E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Prevention of stroke and non-CNS systemic embolism in patients with nonvalvular atrial fibrillation who undergo catheter ablation |
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E.1.1.1 | Medical condition in easily understood language |
Nonvalvular atrial fibrillation patients who undergo catheter ablation procedure |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10003658 |
E.1.2 | Term | Atrial fibrillation |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective is to evaluate the safety of rivaroxaban and uninterrupted vitamin K antagonist (VKA) in adult subjects with nonvalvular atrial fibrillation (NVAF) who undergo catheter ablation as measured by post-procedure major bleeding events. |
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E.2.2 | Secondary objectives of the trial |
The secondary objective is to evaluate the thromboembolism profile of rivaroxaban and uninterrupted VKA as measured by the composite and the individual components of the following post procedure events: myocardial infarction (MI), ischemic stroke, non-CNS systemic embolism, and vascular death. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Have a documented history of paroxysmal (lasting <1 week), persistent (lasting >1 week and <1 year or requiring pharmacological or electrical cardioversion), or long standing persistent (≥ 1 year) NVAF. • Be scheduled for a first catheter ablation procedure for NVAF. • Be willing and able to adhere to the prohibitions and restrictions specified in this protocol. • Be suitable for anticoagulant therapy and catheter ablation as per the judgement of the investigator. • Be a man or woman 18 years of age, or older. • If a woman, before entry she must be: - Postmenopausal, defined as a. >45 years of age with amenorrhoea for at least 18 months - Menstrual a. Surgically sterile (have had a hysterectomy or bilateral oophorectomy, tubal ligation or otherwise be incapable of pregnancy) or b. If heterosexually active, practising a highly effective method of birth control, including hormonal prescription oral contraceptives, contraceptive injections, contraceptive patch, intrauterine device, double-barrier method (eg, condoms, diaphragm or cervical cap with spermicidal foam, cream or gel) or male partner sterilisation, consistent with local regulations regarding use of birth control methods for subjects participating in clinical trials, for the duration of their participation in the study, or c. Not heterosexually active, Note: Women who are not heterosexually active at screening must agree to utilise a highly effective method of birth control if they become heterosexually active during their participation in the study. Women must agree to continue using these methods of contraception throughout the study. • If a woman of childbearing potential, she must have a negative serum pregnancy test at screening. • Have a life expectancy of at least 6 months. |
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E.4 | Principal exclusion criteria |
• Has contraindications to the use of any anticoagulant therapy (eg, bleeding diathesis, history of gastrointestinal bleeding within 1 year or coagulopathy or a platelet count <90,000/μL documented at screening). • Has a history of a major bleeding or thromboembolic event within the 12 months immediately preceding the catheter ablation procedure. • Has a history of a prior stroke, TIA or non-convulsive status epilepticus within 6 months of the screening visit. • Has a CrCl ≤ 50 mL/min at screening • Has moderate to severe hepatic impairment (Child-Pugh B and C). • Has a comorbid condition such as severe pulmonary disease, infection, etc., and a life expectancy of less than 6 months. • Has had major surgery, (eg, requiring general anaesthesia) within 6 months before screening, or will not have fully recovered from surgery, or planned surgery during the time the subject is expected to participate in the study. Note: subjects with planned surgical procedures to be conducted under local anaesthesia may participate. • Has a history of cardiac valvular disease, condition, or procedure that does not meet the NVAF definition (the presence of atrial fibrillation in a person who does not have a prosthetic heart valve [annuloplasty with or without prosthetic ring, commissurotomy and/or valvuloplasty are permitted] and who does not have hemodynamically significant mitral valve stenosis, or rheumatic heart disease). • Has NVAF due to electrolyte imbalance, hyperthyroidism or other reversible or noncardiac cause of NVAF. • Has a left atrial size >55 mm or a documented left atrial thrombus or myxoma on imaging (e.g. echocardiography; the decision about whether or not to have an imaging study prior to the catheter ablation procedure will be made by the principal investigator as per standard of care). • Has a cardiac ejection fraction ≤40%, New York Heart Association Class III or IV, or presence of an implantable cardiac defibrillator. • Has had an MI within the 2 months immediately preceding the catheter ablation procedure or coronary artery bypass graft (CABG) surgery within 6 months immediately preceding the catheter ablation procedure. • Has known allergies, hypersensitivity, or intolerance to any component of rivaroxaban or VKA or its excipients • Is receiving treatment for HIV infection (due to potential drug-drug interactions). • Has a diagnosis or clinical condition requiring use of dual or single anti-platelet therapy (i.e. ASA [any dose] with a thienopyridine or P2Y12 platelet inhibitor, a thienopyridine or P2Y12 platelet inhibitor alone or ASA [>100 mg per day that cannot be decreased to <100 mg at randomisation]). • Has a history of malignancy within 1 year before screening (exceptions are squamous and basal cell carcinomas of the skin and carcinoma in situ of the cervix, or malignancy that in the opinion of the investigator, with concurrence with the sponsor's medical monitor, is considered cured with minimal risk of recurrence). • Uses or receives any of the disallowed therapies before the planned first dose of study drug. • Has received an investigational drug (including investigational vaccines) or used an invasive investigational medical device within 30 days before the planned first dose of study drug. • Is a woman who is pregnant or breast-feeding, or planning to become pregnant or is a man who plans to father a child while enrolled in this study or within 12 weeks after the last dose of study drug. • Has any condition that, in the opinion of the investigator, would make participation not be in the best interest (eg, compromise the well-being) of the subject or that could prevent, limit, or confound the protocol-specified assessments. • Is an employee of the investigator or study site, with direct involvement in the proposed study or other studies under the direction of that investigator or study site, as well as family members of the employees or the investigator. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint for this study is the incidence of post-procedure major bleeding events observed within the first 30 ± 5 days after the catheter ablation procedure |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
From catheter ablation procedure to End of Treatment (30 ± 5 days) |
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E.5.2 | Secondary end point(s) |
The secondary endpoints for this study include: • Event rate, for the 30 ± 5 days after the catheter ablation procedure, of the secondary composite endpoint of MI, ischemic stroke, non-CNS systemic embolism and vascular death. • Event rate, for the 30 ± 5 days after the catheter ablation procedure, of the individual components of the secondary composite endpoint of MI, ischemic stroke, non-CNS systemic embolism and vascular death. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
From catheter ablation procedure to End of Treatment (30 ± 5 days) |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 22 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Belgium |
France |
Germany |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | 2 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 1 |