Reversibility of Apixaban Anticoagulation With the Four Factor Prothrombin Complex Concentrate Kcentra (4PAR)
Primary Purpose
Thrombosis
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Kcentra
Apixaban
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Thrombosis focused on measuring Xa inhibitor, Prothrombin complex concentrate, anticoagulation
Eligibility Criteria
Inclusion Criteria:
In order to be eligible for participation in this trial, the subject must:
- Be a healthy male or female between ages 18-55 (inclusive) at the screening visit
- Have a body mass index (BMI) >19 and <33 (inclusive)
If a female, subject
- Can be of childbearing potential and must demonstrate a urine β-hCG level consistent with the nongravid state at the pretrial (screening) visit and agree to use (and/or have their partner use) an acceptable method of birth control beginning at the pretrial visit throughout the trial (including washout intervals between treatment periods) and until 2 weeks after the last dose of trial drug in the last treatment period.
- Can be of non-childbearing potential which is defined as: a female who is postmenopausal without menses for at least 1 year and an Follicle stimulating hormone value in the postmenopausal range upon pretrial (screening) evaluation and/or a female who is status post hysterectomy, oophorectomy or tubal ligation
- Must be off hormonal oral or transdermal contraceptives for at least 4 weeks prior to initial dose of trial drug
- Be a nonsmoker for at least approximately 6 months
- Have serum creatinine level < 1.5 mg/dL
- Have a prothrombin time (PT) and activated partial thromboplastin time (PTT) level below the upper limit of normal
- Have platelet count within normal limits
- Be willing to refrain from the use of anticoagulants and antiplatelet medications including aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) during the entire period of study participation
- Be willing to provide written informed consent for the trial
- Be willing to comply with trial restrictions
Exclusion Criteria:
- Has a history of clinically significant endocrine, gastrointestinal, cardiovascular, hematological, hepatic, immunological, renal, respiratory, genitourinary or major neurological (including stroke and chronic seizures) abnormalities or diseases
- Has history of cancer (excluding treated cutaneous squamous or basal cell carcinoma of >3 years previous)
- Has history of venous or arterial thromboembolic disease
- Has a history of clinically significant bleeding risks including prior serious head trauma
- Has had major surgery within 6 months prior to screening visit
- Is unable to refrain from or anticipates the use of any medication, including prescription and non-prescription drugs or herbal remedies for 2 weeks prior to trial start date until the post-trial visit
- Is unable to refrain from using any drugs or substance known to be inhibitors or inducers of cytochrome P450 (CYP) enzymes including grapefruit products for 2 weeks prior to dosing and throughout the study, until the post-trial visit
- Has a history of illicit drug abuse within six months prior to screening visit
- Consumes greater than 3 glasses of alcoholic beverages (1 glass is approximately equivalent to: beer [354 mL/12 ounces], wine [118 mL/4 ounces], or distilled spirits [29.5 mL/1 ounce]) per day and cannot refrain from alcohol for the duration of the trial
- Has a history of significant multiple and/or severe allergies (e.g. food, drug), or has had an anaphylactic reaction or significant intolerability to prescription or non-prescription drugs or food
- Has known anaphylactic or severe systemic reactions to any components of study drugs (including heparin induced thrombocytopenia) or contraindication to the administration of PCC or any other related blood products.
- Has moderate or severe hepatic disease or other clinically relevant bleeding risk
- Has positive history for hepatitis B surface antigen, hepatitis C or HIV
- Has first degree relatives with history of bleeding disorder or hypercoagulable disease
- Use of any drugs or products which at the discretion of the investigator would increase bleeding risk
- Is considered inappropriate for participation by the investigator for any reason
Sites / Locations
- Thomas Jefferson University Hosptial
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Apixaban with Kcentra
Apixaban with placebo
Arm Description
Oral apixaban will be administered to steady state in healthy volunteers followed by a single infusion of prothrombin complex concentrate Kcentra at 25 units/Kg
Oral apixaban will be administered to steady state in healthy volunteers followed by a single infusion of saline
Outcomes
Primary Outcome Measures
thrombin generation assay (TGA)
Secondary Outcome Measures
Anti-factor Xa activity
Full Information
NCT ID
NCT02270918
First Posted
October 17, 2014
Last Updated
June 6, 2016
Sponsor
Thomas Jefferson University
Collaborators
Bristol-Myers Squibb, CSL Behring
1. Study Identification
Unique Protocol Identification Number
NCT02270918
Brief Title
Reversibility of Apixaban Anticoagulation With the Four Factor Prothrombin Complex Concentrate Kcentra
Acronym
4PAR
Official Title
A Phase I Placebo-Controlled, Open-Label, Crossover Study to Assess the Reversibility of Apixaban Anticoagulation With the Four Factor Prothrombin Complex Concentrate Kcentra in Healthy Volunteers
Study Type
Interventional
2. Study Status
Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
November 2014 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
December 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Thomas Jefferson University
Collaborators
Bristol-Myers Squibb, CSL Behring
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Apixaban is an anticoagulant (also known as blood thinner) approved by the Food and Drug Administration (FDA) for reducing the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. It has no reliable method of reversal. Kcentra is an FDA approved drug derived from blood that is used as an antidote to treat people with bleeding associated with taking the well-known anticoagulant warfarin. This is a Phase I, placebo-controlled, single site, open-label, crossover trial to evaluate the reversibility apixaban anticoagulation with Kcentra.
Detailed Description
Oral anticoagulants are effective in the treatment and prevention of venous and arterial thrombotic events. For more than 50 years the only class of anticoagulant available had been the vitamin K antagonist (VKA), warfarin, which requires frequent blood work for monitoring. Apixaban is a new approved anticoagulant that is used to treat patients who have blood clots or are at risk for developing blood clots. Unlike warfarin, the use of apixaban does not require frequent blood work for monitoring and is associated with lower bleeding risk. All anticoagulation therapies are associated with spontaneous or provoked bleeding risk and reversal of their blood thinning effects might be needed. Reversal of anticoagulation may also be needed in cases where emergent or urgent surgery is indicated. There is currently no available reversal agent for apixaban. Prothrombin complex concentrate (PCC) contain clotting factors and can replace factors inhibited by anticoagulants. In a recent study in the Netherlands a four factor prothrombin complex concentrate, Cofact (not available in the USA) was shown to be able to reverse the anticoagulation effects of another factor Xa inhibitor, rivaroxaban. Kcentra is a four factor prothrombin complex concentrate that was FDA approved in 2013 and is used as an antidote to treat people with bleeding associated with taking warfarin. It contains clotting factors II, VII, IX and X derived from donated blood and could be effective in reversing the anticoagulation effects of the factor Xa inhibitor, apixaban. No effective reversal agent for apixaban exists. Physicians struggle with bleeding in patients who are on apixaban. Indeed, this is not an uncommon problem for patients who suffer brain bleeds or trauma. This study could potentially identify Kcentra as reversal agent for patients taking apixaban. This study will test the hypothesis that Kcentra has the potential to significantly reduce the anticoagulation effect of apixaban as measured by thrombin generation assay at 30 minutes post infusion of Kcentra as compared to placebo infusion in subjects dosed to steady state with apixaban.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Thrombosis
Keywords
Xa inhibitor, Prothrombin complex concentrate, anticoagulation
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
12 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Apixaban with Kcentra
Arm Type
Active Comparator
Arm Description
Oral apixaban will be administered to steady state in healthy volunteers followed by a single infusion of prothrombin complex concentrate Kcentra at 25 units/Kg
Arm Title
Apixaban with placebo
Arm Type
Placebo Comparator
Arm Description
Oral apixaban will be administered to steady state in healthy volunteers followed by a single infusion of saline
Intervention Type
Drug
Intervention Name(s)
Kcentra
Other Intervention Name(s)
4 factor prothrombin complex concentrate
Intervention Description
IV infusion
Intervention Type
Drug
Intervention Name(s)
Apixaban
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
thrombin generation assay (TGA)
Time Frame
30 minutes
Secondary Outcome Measure Information:
Title
Anti-factor Xa activity
Time Frame
30 minutes
Other Pre-specified Outcome Measures:
Title
prothrombin time (PT)
Time Frame
30 minutes
Title
activated partial thromboplastin time (PTT)
Time Frame
30 minutes
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
In order to be eligible for participation in this trial, the subject must:
Be a healthy male or female between ages 18-55 (inclusive) at the screening visit
Have a body mass index (BMI) >19 and <33 (inclusive)
If a female, subject
Can be of childbearing potential and must demonstrate a urine β-hCG level consistent with the nongravid state at the pretrial (screening) visit and agree to use (and/or have their partner use) an acceptable method of birth control beginning at the pretrial visit throughout the trial (including washout intervals between treatment periods) and until 2 weeks after the last dose of trial drug in the last treatment period.
Can be of non-childbearing potential which is defined as: a female who is postmenopausal without menses for at least 1 year and an Follicle stimulating hormone value in the postmenopausal range upon pretrial (screening) evaluation and/or a female who is status post hysterectomy, oophorectomy or tubal ligation
Must be off hormonal oral or transdermal contraceptives for at least 4 weeks prior to initial dose of trial drug
Be a nonsmoker for at least approximately 6 months
Have serum creatinine level < 1.5 mg/dL
Have a prothrombin time (PT) and activated partial thromboplastin time (PTT) level below the upper limit of normal
Have platelet count within normal limits
Be willing to refrain from the use of anticoagulants and antiplatelet medications including aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) during the entire period of study participation
Be willing to provide written informed consent for the trial
Be willing to comply with trial restrictions
Exclusion Criteria:
Has a history of clinically significant endocrine, gastrointestinal, cardiovascular, hematological, hepatic, immunological, renal, respiratory, genitourinary or major neurological (including stroke and chronic seizures) abnormalities or diseases
Has history of cancer (excluding treated cutaneous squamous or basal cell carcinoma of >3 years previous)
Has history of venous or arterial thromboembolic disease
Has a history of clinically significant bleeding risks including prior serious head trauma
Has had major surgery within 6 months prior to screening visit
Is unable to refrain from or anticipates the use of any medication, including prescription and non-prescription drugs or herbal remedies for 2 weeks prior to trial start date until the post-trial visit
Is unable to refrain from using any drugs or substance known to be inhibitors or inducers of cytochrome P450 (CYP) enzymes including grapefruit products for 2 weeks prior to dosing and throughout the study, until the post-trial visit
Has a history of illicit drug abuse within six months prior to screening visit
Consumes greater than 3 glasses of alcoholic beverages (1 glass is approximately equivalent to: beer [354 mL/12 ounces], wine [118 mL/4 ounces], or distilled spirits [29.5 mL/1 ounce]) per day and cannot refrain from alcohol for the duration of the trial
Has a history of significant multiple and/or severe allergies (e.g. food, drug), or has had an anaphylactic reaction or significant intolerability to prescription or non-prescription drugs or food
Has known anaphylactic or severe systemic reactions to any components of study drugs (including heparin induced thrombocytopenia) or contraindication to the administration of PCC or any other related blood products.
Has moderate or severe hepatic disease or other clinically relevant bleeding risk
Has positive history for hepatitis B surface antigen, hepatitis C or HIV
Has first degree relatives with history of bleeding disorder or hypercoagulable disease
Use of any drugs or products which at the discretion of the investigator would increase bleeding risk
Is considered inappropriate for participation by the investigator for any reason
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Walter K Kraft, MD
Organizational Affiliation
Thomas Jefferson University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Thomas Jefferson University Hosptial
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
Yes
Citations:
PubMed Identifier
27170068
Citation
Nagalla S, Thomson L, Oppong Y, Bachman B, Chervoneva I, Kraft WK. Reversibility of Apixaban Anticoagulation with a Four-Factor Prothrombin Complex Concentrate in Healthy Volunteers. Clin Transl Sci. 2016 Jun;9(3):176-80. doi: 10.1111/cts.12398. Epub 2016 May 12.
Results Reference
result
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Reversibility of Apixaban Anticoagulation With the Four Factor Prothrombin Complex Concentrate Kcentra
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