AzTrials
AzTrials

Atrial FibrillationNCT05262322

Study to Evaluate the Use of Direct Oral Anticoagulants in UK Clinical Practice For Patients With a First Stroke Attributable to Nonvalvular Atrial Fibrillation

An observational study of Atrial Fibrillation, run by Daiichi Sankyo UK Ltd, a Daiichi Sankyo Company at 8 sites in United Kingdom.

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

National Institute of Health and Care Excellence (NICE) guidance recommends anticoagulation for stroke prevention in high risk patients with nonvalvular atrial fibrillation (AF). 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, Apixaban and Rivaroxaban
How many people
234 participants
Where
8 sitesUnited Kingdom
Study dates
15 Feb 2019to 9 Jul 2021
Phase
Observational
Are there results?
None posted in the registry

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

Study population: For the wider retrospective study (Group 1 patients), potentially eligible participants will be identified by members of the direct care team from local department databases. Eligible participants will be selected in consecutive chronological order by the direct care team according to the date of stroke diagnosis until the required sample size or the center-specific recruitment target is reached, over a one-year recruitment period. The first 50 eligible and consenting participants initiated on either apixaban, edoxaban or rivaroxaban at any of the study centers during the 28 month recruitment period will also be included in the prospective component of the study.

Who may be able to join

  • For all patients:
  • Participants presenting to the study centre with a first ischaemic stroke which is, in the clinician's opinion, attributable to nonvalvular AF
  • Participants aged 18 years or over at time of first stroke
  • For group 2 patients:
  • Participants initiated on apixaban, edoxaban or rivaroxaban after their first stroke

Who cannot join

  • For all patients:
  • Participants prescribed any anticoagulant for any purpose in the 12 months prior to stroke diagnosis
  • Participants with haemorrhagic stroke
  • Participants with diagnosis of transient ischemic attack
  • Participants with severe cognitive or emotive deficit
  • Participants whose medical records are not available for review
Show all 9Show fewer
  • Participant unwilling or unable to give written informed consent
  • For group 2 patients:
  • Participant unwilling or unable to complete the patient-reported questionnaires

Trial locations and contacts

8 sites in 1 country.

8 sites in 1 country

United Kingdom8 sites
  • Queen Elizabeth University Hospital - NHS Greater Glasgow and Clyde

    Glasgow, G51 4TF

  • Gloucestershire Royal Hospital - Gloucestershire Hospitals NHS Foundation Trust

    Gloucester, GL1 3NN

  • Leicester Royal Infirmary - University Hospitals of Leicester NHS Trust

    Leicester, LE1 5WW

  • St George's Hospital - St George's University Hospital's NHS Foundation Trust

    London, SW17 0QT

  • Royal Victoria Infirmary - Newcastle upon Tyne Hospitals NHS Foundation Trust

    Newcastle, NE1 4LP

  • Royal Gwent Hospital - Aneurin Beban University Health Board

    Newport, NP20 2UB

  • Musgrove park Hospital - Taunton and Somerset NHS Foundation Trust

    Taunton, TA1 5DA

  • Yeovil District Hospital - Yeovil District Hospital NHS Foundation Trust

    Yeovil, BA21 4AT

Other trials in United Kingdom

About this study

Official title: A Descriptive Non-interventional Study to Evaluate the Use of Direct Oral Anticoagulants in UK Clinical Practice for Patients With a First Stroke Attributable to Nonvalvular Atrial Fibrillation

National Institute of Health and Care Excellence (NICE) guidance recommends anticoagulation for stroke prevention in high risk patients with nonvalvular atrial fibrillation (AF).

Early evidence suggest that patients with atrial fibrillation (AF) who do not receive anticoagulation are more likely to experience a stroke. However, the characteristics of patients experiencing a first AF-related stroke in real-world settings, who have not been receiving anticoagulation, have not been well documented.

It is unclear how the direct anti-FXa oral anticoagulants have been used within real world practice since the introduction of edoxaban in 2015.

Read the detailed description

This non-interventional study will focus specifically on the patient characteristics, management pathways, and patient reported experiences associated with real world use of three direct anti-FXa oral anticoagulants (DOAC) commonly used within United Kingdom clinical practice; apixaban, rivaroxaban and edoxaban.

The primary objective will describe the demographics, clinical characteristics and medical history of patients presenting with a first ischaemic stroke with AF who have not received anticoagulation (for any reason) in the 12 months prior to stroke, by type of anticoagulant treatment subsequently prescribed for secondary prophylaxis of stroke.

Secondary objectives of the study will describe management pathways of patients initiated on DOACs (apixaban, edoxaban or rivaroxaban) for secondary prophylaxis of stroke, including timing and reasons for any dose changes or treatment switches to alternative anticoagulants; describe hospital resource use and clinical assessments associated with DOAC treatment for secondary prophylaxis of stroke; describe real world patient-reported adherence to DOACs for secondary prophylaxis of stroke; and describe patient experience and treatment satisfaction for patients receiving DOAC therapy for secondary prophylaxis of stroke.

Being tested
Edoxaban, Apixaban, Rivaroxaban
Keywords
Atrial Fibrillation, Direct oral anticoagulants, Edoxaban, Apixaban, Rivaroxaban
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

    This was a non-interventional, observational study. No drug was administered in this study.

  • ApixabanDrug

    This was a non-interventional, observational study. No drug was administered in this study.

  • RivaroxabanDrug

    This was a non-interventional, observational study. No drug was administered in this study.

Study groups in NCT05262322
Study groupRoleWhat they receive
All Participants (Group 1; Retrospective)All participants' data will be collected retrospectively from medical records 12 months prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF
Subset of All Participants (Group 2; Prospective)A subset of participants from Group 1 who were initiated on apixaban, edoxaban or rivaroxaban for secondary prophylaxis of stroke will take part in this prospective component of the study, whereby data on their management pathway (treatments and follow-up appointments) and patient-reported outcomes will be collected for 6 months from the date of first dose of DOAC treatment.
Receives: Drug: Edoxaban; Drug: Apixaban; Drug: Rivaroxaban

What is being measured

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

  1. Mean CHA2DS2-VASc Risk Scores In Participants Presenting With A First Stroke with Atrial Fibrillation (AF) Who Have Not Received Anticoagulation Within 12 Months Prior to Stroke

    CHA2DS2-VASc risk scores range from 0-9, where a score of 0 is "low" risk of stroke, 1 is "moderate", and any score above 1 is a "high" risk. Scores will be calculated based on relevant demographic and clinical data recorded in medical notes for pre-index observation period.

    Measured: 12 month period prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF

Secondary outcomes (13)
  1. Mean Time from Atrial Fibrillation (AF) Diagnosis Until Stroke In Participants Presenting With A First Stroke with Atrial Fibrillation Who Have Not Received Anticoagulation Within 12 Months Prior to Stroke

    The time from AF diagnosis until stroke will be assessed.

    Measured: Approximately 12 month period prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF

  2. Stroke Severity In Participants Presenting With A First Stroke with Atrial Fibrillation (AF) Who Have Not Received Anticoagulation Within 12 Months Prior to Stroke

    Stroke severity will be assessed by NIHSS classification (mild, moderate, moderate to severe, and severe), Oxfordshire Community Stroke Project Score, classification based on CT scan, and opinion of treating clinician.

    Measured: Approximately 12 month period prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF

  3. Number of Participants With Relevant Cardiovascular and Related Non-Cardiovascular Conditions In Participants Presenting With A First Stroke with Atrial Fibrillation Who Have Not Received Anticoagulation Within 12 Months Prior to Stroke

    Cardiovascular and related non-cardiovascular events, such as hypertension, congestive heart failure, vascular disease (peripheral artery disease, previous myocardial infarction, aortic plaque), diabetes mellitus, renal impairment, renal failure, hepatic failure, coronary artery disease, carotid artery disease, reduced ejection fraction, liver disease, and other, will be assessed.

    Measured: Approximately 12 month period prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF

  4. Number of Participants Receiving Concomitant Medications At Time of First Stroke and Newly Prescribed Within 1 Month After Stroke

    Concomitant medications may include: beta blockers, diuretics, antiplatelet agents (e.g. aspirin), ACE (angiotensin-converting-enzyme) inhibitors, ATII-receptor antagonists, statins, ASA (acetylsalicylic acid), and P-gp (P-glycoprotein) inhibitors.

    Measured: Approximately 12 month period prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF

  5. Type of First Anticoagulant Medication Prescribed After Stroke In Participants Presenting With A First Stroke with Atrial Fibrillation Who Have Not Received Anticoagulation Within 12 Months Prior to Stroke

    Anticoagulant medications may include apixaban, edoxaban, rivaroxaban, warfarin, dabigatran, and other.

    Measured: Within 1 month after stroke

  6. Time From Stroke to First Dose of Direct Oral Anticoagulant (DOAC) in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    The time from stroke to first dose of anticoagulant medication will be assessed.

    Measured: From stroke to first dose of DOAC, up to 6 months after date of first dose of DOAC

  7. Time to Discontinuation of First Direct Oral Anticoagulant (DOAC) Treatment in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    The time to discontinuation of anticoagulant medication will be assessed.

    Measured: Up to 6 months after date of first dose of DOAC

  8. Number of Participants Receiving Clinical Assessments in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    Clinical assessments may include weight, coagulation screens (international normalized ratio), full blood count (FBC), urea and electrolyte tests (U\&E), renal function and liver function tests (alanine transaminase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], albumin and bilirubin tests) as well as other neurological, heart or functional assessments (thyroid function tests, blood pressure, 12 lead ECG/EKG including heart rate, echocardiography and relevant imaging CT scan, ultrasound, MRI and PET scans.

    Measured: Up to 6 months after date of first dose of DOAC

  9. Number of Secondary Care Visits in 6 Months Post-first Direct Oral Anticoagulant (DOAC) Dose in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    Secondary visits will include inpatient, outpatient, and accident and emergency.

    Measured: Up to 6 months after date of first dose of DOAC

  10. Duration of Inpatient Stays in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    The length of inpatient hospital stays will be assessed.

    Measured: Up to 6 months after date of first dose of DOAC

  11. Mean Absolute Morisky Medication Adherence Scale (MMAS-8) Score After First Direct Oral Anticoagulant (DOAC) Dose in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    Morisky Medication Adherence Scale (MMAS-8) range from 0 to 8, where higher scores indicate medication adherence and lower scores indicate nonadherence. Medication adherence will be assessed at 3 and 6 months.

    Measured: Up to 6 months after date of first dose of DOAC

  12. Number of Participants Taking Direct Oral Anticoagulant (DOAC) Medication Within Past 7 Days in Participants Who Are Initiated on Apixaban, Edoxaban, or Rivaroxaban

    Anticoagulant medication may include apixaban, edoxaban, rivaroxaban, warfarin, dabigatran, and other. DOAC medication will be assessed at 3 and 6 months.

    Measured: Within past 7 days

  13. Mean Absolute Treatment Satisfaction Questionnaire for Medication (TSQM) Score Post-first Direct Oral Anticoagulant Dose

    Treatment Satisfaction Questionnaire for Medication (TSQM) domain scores range from 0 to 100 with higher scores representing higher satisfaction on that domain. Treatment satisfaction will be assessed at 3 and 6 months.

    Measured: Up to 6 months after date of first dose of DOAC

Timeline

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

  1. First posted2 Mar 2022
  2. Study start15 Feb 2019
  3. Primary completion9 Jul 2021
  4. Study completion9 Jul 2021

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
234 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05262322
Sponsor's protocol ID
EDX/18/0414(2)
Status last verified
Jul 2022
First submitted
21 Feb 2022
Last updated
19 Jul 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

An observational study of Atrial Fibrillation, run by Daiichi Sankyo UK Ltd, a Daiichi Sankyo Company at 8 sites in United Kingdom.

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 9 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 19 Jul 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in United Kingdom. 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.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Mean CHA2DS2-VASc Risk Scores In Participants Presenting With A First Stroke with Atrial Fibrillation (AF) Who Have Not Received Anticoagulation Within 12 Months Prior to Stroke (time frame: 12 month period prior to the date of diagnosis of a first ischaemic stroke attributable to nonvalvular AF). 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 19 Jul 2022.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in