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Atrial FibrillationINR-CAPNCT05561244

Weekly Monitoring Strategy of Capillary INR Versus Monthly Monitoring Strategy of Venous INR in Elderly Patients in a Nursing Home.

A study testing Weekly monitoring using the capillary International Normalised Ratio strategy in people with Atrial Fibrillation and Deep Vein Thrombosis, run by Centre Hospitalier Universitaire de Nīmes at 33 sites in France.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This primary care study aims to compare the "time in therapeutic range" (TTR) of two strategies for monitoring the international normalized ratio (INR) over 6 months in nursing homes. Read more about this study

Who is it for?
Ages 60 years and older
Conditions the study is for
Atrial Fibrillation, Deep Vein Thrombosis, Stroke
What is being tested?
Weekly monitoring using the capillary International Normalised Ratio strategy
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
33 sitesFrance
Study dates
18 Nov 2022to 13 Dec 2024
Phase
Interventional
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 60 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

None listed.

Who cannot join

  • The patient is participating in a Type 1 interventional study involving human beings (Jardé law).
  • The patient is in an exclusion period determined by another study
  • The patient is under safeguard of justice.
  • It is not possible to give the patient (or his/her trusted-person/legal representative/tutor) informed information.
  • The patient has a short life expectancy (< 1 month)
  • The Karnofky index is ≤ 20%

Trial locations and contacts

33 sites in 1 country.

33 sites in 1 country

France33 sites
  • EHPAD " Coté Canal "

    Aigues-Mortes, GARD, 30220

  • EHPAD "Samdo Rochebelle"

    Alès, GARD, 30100

  • EHPAD "Docteur Henry Granet"

    Aramon, GARD, 30390

  • EHPAD "Les Capitelles"

    Bernis, GARD, 30620

  • EHPAD Résidence "Les Caprésianes"

    Cabrières, GARD, 30210

  • EHPAD "Jean Lasserre"

    Euzet, GARD, 30360

  • EHPAD "Les Jasses"

    Fons, GARD, 30730

  • EHPAD "Les Dominicaines"

    Ganges, Hérault, 34190

  • EHPAD "Les 5 sens Garons"

    Garons, GARD, 30128

  • EHPAD du centre hospitalier de Langogne

    Langogne, LOZERE, 48300

  • EHPAD La Murelle

    Laurens, 34480

  • EHPAD Saint-Vincent de Paul

    Le Grau-du-Roi, GARD, 30240

  • EHPAD Korian "Les Meunières"

    Lunel, HERAULT, 34400

  • EHPAD "Sophia la Capitelle"

    Meynes, GARD, 30840

  • EHPAD "Les oliviers"

    Montfrin, GARD, 30490

  • EHPAD Malbosc

    Montpellier, HERAULT, 34090

  • Maison de Retraite Protestante

    Montpellier, Hérault, 34090

  • EHPAD "Les Monts d'Aurelle"

    Montpellier, Hérault, 34097

  • Centre Bellevue-CHU Montpellier

    Montpellier, 34090

  • EHPAD "Jacques Saurin"

    Moussac, GARD, 30190

  • EHPAD "Ma Maison"

    Nîmes, GARD, 30000

  • EHPAD Serre-Cavalier Sites 1 and 2

    Nîmes, GARD, 30000

  • Nîmes University Hospital, Place du Pr. Debré

    Nîmes, Gard, 30029

  • EHPAD "Korian Mas de Lauze"

    Nîmes, 30900

  • EHPAD ORPEA "Château Notre Dame"

    Parignargues, GARD, 30730

  • EHPAD "Villa Rediciano"

    Redessan, GARD, 30129

  • SCM Médicale St Bauzille de Putois

    Saint-Bauzille-de-Putois, HERAULT, 34190

  • EHPAD "La BELLE Viste"

    Saint-Gély-du-Fesc, Hérault, 34980

  • EHPAD "Résidence les Magnans"

    Saint-Martin-de-Valgalgues, GARD, 30520

  • EHPAD "Les Jardins de l'Escalette"

    Uzès, GARD, 30700

  • EHPAD Résidence "l'Accueil"

    Vauvert, GARD, 30600

  • EHPAD La Pinède

    Vergèze, 30310

  • EHPAD Léon Bourgeois

    Vilallonga dels Monts, 66740

Other trials in France

About this study

Official title: Assessment of Weekly Monitoring Strategy of Capillary INR Versus Monthly Monitoring Strategy of Venous INR in Elderly Patients in a Nursing Home: Multicentre Randomised Cluster Trial.

This primary care study aims to compare the "time in therapeutic range" (TTR) of two strategies for monitoring the international normalized ratio (INR) over 6 months in nursing homes. The population consists of frail elderly patients for whom Anti-Vitamin K treatments are frequent, and who are consequently more prone to embolic and hemorrhagic complications.

Read the detailed description

Biological monitoring is essential to avoid strokes, deep vein thrombosis and hemorrhage. Generally speaking, this consists of a venous sampling for the international normalized ratio (INR), for which the therapeutic target is approximately 2.5 (tolerance range between 2 and 3) for atrial fibrillation (AF) and deep vein thrombosis (DVT). INR values below 2 indicate high risks of a stroke or DVT, whereas INR values over 3 refer to high risks of hemorrhage. INR monitoring requires monthly follow-ups or even more frequently if the HAS BLED score is ≥ 3.

One parameter used to evaluate the benefit/risk ratio is the "time in therapeutic range" (TTR), referring to the time spent within the INR therapeutic target (INR between 2 and 3 for patients with Atrial Fibrillation/ Deep Vein Thrombosis). It is calculated using the Rosendaal method. According to the "European Society of Cardiology" guidelines, the minimum threshold necessary for a good risk/benefit ratio is 70%. In other countries, it has been shown that the TTR is higher: 61% in Canada, 64.4% in Spain, 68.9% in Italy and 76.2% in Sweden. Moreover, TTR determines the benefit/risk ratio of the treatment, which means that patients with a TTR < 60% have more than 2% absolute total mortality per patient-year compared to patients with TTR > 60%.

As for the pilot study (Manuscript accepted in August 2019 in the Journal of Internal Medicine ), we expect approximately half the patients to be aged over 90. Patients will be recruited in nursing homes where they are monitored by nurses and care quality managers who are responsible for ensuring compliance with good clinical practices. This limits the risk of non-compliance with preanalytical venous INR conditions. Eighteen percent of subjects over 85 are treated with vitamin-K antagonists (VKA). For elderly patients with atrial fibrillation (AF) or deep venous thrombosis (DVT), stroke prophylaxis is a real clinical challenge. VKA treatments are indicated for the prevention of strokes in patients with Atrial Fibrillation, DVT or those who have received heart valve implants. VKAs have a narrow therapeutic range: if they are under-dosed, the risk of embolism (AVC and DVT) is high, whereas in the event of an overdose, the risk of bleeding is high. Given the annual incidence of severe hemorrhage (3-5%), the risk of a hemorrhage is their main side effect. The incidence of brain hemorrhages is 0.6 per 100 patient-years, for gastrointestinal bleeding it is 1.0 per 100 patient-years, and the risk of other serious bleeding is 1.4 per 100 patient-years. This risk of bleeding is usually assessed using the HAS-BLED score. The risk of hemorrhage is 4.2% per year in patients over 75 versus 1.7% per year for those under 75.

Following the results of a pilot study (manuscript accepted in the Journal of Internal Medecine), the hypothesis is that a weekly monitoring strategy for capillary INR should increase the TTR of nursing home patients by 12% compared to the usual monitoring by venous INR, resulting in a decrease of thrombotic or hemorrhagic events.

Being tested
Weekly monitoring using the capillary International Normalised Ratio strategy
Keywords
Atrial Fibrillation, Thrombosis, Stroke, Elderly
Medical subject headings
Atrial Fibrillation, Venous Thrombosis, Stroke, Thrombosis

What participants receive

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

  • Weekly monitoring using the capillary International Normalised Ratio strategyDevice

    Patients in the interventional group will be monitored using the capillary International Normalised Ratio strategy every week, and more often if the International Normalised Ratio is not in the therapeutic target. Venous International Normalised Ratio punctures will also be performed as described for the control group in order to calculate the Time in Therapeutic Range equivalently in both groups. Specific training in handling the device and the dose adjustment protocol will be provided to nurses and prescribers.

Study groups in NCT05561244
Study groupRoleWhat they receive
CONTROL GROUPNo interventionControl group (n = 16 nursing homes, 64 patients): Patients will be monitored as usual using the Venous International Normalised Ratio strategy. Practices will not be changed (i.e. prospective observation of real-life practices; according to recommendations, at least 1 Venous International Normalised Ratio per month will usually be performed) and patients will not receive any supplementary intervention specific to the trial. A reminder of good International Normalised Ratio practices will be provided to nurses and prescribers.
INTERVENTIONAL GROUPExperimentalIntervention group (n = 16 nursing homes, 64 patients): Patients in the interventional group will be monitored using the capillary International Normalised Ratio strategy every week, and more often if the International Normalised Ratio is not in the therapeutic target. Venous International Normalised Ratio punctures will also be performed as described for the control group in order to calculate the Time in Therapeutic Range equivalently in both groups. Specific training in handling the device and the dose adjustment protocol will be provided to nurses and prescribers.
Receives: Device: Weekly monitoring using the capillary International Normalised Ratio strategy

What is being measured

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

  1. Time in Therapeutic Range Using the Capillary International Normalized Range Weekly Monitoring Strategy

    The CoaguChek INRange® device will be used. This small, portable monitoring medical device has already been used in several studies and can be used in hospital beds. After washing the patient's hands, the nurse will insert the strip test into the device, massaging the fingers and hand to activate blood circulation, and perform a capillary puncture using the lancet. An 8 μL drop of blood is required and must be deposited on the test strip less than 180 seconds after inserting the strip into the device and within 15 seconds after the start of blood drop formation. The International Normalized Ratio is displayed within one minute. When the nurse has the result, he/she will complete the VKA dose software (i.e. puncture number, strip number, current VKA type, current VKA dose, INRc value). The software will give the next puncture day and the correct VKA dose. If the INR > 4, there will be an alert and the nurse will have to contact the general practitioner for the rest of the procedure.

    Measured: Over 6 months

Secondary outcomes (6)
  1. Venous Thromboembolic Events Occurring During the 6-month Monitoring Period.

    Venous thromboembolic events (yes / no) occurring during the 6-month monitoring period will be recorded for each patient.

    Measured: Day 0 to Month 6

  2. Haemorrhagic Events Occurring During the 6-month Monitoring Period.

    Haemorrhagic events (yes / no) occurring during the 6-months monitoring period will be recorded for each patient.

    Measured: Day 0 to Month 6

  3. Time in Therapeutic Range Using International Normalized Range Weekly Monitoring Strategy in Patients ≤90.

    Percentage of Time in Therapeutic Range using International Normalized Range weekly monitoring strategy in patients ≤90.

    Measured: Day 0 to 6 months

  4. Time in Therapeutic Range Using the International Normalized Range Weekly Monitoring Strategy in Patients >90.

    Time in Therapeutic Range using the International Normalized Range weekly monitoring strategy in patients >90.

    Measured: Day 0 to 6 months

  5. Cost-consequences Study on the Weekly INRc Monitoring Strategy

    Cost in terms of hospitalisations (due to haemorrhagic, ischemic and thromboembolic events) will be studied including the cost of the device (equipment and consumables) from the public health insurance's perspective and the nursing time from the point of view of the health care institution.

    Measured: Day 0 to 6 months

  6. Agreement Between Capillary and Veinous Measures

    Assess, over the 6-month observation period, the agreement between INRc and INRv

    Measured: Over 6 months

Timeline

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

  1. First posted30 Sep 2022
  2. Study start18 Nov 2022
  3. Primary completion13 Dec 2024
  4. Study completion13 Dec 2024

Why it stopped: In the absence of patients meeting the selection criteria, the study was prematurely terminated. The average number of patients on VKAs per EHPAD has fallen sharply because of the development of direct oral anticoagulants and the Covid crisis.

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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study is interventional, prospective, comparative, superiority, multicentric, randomised by cluster, in closed cohort.
Masking
Single blind
Who is masked
Care provider
Enrolment
45 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05561244
Sponsor's protocol ID
2022-A00516-37
Acronym
INR-CAP
Status last verified
Dec 2024
First submitted
27 Sep 2022
Last updated
3 Mar 2026
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Weekly monitoring using the capillary International Normalised Ratio strategy in people with Atrial Fibrillation and Deep Vein Thrombosis, run by Centre Hospitalier Universitaire de Nīmes at 33 sites in France.

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 0 inclusion and 6 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: stopped early, as of the sponsor's last update on 3 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 33 sites in France. 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.

Are results available for this study?

Yes. Results are posted in the registry (first posted 3 Mar 2026). 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?

Time in Therapeutic Range Using the Capillary International Normalized Range Weekly Monitoring Strategy (time frame: Over 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 Mar 2026.

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