large ischemic stroke
  3. History of major bleeding within the last 6 months from time of subject enrollment (e.g. GI bleed).

  4. History of intracranial bleed

    a. Traumatic intracranial bleed within one year of randomization. (Traumatic ICH greater than one year of randomization is not an exclusion).

  5. Current or history of bleeding disorders (e.g. blood dycrasias)
  6. Blood Pressure of 180/100 mmHg on hypertensive therapy day of randomization per PI discretion 20.
  7. Current illicit drug use and/or chronic alcohol use per PI discretion.
  8. Severe liver disease (AST/ALT 2x upper limit).
  9. Patients with kidney disease meeting criteria to take 2.5 mg twice daily who are taking strong dual inhibitors of CYP3A4 and P-glycoprotein (e.g. ketoconazole, itraconazole, ritonavir, clarithromycin) .
  10. Any other suspected etiology for stroke (e.g. ipsilateral carotid disease).
  11. Greater than 3 Cerebral Micro-bleeds (CMB) on gradient recovery echo (GRE) or evidence of intracranial hemorrhage on CT at time of randomization. (SWI sequencing may be used if GRE sequencing is not obtainable)
  12. Therapeutically anti-coagulated at time of admission (INR at admission greater than 2.0 on warfarin or took two consecutive doses of NOAC).
  13. Absolute indication for use of warfarin only.( e.g. Mechanical Valve)
  14. Absolute indication for anticoagulation prior to randomization window. (e.g. DVT)
  15. Hemoglobin less than 9 gm/dl and/or platelet count less than 100 K/uL.
  16. Requires dual antiplatelet therapy.
  17. Daily use of NSAIDS
  18. Pregnancy or lactation.
  19. Any use of an investigational product within the past 30 days.
  20. Prisoners or subjects who are involuntarily incarcerated.
  21. Subjects who are compulsorily detained for treatment of either a psychiatric or physical (eg, infectious disease) illness.
  22. Concurrent participation in another clinical study where use of an investigational product is used

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: PREVENTION
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Apixaban
Apixaban twice a day for 180 days with drug initiation day 0-3 (TIA), day 3-5(small stroke) or day 7- 9 (medium stroke) respectively
Drug: Apixaban
ACTIVE_COMPARATOR: Warfarin
standard of care warfarin starting at day 7±5 (TIA) or day 14 ±5 (small to medium ischemic stroke).
Drug: Warfarin

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Number of Participants With a Composite Endpoint of Fatal Stroke, Recurrent Ischemic Stroke, or TIA
Time Frame: 180 days
180 days

Secondary Outcome Measures

Outcome Measure
Time Frame
Number of Participants With an Intracranial Hemorrhage Assessed by MRI/CT
Time Frame: 180 days
180 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of South Florida

Collaborators

Bristol-Myers Squibb

Investigators

  • Principal Investigator: Michael Fradley, M.D., University of South Florida, Department of Cardiovascular Sciences

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

April 1, 2015

Primary Completion (ACTUAL)

June 1, 2019

Study Completion (ACTUAL)

June 1, 2019

Study Registration Dates

First Submitted

October 29, 2014

First Submitted That Met QC Criteria

October 31, 2014

First Posted (ESTIMATE)

November 5, 2014

Study Record Updates

Last Update Posted (ACTUAL)

November 30, 2021

Last Update Submitted That Met QC Criteria

November 3, 2021

Last Verified

December 1, 2018

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • PRO00019754

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.

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