Left Atrial Appendage CLOSURE in Patients With Atrial Fibrillation Compared to Medical Therapy (CLOSURE-AF)
Atrial Fibrillation
About this trial
This is an interventional prevention trial for Atrial Fibrillation focused on measuring Atrial Fibrillation, Anticoagulation, Left atrial appendage closure, Stroke
Eligibility Criteria
Key Inclusion Criteria:
- Signed written informed consent
- Documented atrial fibrillation (paroxysmal, persistent, long-standing persistent or permanent)
- CHA2DS2VASc-Score ≥ 2
High risk of bleeding under oral anticoagulation or contraindication for (N)OAC therapy, in particular patients with at least one of the following conditions (a-e):
- HAS-BLED-Score ≥ 3
- Prior intracranial/intraspinal bleed, intraocular bleed compromising vision (BARC: type 3c)
- Hemorrhagic/bleeding complication fulfilling BARC type 3a or 3b: gastrointestinal tract, genitourinary tract or respiratory tract bleeding, where the patient is considered to be at a persistently increased risk of bleeding, e.g. the cause of bleeding cannot be successfully eliminated
- Chronic kidney disease with eGFR 15-29 ml/min/1.73 m2
- Any recurrent bleeding making chronic anticoagulation not feasible
- Subject eligible for an LAA occluder device
- Age ≥18 years
- Willing and capable of providing informed consent, participating in all associated study activities
Key Exclusion Criteria:
- Absolute contraindication to acetylsalicylic acid
- Comorbidities other than AF requiring chronic (N)OAC therapy, e.g. mechanical heart valve prosthesis
- Symptomatic carotid disease (if not treated)
- Complex aortic atheroma with mobile plaque (Kronzon classification grade V)
- Heart transplant
- Active infection or active endocarditis or other infections resulting in bacteremia
- Cardiac tumor
- Severe liver failure (Child-Pugh class C or liver failure with coagulopathy)
- Severe renal failure (GFR <15 ml/min/1.73m2)
- Pregnancy or breastfeeding
- For female patients of reproductive potential: Unwilling to agree to use a highly effective method of contraception (Pearl index <1) throughout the study period
- Subject with participation in another interventional clinical trial during this study or within 30 days before entry into this trial.
- Known terminating disease with life expectancy <1 year (including those with end-stage heart failure)
- Subjects, who are committed to an institution due to binding official or court order
- Subject who is dependent on the Site, the Site Investigator, any sub- investigator, his/her representative and/or the sponsor
- Persons who are not proficient in the German language
- Acute heart failure within the last 30 days
- Cardiac intervention within the last 30 days
- Subjects with planned cardiac or non-cardiac surgery or intervention. (These subject can be included 30 days after such intervention / surgery.)
Sites / Locations
- Vivantes Klinik Am Urban, KardiologieRecruiting
- Charité Universitätsmedizin Berlin, CBF, KardiologieRecruiting
- Vivantes Klinikum Neukölln, KardiologieRecruiting
- DRK-Kliniken Berlin Köpenick, Klinik für Innere Medizin - Schwerpunkt Kardiologie und AngiologieRecruiting
- Charité Universitätsmedizin Berlin, CVK, KardiologieRecruiting
- Deutsches Herzzentrum Berlin, Innere Medizin - KardiologieRecruiting
- Klinikum Brandenburg GmbH, Zentrum für Innere Medizin IRecruiting
- Gesundheit Nord gGmbH, Klinikum Links der Weser, Klinik für Kardiologie und AngiologieRecruiting
- Klinikum Lippe, Klinik für Kardiologie, Angiologie und Internistische IntensivmedizinRecruiting
- Katholisches Krankenhaus "St. Johann Nepomuk", Klinik für Innere Medizin II - KardiologieRecruiting
- Universitätsklinikum Erlangen, Medizinische Klinik II - Kardiologie und AngiologieRecruiting
- Alfried Krupp KrankenhausRecruiting
- Universität Greifswald, Klinik für Innere Medizin B - KardiologieRecruiting
- Asklepios Klinik Barmbek, I. Med. Abteilung - KardiologieRecruiting
- Klinikum Herford, Med. Klinik III/ KardiologieRecruiting
- Westpfalz-Klinikum GmbH, Klinik für Innere Medizin II - KardiologieRecruiting
- UKSH - Campus Kiel, Medizinische Klinik III - Kardiologie, Angiologie, IntensivmedizinRecruiting
- UKSH - Universitäres Herzzentrum Lübeck, Medizinische Klinik II - Kardiologie, Angiologie, IntensivmedizinRecruiting
- Universitätsmedizin Mainz, Kardiologie I - Zentrum für KardiologieRecruiting
- Universitätsmedizin Mannheim, I. Medizinische Klinik - Kardiologie, Angiologie, IntensivmedizinRecruiting
- Deutsches Herzzentrum München, Klinik an der TU MünchenRecruiting
- LMU Universität München, Medizinische Klinik und Poliklinik IRecruiting
- Peter Osypka Herzzentrum MünchenRecruiting
- Städt. Klinikum München GmbH, Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie, intern. IntensivmedizinRecruiting
- Universitätsklinik Ulm, Klinik für Innere Medizin II - KardiologieRecruiting
- Heinrich-Braun-Klinikum Zwickau, Klinik für Innere Medizin I - Kardiologie, Angiologie, Intern. InternsivmedizinRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
LAA closure group
Best medical care group
Left atrial appendage closure by use of CE-mark approved LAA closure devices followed by post procedure treatment (antiplatelet therapy e.g. acetylsalicylic acid, clopidogrel)
No left atrial appendage closure. Treatment with best medical care (NOACs (dabigatran, rivaroxaban, apixaban, edoxaban) or VKA (phenprocoumon, warfarin)