Observational Study to Characterize Patients Experiencing Major Acute Bleeding Events During Anticoagulation Treatment With Oral Factor Xa Inhibitors. (EMERALD)
Observational, Prospective, Multicentre, Collaborative Study, to Characterize Patients Experiencing Major Acute Bleeding Events During Anticoagulation Treatment With Oral Factor Xa Inhibitors
Oral factor Xa inhibitors are widely used for the prevention of cardioembolic events in patients with atrial fibrillation and for the treatment of venous thromboembolism, thanks to their good efficacy/safety ratio compared to vitamin K antagonists. However, major bleeding remains a potentially life-threatening event, a relevant complication and real-world treatments are still heterogeneous and there are limited data available in the literature.It is therefore considered particularly important to collect and analyze information on how major bleeding complications are treated in clinical practice and to examine the outcomes.
The objective of this study is to implement a prospective, computerized collection of clinical information, as a basis for identifying and analysing patient characteristics and treatment methods for major acute bleeding events occurring during anticoagulation with oral FXa inhibitors (apixaban, edoxaban, rivaroxaban) documenting the short-term clinical outcomes and those 3 months (90 days) after the acute event.
The main questions the study aims to answer are:
- What are the severe clinical outcomes for these patients, specifically the composite incidence of death, the need for Intensive Care Unit (ICU) admission, or the need for bleeding-related rescue surgery?
- What are the characteristics of the patients experiencing these events, and how are these bleeding complications managed in real-world clinical practice? Because this is an observational study, there are no experimental pharmacological interventions. Participants will receive standard clinical care based on the normal practice of each participating hospital. Data will be evaluated during the acute hospitalization phase and at a 3-month (90 days) follow-up after the initial event The study is coordinated by FADOI (Italian Society of Hospital Internal Medicine) in collaboration with AIGO (Italian Association of Hospital Gastroenterologists and Digestive Endoscopists), AII-ISA (Italian Stroke Association) and SIMEU (Italian Society of Emergency Medicine); for this the study involves not fewer than 500 consecutive patients hospitalized in Internal Medicine, Gastroenterology, Neurology and Emergency Medicine in 50 hospital centers distributed throughout Italy.
This is a prospective, observational, multicentre, pharmacological, collaborative study. Information will be collected on patients experiencing major acute bleeding events, with details of the treatment given and the clinical outcome, both in the acute phase and 3 months (90 days) after the index event. Given the observational nature of the study, there are no indications regarding the type of patients' management and/or treatment to be performed. However, major bleeding remains a relevant complication and real-world treatments are still heterogeneous and this study aims to prospectively collect data on the management of these events, including the use of available therapies.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Studientyp
Studientyp
Einschreibung (Tatsächlich)
Einschreibung
Kontakte und Standorte
Studienorte
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Milan, Italien, 20157
- Antonella Valerio - Centro Studi FADOI
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Probenahmeverfahren
Studienpopulation
Beschreibung
Inclusion Criteria:
Patients currently receiving oral FXa inhibitors (apixaban, edoxaban, rivaroxaban), irrespective of anticoagulant dosage and duration of treatment, and presenting a major acute bleeding complication *
* Events that qualify patients for the study:
• Major spontaneous or post-traumatic bleeding, in accordance with the International Society on Thrombosis and Haemostasis (ISTH) definition
- Age >18 years
- Provision of informed consent prior to any study specific procedures
Exclusion Criteria:
1) None
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
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Composite Incidence of Death, ICU Admission, or Bleeding-Related Rescue Surgery
Zeitfenster: 3 months post-index event
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Number of participants experiencing at least one of the following events: all-cause mortality, admission to the Intensive Care Unit (ICU), or need for bleeding-related rescue surgery following an acute major bleeding event while on oral FXa inhibitor therapy.
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3 months post-index event
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Patient Age
Zeitfenster: Baseline (at enrollment)
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Age of participants at baseline
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Baseline (at enrollment)
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Biological Sex Distribution
Zeitfenster: Baseline (at enrollment)
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Number of male and female participants enrolled in the study.
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Baseline (at enrollment)
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Distribution of Oral FXa Inhibitors
Zeitfenster: Baseline (at enrollment)
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Number of participants receiving apixaban, edoxaban, or rivaroxaban at the time of the index bleeding event.
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Baseline (at enrollment)
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In-Hospital Composite Incidence of Death, ICU Admission, or Rescue Surgery
Zeitfenster: From index event up to hospital discharge (assessed up to 3 months)
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Number of participants experiencing death, ICU admission, or need for bleeding-related rescue surgery during the index hospitalization period.
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From index event up to hospital discharge (assessed up to 3 months)
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Time to Hemostasis
Zeitfenster: From treatment initiation up to 24 hours
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Time elapsed from initiation of acute bleeding treatment to cessation of active bleeding (door-to-needle time and treatment duration).
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From treatment initiation up to 24 hours
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Hemostatic Efficacy Grade
Zeitfenster: At 24 hours post-treatment
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Proportion of participants achieving effective hemostasis evaluated according to specific clinical criteria.
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At 24 hours post-treatment
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Incidence of Thromboembolic Events and Recurrent Bleeding
Zeitfenster: Through 3 months follow-up
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Number of participants experiencing ischemic stroke, myocardial infarction, pulmonary embolism, deep vein thrombosis, systemic embolism, or new bleeding episodes.
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Through 3 months follow-up
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Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Zeitfenster: Through 3 months follow-up
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Number of participants experiencing any AE or SAE possibly related to the administered hemostatic treatments.
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Through 3 months follow-up
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Studienstuhl: Francesco Dentali, Prof., Fadoi Foundation President / Department of Medicine, ASST-Settelaghi, Varese
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014 Mar 15;383(9921):955-62. doi: 10.1016/S0140-6736(13)62343-0. Epub 2013 Dec 4.
- Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Vanassche T, Potpara T, Camm AJ, Heidbuchel H; External reviewers. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Oct 9;23(10):1612-1676. doi: 10.1093/europace/euab065. No abstract available.
- Katsanos AH, Schellinger PD, Kohrmann M, Filippatou A, Gurol ME, Caso V, Paciaroni M, Perren F, Alexandrov AV, Tsivgoulis G. Fatal oral anticoagulant-related intracranial hemorrhage: a systematic review and meta-analysis. Eur J Neurol. 2018 Oct;25(10):1299-1302. doi: 10.1111/ene.13742. Epub 2018 Jul 21.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Tatsächlich)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- FADOI.03.2022
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