- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02478294
LAA Excision With AF Ablation Versus Oral Anticoagulants for Secondary Prevention of Stroke (5A)
Evaluation of Thoracoscopic Left Atrial Appendage Excision Plus Atrial Fibrillation Ablation Versus Oral Anticoagulants for Secondary Prevention of Stroke and Non-central Nervous Systemic Embolism in Patients With AF: 5A Pilot Cohort
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Brief Summary: This cohort study aims to compare thoracoscopic left atrial appendage excision plus atrial fibrillation ablation versus oral anticoagulants for secondary prevention of stroke and non-central nervous systemic embolism in patients with atrial fibrillation and thromboembolism.
Detailed Description: BACKGROUND: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and has been shown to be an important cause of stroke. AF is responsible for 15% of all strokes. Most strokes in AF are caused by cardioembolism. The left atrial appendage (LAA) is the dominant source of cardioembolism. The greatest priority in treating AF is stroke prevention. There are now 3 main approaches for prevention: (1) oral anticoagulation (OAC), (2) eradication of AF, and (3) exclusion of the LAA from the systemic circulation. OAC therapy, including warfarin and novel oral anticoagulants, effectively reduces the risk of stroke in AF and is currently the first line of treatment in patients with AF and one or more risk factors. Despite the advancements in medical therapy, the risk of stroke in patients with AF who undergo optimal anticoagulation therapy still remains between 2% and 5% per year, regardless of the agent used. The limitations of OAC include (1) patient unsuitability for OAC, (2) increased risk of bleeding, (3) need for monitoring optimal international normalized ratio (INR) levels (with warfarin), and (4) patient noncompliance. Percutaneous methods of ablation are widely used to attempt to eliminate AF. Approximately 20% of patients who underwent ablation had AF recurrence. It is because of this well-demonstrated occurrence that the guidelines do not recommend discontinuation of warfarin or equivalent therapies after ablation. Since at least 90% of all left atrial thrombi are found within the LAA, it is plausible that its occlusion will lead to a decreased risk of stroke in patients with AF. However, the evidence for surgical excision is extremely limited.
AIM OF THE STUDY: The primary objective of this study is to evaluate whether thoracoscopic LAA excision plus atrial fibrillation ablation for the purpose of prevention of thromboembolism in patients with AF and thromboembolism is more effective and safer compared with OACs for reducing the composite endpoint of stroke, TIA and systemic embolism. The primary end point was the composite of ischemic stroke/systemic embolism/transient ischemic attack (TIA), major bleeding, or all-cause mortality. The secondary end point is defined as ischemic strokes, all strokes (including ischemic and hemorrhagic), major and fatal bleeding events, minor bleeding complication, all-cause mortality, cardiovascular death, and hospitalization due to cardiovascular or cerebral diseases.
STUDY DESIGN: This is a single-center prospective cohort study. Adult patients with non-valvular AF and a previous history of ischemic stroke/systemic embolism/ TIA are eligible for inclusion of this study. Approximately 300 patients with paroxysmal or persistent AF and previous thromboembolic events will receive novel oral anticoagulant or warfarin treatment with a targeted INR between 2.0 and 3.0 or surgical LAA excision plus AF ablation. Follow-up for these patients includes visits at 3 m, 6 m, 9 m, 12 m, and every additional 6 months there after.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
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Jiangsu
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Nanjing, Jiangsu, China, 201129
- The First Affiliated Hospital of Nanjing Medical University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- 18-80 years
- Have documented AF episodes
- The occurrence of ischemic stroke, TIA or systemic thromboembolism at least one month before enrollment
- Capable of understanding and signing the CRF
Exclusion Criteria:
- Reversible AF
- Modified Rankin score ≥4
- Having a history of rheumatic, severe valvular heart disease or heart valve replacement
- Having symptomatic carotid artery disease
- Having another disease which requires lifelong warfarin therapy
- Medical conditions limiting expected survival to <1 year
- Women of childbearing potential (unless post-menopausal or surgically sterile)
- Participation in any other clinical mortality trial
- Unable to give informed consent
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
the surgical intervention group
Thoracoscopic LAA Excision plus AF Ablation.
Patients receiving thoracoscopic left atrial appendage excision plus atrial fibrillation alation
|
In this group, patients receive thoracoscopic LAA excision plus AF ablation, which means thoracoscopic left atrial appendage excision plus atrial fibrillation ablation.
|
oral anticoagulant treatment group
Warfarin or Novel Oral Anticoagulants.
Patients receiving warfarin treatment (INR 2.0-3.0) or novel oral anticoagulants
|
In this group, patients receive warfarin or novel oral anticoagulants
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
the composite of ischemic stroke/systemic embolism/transient ischemic attack (TIA), major bleeding, or all-cause mortality.
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
ischemic strokes
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
all strokes (including ischemic and hemorrhagic)
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
Major and fatal bleeding events
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
Minor bleeding complication
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
all-cause mortality
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
cardiovascular death
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
hospitalization due to cardiovascular or cerebral diseases
Time Frame: at least 3 month follow-up
|
at least 3 month follow-up
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2014-SR-113
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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