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Atrial FibrillationPhase 4DANNOAC-AFNCT03129490

The Danish Non-vitamin K Antagonist Oral Anticoagulation Study in Patients With Atrial Fibrillation

A Phase 4 study testing Dabigatran Etexilate Oral Capsule, Rivaroxaban Oral Tablet and Edoxaban Oral Tablet in people with Atrial Fibrillation and Atrial Flutter, run by Herlev and Gentofte Hospital at 38 sites in Denmark.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

No randomized head-to-head comparison between the individual Non-vitamin K Antagonist Oral Anticoagulants (NOAC) exists. The DANNOAC-AF study is a nationwide cluster randomized cross-over study comparing efficacy and safety of the four NOACs, edoxaban, apixaban, rivaroxaban and dabigatran for oral anticoagulation in… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Atrial Fibrillation, Atrial Flutter
What is being tested?
Dabigatran Etexilate Oral Capsule, Rivaroxaban Oral Tablet and Edoxaban Oral Tablet
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
11,000 participants
Where
38 sitesDenmark
Study dates
1 Apr 2023to 30 Oct 2027
Phase
Phase 4
Are there results?
Not yet: the study is under way

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

  • A diagnosis of atrial fibrillation or atrial flutter in outpatient clinic or as discharge diagnosis after hospitalization.
  • A claimed prescription of a NOAC from a Danish pharmacy within 14 days of discharge or outpatient clinic visit.

Who cannot join

  • A prescription of a NOAC within 90 days prior to hospitalization or outpatient clinic visit for atrial fibrillation or atrial flutter.

Trial locations and contacts

38 sites in 1 country.

38 sites in 1 country

Denmark38 sites
  • Hjerteklinik Nordjylland

    Aalborg

  • Aarhus University Hospital

    Aarhus, 8200

  • Hjertelægerne i Ballerup

    Ballerup Municipality, 2750

  • Hjertelæge Christian Lange

    Copenhagen, 1264

  • Bispebjerg Hospital - Department of Geriatrics

    Copenhagen

  • Hjerteklinikken Amaliegade

    Copenhagen

  • Hjerteklinikken ved Speciallæge Anders Galløe

    Copenhagen

  • Bispebjerg Hospital - Department of Neurology

    Copenhagen NV, 2400

  • Hjerteklinik Østerbro I/S

    Copenhagen Ø, 2100

  • Rigshospitalet

    Copenhagen Ø, 2100

  • Amager Hospital

    Copenhagen S, 2300

  • Esbjerg Hospital

    Esbjerg, 6700

  • Bispebjerg and Frederiksberg Hospital - Department of Cardiology

    Frederiksberg, 2000

  • Frederiksberg Hjerteklinik

    Frederiksberg, 2000

  • Nordsjællands Hospital - Frederiksund

    Frederikssund, 3600

  • Gentofte Hospital

    Gentofte Municipality, 2900

  • Glostrup Hospital - Department of Emergency Medicine

    Glostrup Municipality, 2600

  • Glostrup Hospital - Department of Medicine / Cardiology

    Glostrup Municipality, 2600

  • Glostrup Hospital - Department of Neurology

    Glostrup Municipality, 2600

  • Herlev-Gentofte Hospital - Department of Medicine

    Herlev, 2730

  • Hjertelægerne i Hillerød

    Hillerød, 3400

  • Nordsjællands Hospital - Hillerød

    Hillerød, 3400

  • Hjørring Hospital

    Hjørring, 9800

  • Holbæk Hospital

    Holbæk, 4300

  • Speciallæge Michael Dilou Jacobsen

    Holte, 2840

  • Hvidovre Hospital

    Hvidovre, 2650

  • Næstved Hospital

    Næstved, 4700

  • Odense University Hospital - Department of Cardiology

    Odense, 5000

  • Odense University Hospital - Department of Emergency Medicine

    Odense, 5000

  • Odense University Hospital - Department of Geriatrics

    Odense, 5000

  • Odense University Hospital - Department of Neurology

    Odense, 5000

  • Bornholms Hospital

    Rønne, 3700

  • Zealand University Hospital - Department of Neurology

    Roskilde, 4000

  • Zealand University Hospital Roskilde - Department of Cardiology

    Roskilde, 4000

  • Slagelse Hospital

    Slagelse, 4200

  • Odense University Hospital Svendborg

    Svendborg, 5700

  • Klinik Hjertesund

    Taastrup, 2630

  • Vejle Hospital

    Vejle, 7100

Other trials in Denmark

About this study

Official title: The Danish Non-vitamin K Antagonist Oral Anticoagulation Study. A Cluster Randomized Study Comparing Safety and Efficacy of Edoxaban, Apixaban, Rivaroxaban and Dabigatran for Oral Anticoagulation in Atrial Fibrillation (DANNOAC-AF).

No randomized head-to-head comparison between the individual Non-vitamin K Antagonist Oral Anticoagulants (NOAC) exists. The DANNOAC-AF study is a nationwide cluster randomized cross-over study comparing efficacy and safety of the four NOACs, edoxaban, apixaban, rivaroxaban and dabigatran for oral anticoagulation in atrial fibrillation and atrial flutter across Danish hospitals and cardiology clinics.

Read the detailed description

No randomized head-to-head comparison between the individual Non-vitamin K Antagonist Oral Anticoagulants (NOAC) exists, but such data are warranted to evaluate if the four NOACs are equal in stroke prevention without an additional cost of increased bleeding risk. Furthermore, classic randomized trials are highly selective, as elderly and/or fragile patients and patients with comorbidity are underrepresented. Therefore, there is a need of randomized trials that include a broader population of patients.

The DANNOAC-AF study is a nationwide cluster randomized cross-over study comparing efficacy and safety of the four NOACs, edoxaban, apixaban, rivaroxaban and dabigatran for oral anticoagulation in non-valvular atrial fibrillation and atrial flutter across Danish hospitals and cardiology clinics. The aim of the present study is to: 1) examine if the four NOACs are equally effective in preventing strokes, death and hospitalizations without increasing the risk of major bleeding requiring hospitalization; 2) conduct a randomized study that includes elderly and fragile patients and patients with comorbidity that would otherwise not be included in a traditional randomized clinical trial.

For a variety of reasons, Danish hospitals and clinicians often prefer one particular NOAC. This can make work simpler for the busy clinician, although there may also be economic advantages on a local or a regional larger scale. For a period of two years, this study will replace this individually preferred selection with a random selection. The hospitals and clinics that participate in this study will be randomly selected to primarily use one specific NOAC for 6 months at a time during a total period of two years. This only applies to patients with non-valvular atrial fibrillation or atrial flutter that are selected by the physician to be eligible for NOAC treatment.

Endpoints

  • Primary efficacy outcome: a composite endpoint of stroke, myocardial infarction, thromboembolic event or all-cause death.
  • Secondary efficacy outcomes: Individually components of the primary endpoints; stroke, myocardial infarction, thromboembolism or all-cause death.
  • Primary safety outcome: bleeding requiring hospitalization.
  • Other effect measures:
  1. discontinuation of therapy.
  2. adherence to therapy.
  3. other reasons of admission to hospital than included in the primary and secondary endpoint.
  • Sensitivity analyses:
  1. primary endpoint stratified by gender.
  2. primary endpoint stratified by age (≤65, 65-75, >75 years of age).
  3. primary endpoint stratified by levels of the CHA2DS2VASc score (0-1, 2-3, >3).
  4. primary endpoint with exclusion of clusters with non-compliance greater than 20% of cluster randomization.
  5. primary endpoint where the actual treatment is used instead of the allocated treatment.
  6. primary safety endpoint stratified by HAS-BLED score.

Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Drug discontinuation and adherence will be examined using information from the Danish Registry of Medicinal Product Statistics. The prespecified endpoints will be evaluated after 2 years as intention-to-treat analysis. In addition, the prespecified endpoints will be evaluated after 5 and 10 years.

A cluster is defined as a hospital or a cardiology clinic. the clusters will be initiated in the study from 1. of April 2023 to 1. October 2023.

Being tested
Dabigatran Etexilate Oral Capsule, Rivaroxaban Oral Tablet, Edoxaban Oral Tablet, Apixaban Oral Tablet
Keywords
Atrial Fibrillation, Non-vitamin K antagonist oral anticoagulation, Direct-acting oral anticoagulants, Novel oral anticoagulant drugs, Non-vitamin K antagonist oral anticoagulants, Atrial Flutter
Medical subject headings
Atrial Fibrillation, Atrial Flutter

What participants receive

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

  • Dabigatran Etexilate Oral CapsuleDrug

    After cluster randomization, the cluster will use dabigatran to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time. It is the clusters and not the patient that are randomized.

  • Rivaroxaban Oral TabletDrug

    After cluster randomization, the cluster will use rivaroxaban to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time. It is the clusters and not the patient that are randomized.

  • Edoxaban Oral TabletDrug

    After cluster randomization, the cluster will use edoxaban to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time. It is the clusters and not the patient that are randomized.

  • Apixaban Oral TabletDrug

    After cluster randomization, the cluster will use apixaban to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time. It is the clusters and not the patient that are randomized.

Study groups in NCT03129490
Study groupRoleWhat they receive
DabigatranActive comparatorAfter randomization, the cluster will use dabigatran to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time.
Receives: Drug: Dabigatran Etexilate Oral Capsule; Drug: Rivaroxaban Oral Tablet; Drug: Edoxaban Oral Tablet; Drug: Apixaban Oral Tablet
RivaroxabanActive comparatorAfter randomization, the cluster will use rivaroxaban to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time.
Receives: Drug: Dabigatran Etexilate Oral Capsule; Drug: Rivaroxaban Oral Tablet; Drug: Edoxaban Oral Tablet; Drug: Apixaban Oral Tablet
EdoxabanActive comparatorAfter randomization, the cluster will use edoxaban to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time.
Receives: Drug: Dabigatran Etexilate Oral Capsule; Drug: Rivaroxaban Oral Tablet; Drug: Edoxaban Oral Tablet; Drug: Apixaban Oral Tablet
ApixabanActive comparatorAfter randomization, the cluster will use apixaban to all their patients with non-valvular atrial fibrillation when possible for six months. Hereafter the cluster will use the other three NOACs for six months one at the time.
Receives: Drug: Dabigatran Etexilate Oral Capsule; Drug: Rivaroxaban Oral Tablet; Drug: Edoxaban Oral Tablet; Drug: Apixaban Oral Tablet

What is being measured

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

  1. Primary efficacy outcome: A composite endpoint of stroke, myocardial infarction, thromboembolic event or all-cause death.

    First occurrence of stroke, myocardial infarction, thromboembolic event or all-cause death.

    Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Information of prescribed drug will be obtained using information from the Danish Registry of Medicinal Product Statistics.

    Measured: 2 years.

Secondary outcomes (5)
  1. Primary safety outcome: bleeding requiring hospitalization.

    First occurrence of bleeding requiring hospitalization. Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Information of prescribed drug will be obtained using information from the Danish Registry of Medicinal Product Statistics.

    Measured: 2 years.

  2. Secondary efficacy outcome: Stroke

    Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Information of prescribed drug will be obtained using information from the Danish Registry of Medicinal Product Statistics.

    Measured: 2 years.

  3. Secondary efficacy outcome: Myocardial infarction.

    Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Information of prescribed drug will be obtained using information from the Danish Registry of Medicinal Product Statistics.

    Measured: 2 years.

  4. Secondary efficacy outcome: Thromboembolic event.

    Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Information of prescribed drug will be obtained using information from the Danish Registry of Medicinal Product Statistics.

    Measured: 2 years.

  5. Secondary efficacy outcome: All-cause death.

    Information of endpoints and comorbidity is obtained from the Danish National Patient Register based on ICD-10 diagnostic codes and information of vital status and date of death will be obtained from the Central Person Register. Information of prescribed drug will be obtained using information from the Danish Registry of Medicinal Product Statistics.

    Measured: 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 Apr 2017
  2. Study start1 Apr 2023
  3. Primary completion30 Oct 2027 (estimated)
  4. Study completion30 Oct 2027 (estimated)

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 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Crossover
Model description
Cluster randomized cross-over study.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
11,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03129490
Sponsor's protocol ID
DHF1
Acronym
DANNOAC-AF
Status last verified
May 2025
First submitted
18 Apr 2017
Last updated
18 May 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Dabigatran Etexilate Oral Capsule, Rivaroxaban Oral Tablet and Edoxaban Oral Tablet in people with Atrial Fibrillation and Atrial Flutter, run by Herlev and Gentofte Hospital at 38 sites in Denmark.

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 2 inclusion and 1 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: under way, not looking for participants, as of the sponsor's last update on 18 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 38 sites in Denmark. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

Primary efficacy outcome: A composite endpoint of stroke, myocardial infarction, thromboembolic event or all-cause death. (time frame: 2 years.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 18 May 2025.

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