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AzTrials

Atrial FibrillationPhase 3ENSURE-AFNCT02072434

Edoxaban vs. Warfarin in Subjects Undergoing Cardioversion of Nonvalvular Atrial Fibrillation (NVAF)

A Phase 3 study testing Edoxaban, Warfarin and Enoxaparin in people with Atrial Fibrillation, run by Daiichi Sankyo at 228 sites in 19 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The purpose of this study is to compare edoxaban to warfarin (with enoxaparin, if needed). It will see if edoxaban prevents stroke and other blood clotting problems as well and as safely as warfarin. People with atrial fibrillation (irregular heartbeat) might be able to join. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Atrial Fibrillation
What is being tested?
Edoxaban, Warfarin and Enoxaparin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,199 participants
Where
228 sitesin 19 countries
Study dates
25 Mar 2014to 3 Feb 2016
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Has signed informed consent
  • Is older than minimum legal adult age (country specific)
  • Has had ongoing AF lasting at least 48 hrs but <= 12 months (with or without valvular heart disease)
  • Has treatment plan that includes for electrical cardioversion
  • Has NVAF or other specific valvular heart diseases (eg, mitral valve prolapse, mitral valve regurgitation, and aortic valve disease)

Who cannot join

  • Has AF that is transient or reversible
  • Has contraindicated condition, ie, conditions considered to be formal indication for conventional anticoagulation
  • Has a history of left atrial appendage (LAA) closure
  • Has a known thrombus in LAA, the left atrial, left ventricle or aorta - or an intracardial mass
  • Has had myocardial infarction (MI), stroke, acute coronary syndrome (ACS), or percutaneous coronary intervention (PCI) within the past 30 days
  • Has any contraindication to anticoagulant agents
Show all 17Show fewer
  • Has had protocol-defined signs of bleeding or conditions associated with high risk of bleeding that would preclude participation
  • Is receiving, or plans to receive during the study period, dual antiplatelet therapy (DAPT) or invasive procedures (other than routine endoscopy) in which bleeding would be anticipated
  • Has received prohibited concomitant medication or therapy
  • Has had protocol-defined signs of bleeding or high
  • Has inadequate liver, kidney, and blood test results
  • Received any investigational drug or device within the past 30 days or plans to during the study period
  • Has reproductive potential and does not agree to take proper contraceptive measures
  • Has active cancer requiring chemotherapy/radiation/major surgery within the next 3 months
  • Has significant active concurrent medical illness or infection or life expectancy less than 6 months
  • In the opinion of the investigator, is unlikely to comply with the protocol or complete the study, has had drug or alcohol dependence within the past year, or has any other condition that might place the participant at increased risk of harm
  • Is a participant in the United States after January 2015 with creatinine clearance (CrCL) greater than 95 mL/minute

Trial locations and contacts

228 sites in 19 countries.

228 sites in 19 countries

United States28 sites
  • Study site

    Allentown, Pennsylvania

  • Study site

    Auburn, Maine

  • Study site

    Boise, Idaho

  • Study site

    Butler, Pennsylvania

  • Study site

    Camp Hill, Pennsylvania

  • Study site

    Clearwater, Florida

  • Study site

    Dallas, Texas

  • Study site

    Daytona Beach, Florida

  • Study site

    Denver, Colorado

  • Study site

    Escondido, California

  • Study site

    Fort Worth, Texas

  • Study site

    Hershey, Pennsylvania

  • Study site

    Jackson, Tennessee

  • Study site

    Jupiter, Florida

  • Study site

    Newark, Delaware

  • Study site

    Newport Beach, California

  • Study site

    Phoenix, Arizona

  • Study site

    Plano, Texas

  • Study site

    Richmond, Virginia

  • Study site

    Riverside, California

  • Study site

    Rochester, Minnesota

  • Study site

    Rockledge, Florida

  • Study site

    San Francisco, California

  • Study site

    Santa Rosa, California

  • Study site

    Sarasota, Florida

  • Study site

    Stamford, Connecticut

  • Study site

    Tampa, Florida

  • Study site

    Tyler, Texas

Other trials in United States

United Kingdom22 sites
  • Study site

    Barnet

  • Study site

    Basildon

  • Study site

    Birmingham

  • Study site

    Blackpool, Lancashire

  • Study site

    Bournemouth

  • Study site

    Bradford

  • Study site

    Chertsey

  • Study site

    Doncaster

  • Study site

    Dundee

  • Study site

    Harrow

  • Study site

    Leeds

  • Study site

    Leicester

  • Study site

    Liverpool

  • Study site

    Llanelli

  • Study site

    London

  • Study site

    Luton

  • Study site

    Newport

  • Study site

    Oxford

  • Study site

    Plymouth

  • Study site

    Romford, Essex

  • Study site

    Southampton, Hampshire

  • Study site

    Swansea

Other trials in United Kingdom

Germany20 sites
  • Study site

    Bad Berka

  • Study site

    Berlin

  • Study site

    Bielefeld

  • Study site

    Coburg

  • Study site

    Dortmund

  • Study site

    Dresden

  • Study site

    Freiburg im Breisgau

  • Study site

    Giessen

  • Study site

    Hamburg

  • Study site

    Heidelberg

  • Bad Friedrichshall

    Heilbronn

  • Study site

    Langen

  • Study site

    Leipzig

  • Study site

    Ludwigsburg

  • Study site

    Mainz

  • Study site

    Marburg

  • Study site

    Mönchengladbach

  • Study site

    München

  • Study site

    Paderborn

  • Study site

    Regensburg

Other trials in Germany

Hungary16 sites
  • Study site

    Balatonfüred

  • First site in

    Budapest

  • Second site in

    Budapest

  • Study site

    Cegléd

  • Study site

    Debrecen

  • Study site

    Győr

  • Study site

    Gyula

  • Study site

    Hódmezővásárhely

  • Study site

    Kecskemét

  • Study site

    Nagykanizsa

  • Study site

    Pécs

  • Study site

    Szeged

  • Study site

    Székesfehérvár

  • Study site

    Szolnok

  • Study site

    Szombathely

  • Study site

    Zalaegerszeg

Other trials in Hungary

France15 sites
  • Study site

    Angers

  • Study site

    Bordeaux

  • Study site

    Bron

  • Study site

    Corbeil-Essonnes

  • Study site

    Dijon

  • Study site

    Grenoble

  • Study site

    Lyon

  • Study site

    Marseille

  • Study site

    Montfermeil

  • Study site

    Montpellier

  • Study site

    Nice

  • Study site

    Paris

  • Study site

    Saint-Denis

  • Study site

    Toulouse

  • Study site

    Vandœuvre-lès-Nancy

Other trials in France

Spain15 sites
  • Study site

    Almería

  • First site in

    Barcelona

  • Second site in

    Barcelona

  • Study site

    Granada

  • Study site

    Lugo

  • First site in

    Madrid

  • Second site in

    Madrid

  • Third site in

    Madrid

  • Study site

    Ourense

  • Study site

    Sabadell, Barcelona

  • Study site

    Salt, Girona

  • Study site

    Sant Joan d'Alacant, Alicante

  • Study site

    Santiago de Compostela

  • Study site

    Valencia

  • Study site

    Vigo

Other trials in Spain

Denmark13 sites
  • Study site

    Aalborg

  • First site in

    Copenhagen

  • Second site in

    Copenhagen

  • Study site

    Frederiksberg

  • Study site

    Hellerup

  • Study site

    Herning

  • Study site

    Holbæk

  • Study site

    Køge

  • Study site

    Silkeborg

  • Study site

    Slagelse

  • Study site

    Svendborg

  • Study site

    Vejle

  • Study site

    Viborg

Other trials in Denmark

Romania12 sites
  • Study site

    Baia Mare

  • Study site

    Brăila

  • Study site

    Bucharest

  • Study site

    Cluj-Napoca

  • Study site

    Craiova, Dolj

  • Study site

    Focşani, Vrancea

  • Study site

    Iași

  • Study site

    Oradea, Bihor County

  • Study site

    Piteşti

  • Study site

    Targoviste

  • Study site

    Târgu Mureş

  • Study site

    Timișoara

Other trials in Romania

Italy11 sites
  • Study site

    Acquaviva delle Fonti, BA

  • Study site

    Bologna

  • Study site

    Catania

  • Study site

    Chieti

  • Study site

    Mestre, VE

  • Study site

    Naples

  • Study site

    Pavia

  • First site in

    Roma

  • Second site in

    Roma

  • Study site

    Santa Maria Capua Vetere, CE

  • Study site

    Trieste

Other trials in Italy

Belgium10 sites
  • Study site

    Brussels

  • Study site

    Genk

  • Study site

    Ghent

  • Study site

    Hasselt

  • Study site

    Huy

  • Study site

    Leuven

  • Study site

    Liège

  • Study site

    Mechelen

  • Study site

    Tienen

  • Study site

    Turnhout

Other trials in Belgium

Czechia10 sites
  • Study site

    Brno

  • Study site

    Český Krumlov

  • Study site

    Havlíčkův Brod

  • Study site

    Hodonín

  • Study site

    Kolín

  • Study site

    Kroměříž

  • Study site

    Náchod

  • Study site

    Prague

  • Study site

    Příbram

  • Study site

    Slaný

Other trials in Czechia

Bulgaria9 sites
  • Study site

    Burgas

  • Study site

    Gabrovo

  • Study site

    Pazardzhik

  • Study site

    Pleven

  • Study site

    Plovdiv

  • Study site

    Sofia

  • Study site

    Stara Zagora

  • Study site

    Varna

  • Study site

    Veliko Tarnovo

Other trials in Bulgaria

Israel9 sites
  • Study site

    Afula

  • Study site

    Ashkelon

  • Study site

    Hadera

  • Study site

    Haifa

  • Study site

    Holon

  • Study site

    Jerusalem

  • Study site

    Kfar Saba

  • Study site

    Ramat Gan

  • Study site

    Tel Aviv

Other trials in Israel

Ukraine9 sites
  • Study site

    Cherkasy

  • Study site

    Ivano-Frankivsk

  • Study site

    Kharkiv

  • Study site

    Kyiv

  • Study site

    Odesa

  • Study site

    Uzhhorod

  • Study site

    Vinnytsia

  • Study site

    Zaporizhzhya

  • Study site

    Zhytomyr

Other trials in Ukraine

Poland8 sites
  • Study site

    Elblag

  • Study site

    Krakow

  • Study site

    Lodz

  • Study site

    Lublin

  • Study site

    Puławy

  • Study site

    Torun

  • Study site

    Warsaw

  • Study site

    Wroclaw

Other trials in Poland

Netherlands7 sites
  • Study site

    Amsterdam

  • Study site

    Hilversum

  • Study site

    Leeuwarden

  • Study site

    Rotterdam

  • Study site

    The Hague

  • Study site

    Venlo

  • Study site

    Zwolle

Other trials in Netherlands

Russia7 sites
  • Study site

    Barnaul

  • Study site

    Kemerovo

  • Study site

    Moscow

  • Study site

    Novosibirsk

  • Study site

    Saint Petersburg

  • Study site

    Tyumen

  • Study site

    Yaroslavl

Other trials in Russia

Austria5 sites
  • Study site

    Graz

  • Study site

    Innsbruck

  • Study site

    Linz

  • Study site

    Mödling

  • Study site

    Vienna

Other trials in Austria

Sweden2 sites
  • Study site

    Helsingborg

  • Study site

    Uppsala

Other trials in Sweden

About this study

Official title: A Prospective, Randomized, Open-Label Blinded Endpoint Evaluation (PROBE) Parallel Group Study Comparing Edoxaban (DU-176b) With Enoxaparin/Warfarin Followed by Warfarin Alone in Subjects Undergoing Planned Electrical Cardioversion of Nonvalvular Atrial Fibrillation

The purpose of this study is to compare edoxaban to warfarin (with enoxaparin, if needed). It will see if edoxaban prevents stroke and other blood clotting problems as well and as safely as warfarin. People with atrial fibrillation (irregular heartbeat) might be able to join. Their doctors must plan to use shock to make their hearts beat normally. About 2200 people from different countries will join. They will have an equal chance of receiving either treatment. They are anticipated to be in the study for around 82 days. Tests will include physicals and finger-pricks. Participants will provide blood and urine samples.

Read the detailed description

The purpose of this study is to compare edoxaban (investigational drug) with warfarin and enoxaparin, to see if it is safe and effective in preventing stroke and other blood clot complications in subjects with atrial fibrillation whose doctors plan to treat them with an electrical cardioversion. It is expected that 284 sites will recruit 2200 subjects from North America, EU, Russia, Ukraine and Israel. Participants will be randomly allocated to receive either treatment with edoxaban, or treatment with warfarin, plus enoxaparin if required. Participants will have an equal chance of receiving either treatment. Participants will be in the study for a maximum of 82 days. Study procedures will include physical examinations, vital signs (pulse and sitting blood pressure), ECG (electrocardiogram), finger prick blood clotting tests, blood samples and urine samples.

The study is expected to show that edoxaban will provide comparable incidence rates to warfarin plus enoxaparin, the current standard treatment for both efficacy and bleeding.

Being tested
Edoxaban, Warfarin, Enoxaparin
Keywords
Nonvalvular atrial fibrillation (NVAF), anti-coagulant, warfarin, edoxaban, electrical cardioversion
Medical subject headings
Atrial Fibrillation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EdoxabanDrug

    Edoxaban 30 mg tablets for oral administration

  • WarfarinDrug

    Warfarin tablet, 1.0 or 2.5 mg, for oral administration

  • EnoxaparinDrug

    Enoxaparin per label, at prescribed dose until PT INR at least 2.0

Study groups in NCT02072434
Study groupRoleWhat they receive
EdoxabanExperimentalEdoxaban oral tablet, 60 mg-once daily (QD), reduced to 30 mg based on protocol-defined parameters, for up to 49 days
Receives: Drug: Edoxaban
WarfarinActive comparatorParticipants naïve to anticoagulation, taking anticoagulants other than a Vitamin K antagonist (VKA) or taking a VKA but with a prothrombin time (PT) international normalized ratio (INR) of less than 2.0 receive enoxaparin until they reach a PT INR of at least 2.0, before taking warfarin. All participants in this arm receive warfarin oral tablet QD at their doctor's prescribed dose, for up to 49 days.
Receives: Drug: Warfarin; Drug: Enoxaparin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants With Composite Endpoint of Stroke, Systemic Embolic Stroke (SEE), Myocardial Infarction (MI) and Cardiovascular (CV) Mortality From Randomization to End of Follow up

    Measured: Randomization to end of follow-up (within 2 years)

  2. Percentage of Participants With Composite Endpoints of Major and Clinically-relevant Non-major (CRNM) Bleeding

    Measured: During treatment period (within 2 years)

Secondary outcomes (1)
  1. Percentage of Participants With Composite Endpoints of Stroke, SEE, MI, CV Mortality, and Major Bleeding

    Measured: From randomization to the end of follow-up (within 2 years)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Feb 2014 (estimated)
  2. Study start25 Mar 2014
  3. Primary completion3 Feb 2016
  4. Study completion3 Feb 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
2,199 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02072434
Sponsor's protocol ID
DU176b-F-E308
Other IDs
2013-003148-21
Acronym
ENSURE-AF
Status last verified
Mar 2019
First submitted
20 Feb 2014
Last updated
15 Mar 2019
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: De-identified individual participant data (IPD) and applicable supporting clinical trial documents may be available upon request at https://vivli.org/. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. Details on data sharing criteria and the procedure for requesting access can be found at this web address: https://vivli.org/ourmember/daiichi-sankyo/

Publications

  • Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Spinar J, Ruzyllo W, Ruda M, Koretsune Y, Betcher J, Shi M, Grip LT, Patel SP, Patel I, Hanyok JJ, Mercuri M, Antman EM; ENGAGE AF-TIMI 48 Investigators. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013 Nov 28;369(22):2093-104. doi: 10.1056/NEJMoa1310907. Epub 2013 Nov 19.

    PubMed 24251359
  • Goette A, Kwong WJ, Ezekowitz MD, Banach M, Hjortshoj SP, Zamoryakhin D, Lip GYH. Edoxaban therapy increases treatment satisfaction and reduces utilization of healthcare resources: an analysis from the EdoxabaN vs. warfarin in subjectS UndeRgoing cardiovErsion of atrial fibrillation (ENSURE-AF) study. Europace. 2018 Dec 1;20(12):1936-1943. doi: 10.1093/europace/euy141.

    PubMed 29947751
  • Goette A, Merino JL, Ezekowitz MD, Zamoryakhin D, Melino M, Jin J, Mercuri MF, Grosso MA, Fernandez V, Al-Saady N, Pelekh N, Merkely B, Zenin S, Kushnir M, Spinar J, Batushkin V, de Groot JR, Lip GY; ENSURE-AF investigators. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016 Oct 22;388(10055):1995-2003. doi: 10.1016/S0140-6736(16)31474-X. Epub 2016 Aug 30.

    PubMed 27590218
  • Lip GY, Merino J, Ezekowitz M, Ellenbogen K, Zamoryakhin D, Lanz H, Jin J, Al-Saadi N, Mercuri M, Goette A. A prospective evaluation of edoxaban compared to warfarin in subjects undergoing cardioversion of atrial fibrillation: The EdoxabaN vs. warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) study. Am Heart J. 2015 May;169(5):597-604.e5. doi: 10.1016/j.ahj.2015.02.009. Epub 2015 Feb 21.

    PubMed 25965706

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Edoxaban, Warfarin and Enoxaparin in people with Atrial Fibrillation, run by Daiichi Sankyo at 228 sites in 19 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Mar 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 228 sites in United States, United Kingdom, Germany, Hungary, France and 14 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Mar 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants With Composite Endpoint of Stroke, Systemic Embolic Stroke (SEE), Myocardial Infarction (MI) and Cardiovascular (CV) Mortality From Randomization to End of Follow up (time frame: Randomization to end of follow-up (within 2 years)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02072434, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Mar 2019.

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