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Rivaroxaban Versus Warfarin for Thromboprophylaxis in Children With Giant Coronary Aneurysms After Kawasaki Disease

Primary Purpose

Kawasaki Disease, Coronary Aneurysm, Rivaroxaban

Status
Not yet recruiting
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Rivaroxaban Oral Tablet or Suspension [Xarelto]
Aspirin or Clopidogrel
Warfarin
Sponsored by
Children's Hospital of Fudan University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Kawasaki Disease focused on measuring Kawasaki disease, Giant coronary aneurysm, Rivaroxaban, Warfarin

Eligibility Criteria

1 Month - 18 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Children aged 1 Month to <18 years with confirmed giant coronary aneurysm(s) in any coronary artery during acute or cardiac sequelae phase of Kawasaki disease. Giant coronary aneurysm(s) should confirmed by diagnostic imaging examination and meet the diagnostic criteria of Z-score ≥10 or coronary artery internal lumen diameter ≥8mm. Current anticoagulation therapy is long-term oral Warfarin treatment with stable INR. INR monitoring has reached the target range (1.5-2.5) for two consecutive times in the past month, with each examination interval of at least one week Participant should be able to tolerate oral/nasogastric/gastric feeding and require antithrombotic drug therapy for at least 1 year. For children with history of severe occlusion of coronary artery and performed coronary artery bypass grafting, percutaneous coronary intervention or thrombolytic therapy: At least 1 week after medical intervention Clinically stable Body weight ≥ 2600g Informed consent from parents or legal guardians provided. If children aged ≥ 10 years, informed consent from children is required. Exclusion Criteria: Active bleeding or bleeding risk contraindicating anticoagulant therapy With history of venous thromboembolism or risk factors related with venous thromboembolism, like congenital heart disease, carcinoma, central venous catheter or long-term immobilization. Thrombus within giant coronary aneurysm was confirmed by previous imaging examinations, including echocardiography, computed tomography angiography in coronary artery or coronary angiography An estimated glomerular filtration rate (eGFR) <30mL/min/1.73 m2 (in children younger than 1 year, serum creatinine results above 97.5th percentile excludes participation) Platelet count < 50 x 109/L Hepatic disease which is associated w ith either: coagulopathy leading to a clinically relevant bleeding risk, or alanine aminotransferase (ALT)> 5x upper level of normal (ULN) or total bilirubin (TB)> 2x ULN with direct bilirubin > 20% of the total Sustained uncontrolled hypertension defined as systolic and/or diastolic blood pressure >95 th age percentile Concomitant use of strong inhibitors of both cytochrome P450 isoenzyme 3A4 (CYP3A4) and P-glycoprotein (P-gp),including but not limited to all human immunodeficiency virus protease inhibitors and the following azole-antimycotics agents: ketoconazole, itraconazole, voriconazole, posaconazole, if used systemically (fluconazole is allowed) Concomitant use of strong inducers of CYP3A4, including but not limited to rifampicin, rifabutin, phenobarbital, phenytoin and carbamazepine Childbearing potential without proper contraceptive measures, pregnancy or breast feeding Life expectancy <3 Month Hypersensitivity or any other contraindication listed in the local labeling for the comparator treatment or experimental treatment Inability to cooperate with the study procedures Participation in a study with an investigational drug or medical device within 30 days prior to randomization

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Rivaroxaban+Antiplatelet drug

    Standard antithrombotic care

    Arm Description

    Rivaroxaban as antithrombotic drug will be administered jointly with Antiplatelet drug for 6 months. Antiplatelet drug can choose Aspirin or Clopidogrel depending on participant medical history and physician's recommendation.

    Warfarin as antithrombotic drug will be administered jointly with Antiplatelet drug for 6 months. Antiplatelet drug can choose Aspirin or Clopidogrel depending on participant medical history and physician's recommendation. International normalized ratio(INR) should be tested once a month and maintained in target range(1.5~2.5). 2.Aspirin[3 ~5mg/(kg·d), once daily] or Clopidogrel[ <2 years: 0.2~1.0mg/kg, ≥2 years: 1 mg/kg; once daily] according to experienced clinician recommendation and individual condition.

    Outcomes

    Primary Outcome Measures

    Incidence rate of new thrombogenesis within giant coronary aneurysm
    Echocardiography will be performed when participant present symptoms suggesting cardiac infarction (like palpitation, chest pain, decline in exercise capacity and etc.) or at each scheduled visits(Enrollment,1 month, 2 month, 3 month, 4 month, 5 month and 6 month) New thrombogenesis will be assessed and confirmed by masked sonographer.Incidence = Number of events / Number at risk, where: number of events = number of participant having the event in the time window. number at risk = number of participant in assigned arm

    Secondary Outcome Measures

    Cumulative incidence rate of new thrombogenesis within giant coronary aneurysm
    It is time to event data. Echocardiography will be perform when participant present symptoms suggesting cardiac infarction (like palpitation, chest pain, decline in exercise capacity and etc.) or each scheduled visits(Enrollment,1 month, 2 month, 3 month, 4 month, 5 month and 6 month) New thrombogenesis will be assessed and confirmed by masked sonographer.
    Incidence Rate of the Composite of Major bleeding event or Clinically relevant non-major bleeding event
    According to International society of thrombosis and hemostasis(ISTH), major bleeding event is defined as overt bleeding and: associated with a fall in hemoglobin of 2 g/dL or more, or leading to a transfusion of the equivalent of 2 or more units of packed red blood cells or whole blood in adults, or occurring in a critical site, e.g. intracranial, intraspinal, intraocular, pericardial, intraarticular, intramuscular with compartment syndrome, retroperitoneal, or contributing to death. Clinically relevant non-major bleeding event is defined as overt bleeding not meeting the criteria for major bleeding, but associated with: medical intervention, or unscheduled contact (visit or telephone call) with a physician, or (temporary) cessation of study treatment, or discomfort for the child such as pain or impairment of activities of daily life (such as loss of school days or hospitalization).
    Incidence rate of any adverse events
    It is a binary variable. If any adverse events( including durg allergy, severe infection, hepatic dysfunction, renal dysfunction, hypertension, fatigue, abdominal pain or others) happens, this variable would be recorded as 1 or it would be recorded as 0.
    Changes in Z-score of giant coronary aneurysm
    This is a repeated measurement. The internal diameter of giant coronary aneurysm will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Changes in Z-score of Left Main Coronary Artery(LMCA)
    This is a repeated measurement. The internal diameter of LMCA will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Changes in Z-score of Left Anterior Descending Artery(LAD)
    This is a repeated measurement. The internal diameter of LAD will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Changes in Z-score of Left Circumflex Artery(LCX)
    This is a repeated measurement. The internal diameter of LCX will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Changes in Z-score of Proximal segment of Right Coronary Artery(RCA)
    This is a repeated measurement. The internal diameter of Proximal segment of RCA will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Changes in Z-score of Middle segment of Right Coronary Artery(RCA)
    This is a repeated measurement. The internal diameter of Middle segment of RCA will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.

    Full Information

    First Posted
    November 25, 2022
    Last Updated
    December 6, 2022
    Sponsor
    Children's Hospital of Fudan University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05643651
    Brief Title
    Rivaroxaban Versus Warfarin for Thromboprophylaxis in Children With Giant Coronary Aneurysms After Kawasaki Disease
    Official Title
    Multicenter, Randomized, Non-inferiority Trial to Evaluate the Safety and Efficacy of Rivaroxaban Compared to Warfarin for Thromboprophylaxis in Children With Giant Coronary Aneurysms After Kawasaki Disease
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    December 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    March 1, 2023 (Anticipated)
    Primary Completion Date
    January 1, 2025 (Anticipated)
    Study Completion Date
    June 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Children's Hospital of Fudan University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    To evaluate the efficacy and safety of rivaroxaban compared to warfarin for thromboprophylaxis in children with giant coronary aneurysms after Kawasaki disease
    Detailed Description
    This study is a multicenter, open-label, active-controlled, randomized, non-inferiority trial to assess the efficacy and safety of rivaroxaban for thromboprophylaxis in children with giant coronary aneurysms after Kawasaki disease. Participants will be randomly assigned to the control or experiment groups. Randomization ratio will be 1:1. The control group will receive warfarin plus aspirin or clopidogrel, and the experiment group will receive Rivaroxaban plus aspirin or clopidogrel. This study will last for 6 months. Baseline characters, efficacy outcomes, bleeding events, adverse events and compliance of intervention of each participant will be collected. Two-dimensional echocardiography will be performed at admission and each scheduled visits to detect whether new thrombogenesis occurred in the giant coronary aneurysms.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Kawasaki Disease, Coronary Aneurysm, Rivaroxaban, Warfarin, Antithrombotic Drug
    Keywords
    Kawasaki disease, Giant coronary aneurysm, Rivaroxaban, Warfarin

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    Outcomes Assessor
    Masking Description
    Investigator, Participant and Care provider will not be masked. However, sonographer who is responsible for assessing coronary artery lesions should be masked.
    Allocation
    Randomized
    Enrollment
    332 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Rivaroxaban+Antiplatelet drug
    Arm Type
    Experimental
    Arm Description
    Rivaroxaban as antithrombotic drug will be administered jointly with Antiplatelet drug for 6 months. Antiplatelet drug can choose Aspirin or Clopidogrel depending on participant medical history and physician's recommendation.
    Arm Title
    Standard antithrombotic care
    Arm Type
    Active Comparator
    Arm Description
    Warfarin as antithrombotic drug will be administered jointly with Antiplatelet drug for 6 months. Antiplatelet drug can choose Aspirin or Clopidogrel depending on participant medical history and physician's recommendation. International normalized ratio(INR) should be tested once a month and maintained in target range(1.5~2.5). 2.Aspirin[3 ~5mg/(kg·d), once daily] or Clopidogrel[ <2 years: 0.2~1.0mg/kg, ≥2 years: 1 mg/kg; once daily] according to experienced clinician recommendation and individual condition.
    Intervention Type
    Drug
    Intervention Name(s)
    Rivaroxaban Oral Tablet or Suspension [Xarelto]
    Other Intervention Name(s)
    Xarelto
    Intervention Description
    Administered in a body weight-adjusted 20 mg-equivalent total daily dose regimen
    Intervention Type
    Drug
    Intervention Name(s)
    Aspirin or Clopidogrel
    Intervention Description
    Aspirin [3 ~5mg/(kg·d) once daily] or Clopidogrel [0.2~1.0 mg/kg(<2 years old),1 mg/kg(≥2 years old); once daily]
    Intervention Type
    Drug
    Intervention Name(s)
    Warfarin
    Other Intervention Name(s)
    Vitamin K Antagonist
    Intervention Description
    Warfarin 0.05~0.12 mg/(kg·d) once daily. INR should maintain within 1.5 to 2.5
    Primary Outcome Measure Information:
    Title
    Incidence rate of new thrombogenesis within giant coronary aneurysm
    Description
    Echocardiography will be performed when participant present symptoms suggesting cardiac infarction (like palpitation, chest pain, decline in exercise capacity and etc.) or at each scheduled visits(Enrollment,1 month, 2 month, 3 month, 4 month, 5 month and 6 month) New thrombogenesis will be assessed and confirmed by masked sonographer.Incidence = Number of events / Number at risk, where: number of events = number of participant having the event in the time window. number at risk = number of participant in assigned arm
    Time Frame
    from enrollment to the 6th month
    Secondary Outcome Measure Information:
    Title
    Cumulative incidence rate of new thrombogenesis within giant coronary aneurysm
    Description
    It is time to event data. Echocardiography will be perform when participant present symptoms suggesting cardiac infarction (like palpitation, chest pain, decline in exercise capacity and etc.) or each scheduled visits(Enrollment,1 month, 2 month, 3 month, 4 month, 5 month and 6 month) New thrombogenesis will be assessed and confirmed by masked sonographer.
    Time Frame
    from enrollment to the 6th month
    Title
    Incidence Rate of the Composite of Major bleeding event or Clinically relevant non-major bleeding event
    Description
    According to International society of thrombosis and hemostasis(ISTH), major bleeding event is defined as overt bleeding and: associated with a fall in hemoglobin of 2 g/dL or more, or leading to a transfusion of the equivalent of 2 or more units of packed red blood cells or whole blood in adults, or occurring in a critical site, e.g. intracranial, intraspinal, intraocular, pericardial, intraarticular, intramuscular with compartment syndrome, retroperitoneal, or contributing to death. Clinically relevant non-major bleeding event is defined as overt bleeding not meeting the criteria for major bleeding, but associated with: medical intervention, or unscheduled contact (visit or telephone call) with a physician, or (temporary) cessation of study treatment, or discomfort for the child such as pain or impairment of activities of daily life (such as loss of school days or hospitalization).
    Time Frame
    from enrollment to the 6th month
    Title
    Incidence rate of any adverse events
    Description
    It is a binary variable. If any adverse events( including durg allergy, severe infection, hepatic dysfunction, renal dysfunction, hypertension, fatigue, abdominal pain or others) happens, this variable would be recorded as 1 or it would be recorded as 0.
    Time Frame
    from enrollment to the 6th month
    Title
    Changes in Z-score of giant coronary aneurysm
    Description
    This is a repeated measurement. The internal diameter of giant coronary aneurysm will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Time Frame
    Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month
    Title
    Changes in Z-score of Left Main Coronary Artery(LMCA)
    Description
    This is a repeated measurement. The internal diameter of LMCA will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Time Frame
    Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month
    Title
    Changes in Z-score of Left Anterior Descending Artery(LAD)
    Description
    This is a repeated measurement. The internal diameter of LAD will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Time Frame
    Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month
    Title
    Changes in Z-score of Left Circumflex Artery(LCX)
    Description
    This is a repeated measurement. The internal diameter of LCX will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Time Frame
    Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month
    Title
    Changes in Z-score of Proximal segment of Right Coronary Artery(RCA)
    Description
    This is a repeated measurement. The internal diameter of Proximal segment of RCA will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Time Frame
    Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month
    Title
    Changes in Z-score of Middle segment of Right Coronary Artery(RCA)
    Description
    This is a repeated measurement. The internal diameter of Middle segment of RCA will be measured by echocardiography at each scheduled visit(Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month). Z score will be calculated based on the height, weight and coronary artery internal diameter.
    Time Frame
    Enrollment, 1 month, 2 month,3 month, 4 month, 5 month and 6 month

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    1 Month
    Maximum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Children aged 1 Month to <18 years with confirmed giant coronary aneurysm(s) in any coronary artery during acute or cardiac sequelae phase of Kawasaki disease. Giant coronary aneurysm(s) should confirmed by diagnostic imaging examination and meet the diagnostic criteria of Z-score ≥10 or coronary artery internal lumen diameter ≥8mm. Current anticoagulation therapy is long-term oral Warfarin treatment with stable INR. INR monitoring has reached the target range (1.5-2.5) for two consecutive times in the past month, with each examination interval of at least one week Participant should be able to tolerate oral/nasogastric/gastric feeding and require antithrombotic drug therapy for at least 1 year. For children with history of severe occlusion of coronary artery and performed coronary artery bypass grafting, percutaneous coronary intervention or thrombolytic therapy: At least 1 week after medical intervention Clinically stable Body weight ≥ 2600g Informed consent from parents or legal guardians provided. If children aged ≥ 10 years, informed consent from children is required. Exclusion Criteria: Active bleeding or bleeding risk contraindicating anticoagulant therapy With history of venous thromboembolism or risk factors related with venous thromboembolism, like congenital heart disease, carcinoma, central venous catheter or long-term immobilization. Thrombus within giant coronary aneurysm was confirmed by previous imaging examinations, including echocardiography, computed tomography angiography in coronary artery or coronary angiography An estimated glomerular filtration rate (eGFR) <30mL/min/1.73 m2 (in children younger than 1 year, serum creatinine results above 97.5th percentile excludes participation) Platelet count < 50 x 109/L Hepatic disease which is associated w ith either: coagulopathy leading to a clinically relevant bleeding risk, or alanine aminotransferase (ALT)> 5x upper level of normal (ULN) or total bilirubin (TB)> 2x ULN with direct bilirubin > 20% of the total Sustained uncontrolled hypertension defined as systolic and/or diastolic blood pressure >95 th age percentile Concomitant use of strong inhibitors of both cytochrome P450 isoenzyme 3A4 (CYP3A4) and P-glycoprotein (P-gp),including but not limited to all human immunodeficiency virus protease inhibitors and the following azole-antimycotics agents: ketoconazole, itraconazole, voriconazole, posaconazole, if used systemically (fluconazole is allowed) Concomitant use of strong inducers of CYP3A4, including but not limited to rifampicin, rifabutin, phenobarbital, phenytoin and carbamazepine Childbearing potential without proper contraceptive measures, pregnancy or breast feeding Life expectancy <3 Month Hypersensitivity or any other contraindication listed in the local labeling for the comparator treatment or experimental treatment Inability to cooperate with the study procedures Participation in a study with an investigational drug or medical device within 30 days prior to randomization
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Fang Liu, MD
    Phone
    18017590880
    Email
    liufang@fudan.edu.cn
    First Name & Middle Initial & Last Name or Official Title & Degree
    Guangan Dai
    Phone
    13580762996
    Email
    21211240004@m.fudan.edu.cn
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Fang Liu, MD
    Organizational Affiliation
    Children's Hospital of Fudan University
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Rivaroxaban Versus Warfarin for Thromboprophylaxis in Children With Giant Coronary Aneurysms After Kawasaki Disease

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