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Rivaroxaban for Scheduled Work-up of DVT - The Ri-Schedule Study (Ri-Schedule)

Primary Purpose

Deep Venous Thrombosis

Status
Completed
Phase
Phase 3
Locations
Norway
Study Type
Interventional
Intervention
Rivaroxaban
Sponsored by
Ostfold Hospital Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Deep Venous Thrombosis focused on measuring Deep venous thrombosis, Rivaroxaban

Eligibility Criteria

18 Years - 95 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Consecutive outpatients referred to ER because of suspected DVT
  • 18 years of age
  • Signed informed consent

Exclusion Criteria:

1- refuse to consent

Patients with the criteria below will not be eligible for scheduled work-up:

  1. Duration of the diagnostic work-up is expected to last < 2 hours
  2. Presence of active cancer or receiving chemotherapy for cancer
  3. Suspicion of coexisting clinical PE
  4. Suspicion of active bleeding (gastrointestinal bleeding or muscle hematoma)
  5. Signs of threatened circulation or having intractable pain in the lower extremity or may be considered as candidate for thrombolytic treatment
  6. Physician does not consider it safe to discharge the patient
  7. Presence of logistic factors that may hinder a scheduled work-up
  8. Presence of co-morbid conditions that require hospital admission
  9. Patient prefers not to be discharged before diagnosis is completed
  10. Glomerular Filtration Rate < 45 ml/min
  11. Presence of contraindications to rivaroxaban including;

    • Lesion or condition, if considered to be a significant risk for major bleeding e.g current or recent gastrointestinal ulceration, presence of malignant neoplasms at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, known or suspected oesophageal varices, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities
    • Concomitant treatment with any other anticoagulants e.g. unfractionated heparin (UFH), low molecular weight heparins (enoxaparin, dalteparin, etc.), heparin derivatives (fondaparinux, etc.), oral anticoagulants (warfarin, dabigatran etexilate, apixaban etc.)
    • Hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C.
    • Pregnancy/positive pregnancy test and breastfeeding (see section 4.6)

11. Hb < 11 g/dl 12. Presence of drug interaction with rivaroxaban including concomitant systemic treatment with azole-antimycotics (such as ketoconazole, itraconazole, voriconazole and posaconazole) or HIV protease inhibitors (e.g. ritonavir), acetylsalicylic acid at a dose higher than 160 mg or platelet aggregation inhibitors

Sites / Locations

  • Ostfold Hospital Trust

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Rivaroxaban

Arm Description

Rivaroxaban 15 mg every 12 hours until the completion of the diagnostic work-up, which should not exceed 24 hours.

Outcomes

Primary Outcome Measures

Rate of serious bleedings and/or death related to bleeding
Serious bleedings and/or death related to bleeding encountered within 48 hours after the last rivaroxaban tablet was ingested in patients in whom DVT was excluded or until the ingestion of first tablet of oral anticoagulation or application of IV/SC heparin in those in whom DVT is confirmed.

Secondary Outcome Measures

Feasability rate
Assessed by the proportion of patients who can be managed by a scheduled work-up
Failure rate
Worsening in pre-existing complaints or developement of signs/symptoms of pulmonary embolism
90-day outcome
The 90-day outcome of the applied diagnostic strategy using Wells pre-test clinical probability, D-dimer and compression ultrasounography and safety of coagulation

Full Information

First Posted
February 25, 2015
Last Updated
January 18, 2019
Sponsor
Ostfold Hospital Trust
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1. Study Identification

Unique Protocol Identification Number
NCT02486445
Brief Title
Rivaroxaban for Scheduled Work-up of DVT - The Ri-Schedule Study
Acronym
Ri-Schedule
Official Title
Rivaroxaban for Scheduled Work-up of Patients With Suspected Deep Venous Thrombosis
Study Type
Interventional

2. Study Status

Record Verification Date
September 2017
Overall Recruitment Status
Completed
Study Start Date
March 2015 (Actual)
Primary Completion Date
November 30, 2018 (Actual)
Study Completion Date
December 30, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ostfold Hospital Trust

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This prospective outcome study is designed to assess the safety of rivaroxaban in the pre-diagnosis phase of DVT.
Detailed Description
This prospective outcome study is designed to assess the safety of rivaroxaban in the pre-diagnosis phase of DVT. International guidelines suggest the use of low molecular weight heparin (LMWH) if the diagnostic process is expected to be delayed for more than 4 hours. Rivaroxaban is a new DOAC that in clinical trials has proven to be non-inferior to LMWH and warfarin for the treatment of DVT with the added benefit of causing less major bleeding. Because of its rapid onset of action and oral administration, rivaroxaban could be used instead of LMWH in the pre-diagnosis phase pending the results of the diagnostic test. However, the safety of a such proposed indication has to be proven before it can be adopted in clinical practice. This study aims to determine the safety and feasibility of pre-diagnostic treatment with rivaroxaban. The primary outcome of this study "safety" is a composite endpoint of serious bleedings encountered within 48 hours after administration of rivaroxaban.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Deep Venous Thrombosis
Keywords
Deep venous thrombosis, Rivaroxaban

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
625 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Rivaroxaban
Arm Type
Experimental
Arm Description
Rivaroxaban 15 mg every 12 hours until the completion of the diagnostic work-up, which should not exceed 24 hours.
Intervention Type
Drug
Intervention Name(s)
Rivaroxaban
Other Intervention Name(s)
Xarelto
Intervention Description
Rivaroxaban 15 mg every 12 hours until the completion of the diagnostic work-up, which should not exceed 24 hours (maximum 2 tablets)
Primary Outcome Measure Information:
Title
Rate of serious bleedings and/or death related to bleeding
Description
Serious bleedings and/or death related to bleeding encountered within 48 hours after the last rivaroxaban tablet was ingested in patients in whom DVT was excluded or until the ingestion of first tablet of oral anticoagulation or application of IV/SC heparin in those in whom DVT is confirmed.
Time Frame
Until 48 hours after last tablet
Secondary Outcome Measure Information:
Title
Feasability rate
Description
Assessed by the proportion of patients who can be managed by a scheduled work-up
Time Frame
12 hours
Title
Failure rate
Description
Worsening in pre-existing complaints or developement of signs/symptoms of pulmonary embolism
Time Frame
until 48 hours after last tablet
Title
90-day outcome
Description
The 90-day outcome of the applied diagnostic strategy using Wells pre-test clinical probability, D-dimer and compression ultrasounography and safety of coagulation
Time Frame
90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
95 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Consecutive outpatients referred to ER because of suspected DVT 18 years of age Signed informed consent Exclusion Criteria: 1- refuse to consent Patients with the criteria below will not be eligible for scheduled work-up: Duration of the diagnostic work-up is expected to last < 2 hours Presence of active cancer or receiving chemotherapy for cancer Suspicion of coexisting clinical PE Suspicion of active bleeding (gastrointestinal bleeding or muscle hematoma) Signs of threatened circulation or having intractable pain in the lower extremity or may be considered as candidate for thrombolytic treatment Physician does not consider it safe to discharge the patient Presence of logistic factors that may hinder a scheduled work-up Presence of co-morbid conditions that require hospital admission Patient prefers not to be discharged before diagnosis is completed Glomerular Filtration Rate < 45 ml/min Presence of contraindications to rivaroxaban including; Lesion or condition, if considered to be a significant risk for major bleeding e.g current or recent gastrointestinal ulceration, presence of malignant neoplasms at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, known or suspected oesophageal varices, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities Concomitant treatment with any other anticoagulants e.g. unfractionated heparin (UFH), low molecular weight heparins (enoxaparin, dalteparin, etc.), heparin derivatives (fondaparinux, etc.), oral anticoagulants (warfarin, dabigatran etexilate, apixaban etc.) Hepatic disease associated with coagulopathy and clinically relevant bleeding risk including cirrhotic patients with Child Pugh B and C. Pregnancy/positive pregnancy test and breastfeeding (see section 4.6) 11. Hb < 11 g/dl 12. Presence of drug interaction with rivaroxaban including concomitant systemic treatment with azole-antimycotics (such as ketoconazole, itraconazole, voriconazole and posaconazole) or HIV protease inhibitors (e.g. ritonavir), acetylsalicylic acid at a dose higher than 160 mg or platelet aggregation inhibitors
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Waleed Ghanima, PhD
Organizational Affiliation
Ostfold Hospital Trust
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Nezar Raouf
Organizational Affiliation
Ostfold Hopital Trust
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Kristin Utne
Organizational Affiliation
Ostfold Hospital Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ostfold Hospital Trust
City
Fredrikstad
State/Province
Ostfold
ZIP/Postal Code
1606
Country
Norway

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
There is no plan to share IPD
Citations:
PubMed Identifier
33057634
Citation
Fronas SG, Jorgensen CT, Dahm AEA, Wik HS, Gleditsch J, Raouf N, Holst R, Klok FA, Ghanima W. Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis. Blood Adv. 2020 Oct 27;4(20):5002-5010. doi: 10.1182/bloodadvances.2020002173.
Results Reference
derived
PubMed Identifier
32502267
Citation
Fronas SG, Dahm AEA, Wik HS, Jorgensen CT, Gleditsch J, Raouf N, Holst R, Klok FA, Ghanima W. Safety and feasibility of rivaroxaban in deferred workup of patients with suspected deep vein thrombosis. Blood Adv. 2020 Jun 9;4(11):2468-2476. doi: 10.1182/bloodadvances.2020001556.
Results Reference
derived

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Rivaroxaban for Scheduled Work-up of DVT - The Ri-Schedule Study

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