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ThrombosisPhase 2NCT02981472

A Study of the Safety and Pharmacokinetics of Apixaban Versus Vitamin K Antagonist (VKA) or Low Molecular Weight Heparin (LMWH) in Pediatric Subjects With Congenital or Acquired Heart Disease Requiring Anticoagulation

A Phase 2 study testing Apixaban, Vitamin K Antagonist (VKA) and Low Molecular Weight Heparin (LMWH) in people with Thrombosis, run by Bristol-Myers Squibb at 46 sites in 14 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

To investigate the safety and pharmacokinetics of apixaban in children with congenital or acquired heart disease who have a need for anticoagulation. Read more about this study

Who is it for?
Ages 28 days to 17 years
Conditions the study is for
Thrombosis
What is being tested?
Apixaban, Vitamin K Antagonist (VKA) and Low Molecular Weight Heparin (LMWH)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
192 participants
Where
46 sitesin 14 countries
Study dates
19 Jan 2017to 18 Oct 2021
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 28 days to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Males and Females, 28 days to < 18 years of age, inclusive
  • Congenital or acquired heart diseases requiring chronic anticoagulation for thromboprophylaxis (eg, single ventricle physiology including all 3 stages of palliation, dilated cardiomyopathy, Kawasaki disease with coronary aneurysms, and pulmonary hypertension)
  • Eligible participants include those who newly start anticoagulants and those who are currently on VKA or LMWH or other anticoagulants for thromboprophylaxis
  • Able to tolerate enteral medication [eg, by mouth, nasogastric tube, or gastric tube]
  • Participants 28 days to < 3 months must be able to tolerate oral/nasogastric tube (NGT)/gastric tube (GT) feeds for at least 5 days prior to randomization

Who cannot join

  • Recent thromboembolic events less than 6 months prior to enrollment
  • Weight < 3 kg
  • Use of aggressive life-saving therapies such as ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO) at the time of enrollment
  • Artificial heart valves and mechanical heart valves
  • Known inherited bleeding disorder or coagulopathy (e.g. hemophilia, von Willebrand disease, etc.)
  • Active bleeding at the time of enrollment
Show all 11Show fewer
  • Any major bleeding other than perioperative in the preceding 3 months
  • Known intracranial congenital vascular malformation or tumor
  • Confirmed diagnosis of a GI ulcer
  • Known antiphospholipid syndrome (APS).
  • Other protocol defined inclusion/exclusion criteria apply

Trial locations and contacts

46 sites in 14 countries.

46 sites in 14 countries

United States14 sites
  • Local Institution - 0013

    Ann Arbor, Michigan, 48109

  • Childrens Healthcare Of Atlanta

    Atlanta, Georgia, 30322

  • Children'S Hospital Colorado

    Aurora, Colorado, 80045

  • Local Institution - 0009

    Boston, Massachusetts, 02115

  • Local Institution - 0012

    Charleston, South Carolina, 29425

  • Local Institution - 0006

    Cincinnati, Ohio, 45229

  • Local Institution - 0011

    Houston, Texas, 77030-2399

  • Local Institution - 0008

    Indianapolis, Indiana, 46202

  • Childrens Mercy Hospital

    Kansas City, Missouri, 64108

  • University Of California San Diego

    La Jolla, California, 92093-0641

  • Childrens Hospital Of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Phoenix Children'S Hospital

    Phoenix, Arizona, 85016

  • Primary Children's Hospital

    Salt Lake City, Utah, 84113

  • Local Institution - 0055

    Seattle, Washington, 98105

Other trials in United States

Brazil5 sites
  • Local Institution - 0020

    Campinas, São Paulo, 13060-080

  • Local Institution - 0022

    Curitiba, Paraná, 80250-060

  • Instituto De Cardiologia Do Rio Grande Do Sul

    Porto Alegre, Rio Grande do Sul, 90620-001

  • Instituto de Pesquisa PENSI

    São Paulo, 01227-200

  • Universidade Federal De Sao Paulo

    São Paulo, 04024-002

Other trials in Brazil

Mexico4 sites
  • Local Institution - 0044

    León, Guanajuato, 37000

  • Local Institution - 0018

    Mexico City, Mexico City, 04530

  • Local Institution - 0019

    Mexico City, Mexico City, 06720

  • Local Institution - 0016

    Mexico City, Mexico City, 14080

Other trials in Mexico

Russia4 sites
  • Local Institution

    Kazan', 420012

  • Local Institution

    Kemerovo, 650002

  • Local Institution - 0057

    Novosibirsk, 630055

  • Local Institution - 0062

    Yekaterinburg, 620134

Other trials in Russia

Germany3 sites
  • Local Institution - 0002

    Freiburg im Breisgau, 79106

  • Local Institution - 0004

    Hamburg, 20246

  • Local Institution - 0003

    München, 80636

Other trials in Germany

Italy3 sites
  • Local Institution - 0028

    Bologna, 40138

  • Local Institution - 0027

    Milan, 20097

  • Local Institution - 0026

    Rome, Roma, 00165

Other trials in Italy

Spain3 sites
  • Local Institution - 0049

    Barcelona, 08950

  • Local Institution

    Madrid, 28007

  • Local Institution - 0048

    Madrid, 28046

Other trials in Spain

United Kingdom3 sites
  • Local Institution - 0042

    Bristol, Somerset, BS2 8BJ

  • Local Institution - 0040

    Leicester, Leicestershire, LE3 9QP

  • Local Institution

    Manchester, M13 9WL

Other trials in United Kingdom

Israel2 sites
  • Local Institution - 0047

    Petah Tikva, 0

  • Local Institution - 0046

    Tel HaShomer, 52620

Other trials in Israel

Argentina1 site
  • Local Institution

    CABA, Buenos Aires, 1426

Other trials in Argentina

Australia1 site
  • Local Institution - 0030

    Parkville, Victoria, 3052

Other trials in Australia

Austria1 site
  • Local Institution - 0001

    Vienna, 1090

Other trials in Austria

Canada1 site
  • Local Institution - 0015

    Toronto, Ontario, M5G 1X8

Other trials in Canada

Finland1 site
  • Local Institution - 0031

    HUS, 00029

Other trials in Finland

About this study

Official title: A Prospective, Randomized, Open Label, Multi-center Study of the Safety and Pharmacokinetics of Apixaban Versus Vitamin K Antagonist or LMWH in Pediatric Subjects With Congenital or Acquired Heart Disease Requiring Chronic Anticoagulation for Thromboembolism Prevention

To investigate the safety and pharmacokinetics of apixaban in children with congenital or acquired heart disease who have a need for anticoagulation.

Conditions
Thrombosis
Being tested
Apixaban, Vitamin K Antagonist (VKA), Low Molecular Weight Heparin (LMWH)
Medical subject headings
Thrombosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ApixabanDrug

    Also called Eliquis

    Specified dose on specified days

  • Vitamin K Antagonist (VKA)Drug

    Also called Warfarin

    Specified dose on specified days

  • Low Molecular Weight Heparin (LMWH)Drug

    Also called Enoxaparin

    Specified dose on specified days

Study groups in NCT02981472
Study groupRoleWhat they receive
ApixabanExperimentalNot described
Receives: Drug: Apixaban
LMWH/VKAActive comparatorNot described
Receives: Drug: Vitamin K Antagonist (VKA); Drug: Low Molecular Weight Heparin (LMWH)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Composite of Adjudicated Major or Clinically Relevant Non-Major (CRNM) Bleeding Events

    The number of participants with adjudicated major or CRNM bleeding events per the Perinatal and Paediatric Haemostasis Subcommittee of International Society on Thrombosis and Haemostasis (ISTH) criteria. Events are adjudicated by a blinded, independent events adjudication committee (EAC).

    Major bleeding satisfies one or more of the following criteria: fatal bleeding, clinically overt bleeding associated with a decrease in hemoglobin of at least 20 g/L (i.e., 2 g/dL) in a 24-hour period, bleeding that is retroperitoneal, pulmonary, intracranial, or otherwise involves the CNS, or bleeding that requires surgical intervention in an operating suite, including interventional radiology.

    CRNM bleeding satisfies one or both of the following criteria: overt bleeding for which blood product is administered and not directly attributable to the subject's underlying medical condition or bleeding that requires medical or surgical intervention to restore hemostasis, other than in an operating room.

    Measured: From first dose to 2 days after last dose (Up to approximately 12 months)

Secondary outcomes (14)
  1. The Number of Participants With Thrombotic Events and Thromboembolic Event-Related Death

    The number of participants with thromboembolic events (intra-cardiac, shunt, inside Fontan pathway, pulmonary embolism (PE), stroke, other arterial or venous thromboembolic events, etc.) and thromboembolic event-related death detected by imaging or clinical diagnosis.

    Death and thromboembolic events are adjudicated by a blinded, independent events adjudication committee (EAC)

    Measured: From randomization to 2 days after last dose (Up to approximately 12 months)

  2. The Number of Participants With Adjudicated Major Bleeding

    The number of participants with adjudicated major bleeding events per the Perinatal and Paediatric Haemostasis Subcommittee of International Society on Thrombosis and Haemostasis (ISTH) criteria. Major bleeding events are adjudicated by a blinded, independent events adjudication committee (EAC).

    Major bleeding is defined as bleeding that satisfies one or more of the following criteria:

    • fatal bleeding
    • clinically overt bleeding associated with a decrease in hemoglobin of at least 20 g/L (i.e., 2 g/dL) in a 24-hour period
    • bleeding that is retroperitoneal, pulmonary, intracranial, or otherwise involves the CNS
    • bleeding that requires surgical intervention in an operating suite, including interventional radiology

    Measured: From first dose to 2 days after last dose (Up to approximately 12 months)

  3. The Number of Participants With Adjudicated CRNM Bleeding

    The number of participants with adjudicated clinically relevant non-major (CRNM) bleeding events per the Perinatal and Paediatric Haemostasis Subcommittee of International Society on Thrombosis and Haemostasis (ISTH) criteria. CRNM bleeding events are adjudicated by a blinded, independent events adjudication committee (EAC).

    CRNM bleeding is defined as bleeding that satisfies one or both of the following criteria:

    • overt bleeding for which blood product is administered and not directly attributable to the subject's underlying medical condition
    • bleeding that requires medical or surgical intervention to restore hemostasis, other than in an operating room

    Measured: From first dose to 2 days after last dose (Up to approximately 12 months)

  4. The Number of Participants With All Adjudicated Bleeding

    The number of participants with all adjudicated bleeding events

    Measured: From first dose to 2 days after last dose (Up to approximately 12 months)

  5. The Number of Participants With Drug Discontinuation Due to Adverse Effects, Intolerability, or Bleeding

    The number of participants with drug discontinuation due to adverse effects, intolerability, or bleeding.

    Measured: From first dose to 2 days after last dose (Up to approximately 12 months)

  6. The Number of Participant Deaths in the Study

    The number of participant deaths in the study.

    Measured: From first dose to 2 days after last dose (Up to approximately 12 months)

  7. Maximum Observed Concentration (Cmax)

    Measured: From first dose up to 6 months after first dose

  8. Trough Observed Concentration (Cmin)

    Measured: From first dose up to 6 months after first dose

  9. Area Under the Concentration-Time Curve in One Dosing Interval (AUC (TAU))

    Measured: From first dose up to 6 months after first dose

  10. Time of Maximum Observed Concentration (Tmax)

    Measured: From first dose up to 6 months after first dose

  11. Anti-FXa Activity

    Anti-FXa Activity was measured to assess participant plasma apixaban levels.

    125 participants received at least one dose of apixaban and had anti-FXa samples collected that contributed measurements to at least one of the timepoints below.

    Measured: From first dose up to 6 months after first dose

  12. Chromogenic FX Assay (Apparent FX Level)

    Chromogenic FX was measured to assess (apparent) FX levels in participants and inhibition of FXa by apixaban.

    125 participants received at least one dose of apixaban and had chromogenic FX assay samples collected that contributed measurements to at least one of the timepoints below.

    Measured: From first dose up to 6 months after first dose

  13. The Child and Parent Reports of Pediatric Quality of Life Inventory (PedsQL)

    Subjects' quality of life was measured using the PedsQL instrument administered only to English-speaking children/parents. Only subjects who completed the questionnaires at both baseline and post-baseline visits were included in the analyses.

    PedsQL consists of 23 items scored on a 5-point Likert scale from 0 (never) to 4 (almost always) or for the child report for younger children ages 5-7, a 3-point Likert scale: 0 (Not at all), 2 (Sometimes), and 4 (A lot).

    Scores are reverse scored and transformed to a 0-100 scale as follows: 0=100, 1=75, 3=25, 4=0. Higher scores indicate a better HRQOL and/or lower problems.

    Measured: from randomization up to 12 months after randomization

  14. Kids Informed Decrease Complications Learning on Thrombosis (KIDCLOT) IMPACT Score

    Subjects' quality of life was measured using the KIDCLOT instrument administered only to English-speaking children/parents. Only subjects who completed the questionnaires at both baseline and post-baseline visits were included in the analyses.

    KIDCLOT Parent inventory uses a 5 point Likert scale from 1 (N/A), 2 (Never), 3 (Rarely), 4 ( Now and then), 5 (Often). Child inventory uses a 4 point Likert scale 1 (N/A), 2 (Never), 3 (Now and then), 5 (Always). Values are scores as follows 1=0, 2=1, 3=2, 4=3, 5=4. Score interpretation is 0 to 100 percent IMPACT of anticoagulation on a child's life therefore, higher scores indicates a more negative effect.

    Measured: from randomization up to 12 months after randomization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Dec 2016 (estimated)
  2. Study start19 Jan 2017
  3. Primary completion18 Oct 2021
  4. Study completion18 Oct 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
192 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02981472
Sponsor's protocol ID
CV185-362
Other IDs
2016-001247-39, 2016
Status last verified
Sep 2022
First submitted
18 Nov 2016
Last updated
3 Oct 2022
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Payne RM, Burns KM, Glatz AC, Male C, Donti A, Brandao LR, Balling G, VanderPluym CJ, Bu'Lock F, Kochilas LK, Stiller B, Cnota JF 2nd, Rahkonen O, Khan A, Adorisio R, Stoica S, May L, Burns JC, Saraiva JFK, McHugh KE, Kim JS, Rubio A, Chia-Vazquez NG, Meador MR, Dyme JL, Reedy AM, Ajavon-Hartmann T, Jarugula P, Carlson-Taneja LE, Mills D, Wheaton O, Monagle P. Apixaban for Prevention of Thromboembolism in Pediatric Heart Disease. J Am Coll Cardiol. 2023 Dec 12;82(24):2296-2309. doi: 10.1016/j.jacc.2023.10.010.

    PubMed 38057072

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Apixaban, Vitamin K Antagonist (VKA) and Low Molecular Weight Heparin (LMWH) in people with Thrombosis, run by Bristol-Myers Squibb at 46 sites in 14 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 46 sites in United States, Brazil, Mexico, Russia, Germany and 9 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 18 May 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Composite of Adjudicated Major or Clinically Relevant Non-Major (CRNM) Bleeding Events (time frame: From first dose to 2 days after last dose (Up to approximately 12 months)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02981472, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Oct 2022.

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