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Intracardiac ThrombusPhase 3ARGONAUTNCT05825573

Anticoagulation Therapy in Non-device-related Intra-cardiac Thrombus

A Phase 3 study testing Vitamin K antagonist and Direct oral anticoagulant in people with Intracardiac Thrombus and STEMI, run by Centre Hospitalier Universitaire de Nīmes at 35 sites in 2 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Left ventricular thrombus is found in 10 to 25% of patients with impaired left ventricular function following ST-segment elevation myocardial infarction and up to 20% in dilated cardiomyopathy in observational studies. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Intracardiac Thrombus, STEMI, Heart Failure
What is being tested?
Vitamin K antagonist and Direct oral anticoagulant
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
340 participants
Where
35 sitesin 2 countries
Study dates
15 May 2023to Feb 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient with a non-device related intra-cardiac thrombus (all localizations in the four cavities) diagnosed by echocardiography, cardiac CT-scanner or cardiac magnetic resonance imaging independently of underlying heart disease.
  • Anticoagulant naïve patient for at least 3 months
  • Patient affiliated to a health insurance program
  • Patient that accepted not to participate in other studies involving a study medication until the one-year follow-up visit. Registries and studies not involving a study drug are allowed.
  • Patient that signed the consent form

Who cannot join

  • Active internal bleeding or recent (< 6 months) major bleeding event requiring surgical procedure or transfusion
  • History of intracranial, intraocular, spinal bleeding or known intracranial neoplasm, arteriovenous malformation, or aneurysm
  • Severe, disabling stroke (modified Rankin score of 4 to 5, inclusive) within 3 months
  • Planned invasive procedure with potential for uncontrolled bleeding
  • Impaired hemostasis such as known International Normalized Ratio (INR) >1.5; past or present bleeding disorder (including congenital bleeding disorders such as von Willebrand's disease or hemophilia, acquired bleeding disorders, and unexplained clinically significant bleeding disorders), thrombocytopenia (platelet count <100,000/μL)
  • Severe chronic renal failure (creat. clearance<30ml/min)
Show all 15Show fewer
  • Known significant liver disease
  • Device related thrombus (mechanical valve prosthesis, left atrial appendage or septal closure devices, pacemaker leads)
  • Patients with mechanical valve prosthesis
  • Cardiogenic shock
  • Pregnancy or breast-feeding patient
  • Known allergy or hypersensitivity to VKA or DOA drugs
  • Inability or unwillingness to comply with study-related procedures
  • Participation in another clinical research protocol with other investigational agents or devices within the previous 30 days, planned use of investigational drugs or devices, or previous enrolment in this trial (participation in a trial of routine care is authorized at the same time)
  • Patient under tutorship or curatorship

Trial locations and contacts

35 sites in 2 countries.

35 sites in 2 countries

France34 sites
  • CHU Angers

    Angers

  • Ch Auxerre

    Auxerre, 89000

  • Ch Avignon

    Avignon

  • CH Bastia

    Bastia

  • Hôpital Cardiologique du Haut Lévêque

    Bordeaux

  • CHU Brest

    Brest

  • CH Chartres

    Chartres

  • CHU Gabriel Montpied

    Clermont-Ferrand

  • CH Compiègne Noyon

    Compiègne

  • Hôpital Privé Dijon Bourgogne

    Dijon

  • Groupe Hospitalier Mutualiste

    Grenoble

  • CHU Lille

    Lille

  • CHU Limoges

    Limoges

  • Hôpital Cardiovasculaire Louis Pradel

    Lyon

  • AP-HM CHU La Timone

    Marseille

  • CHR Metz-Thionville

    Metz

  • CHU Arnaud de Villeneuve

    Montpellier

  • Clinique du Millenaire

    Montpellier

  • CHU Nantes

    Nantes

  • CHU Nice

    Nice

  • CHU de Nimes

    Nîmes

  • AP-HP CHU Bichat

    Paris

  • AP-HP CHU Lariboisière

    Paris

  • Ap-Hp Hegp

    Paris

  • AP-HP Hopital Ambroise Paré

    Paris

  • CHU Pitié-Salpêtrière

    Paris

  • CH Francois Mitterand

    Pau

  • CHU Poitiers

    Potiers

  • CHU Rennes

    Rennes

  • Centre Cardiologique du Nord

    Saint-Denis

  • CHU Strasbourg

    Strasbourg

  • CHU Toulouse

    Toulouse

  • Centre Hopistalier de Valence

    Valence, 26000

  • Ch Bretagne Atlantique

    Vannes, 56000

Other trials in France

Reunion1 site
  • CHU La réunion NORD

    Saint-Denis

Other trials in Reunion

About this study

Official title: Anticoagulant Regimens Given to Achieve Thrombus Regression and Reduce Clinical Outcomes Among Patients With Non Device-related Intra-cardiac Thrombus: a Randomized Assessment Under Direct Oral Anticoagulant and Vitamin-k Antagonist Therapy

Left ventricular thrombus is found in 10 to 25% of patients with impaired left ventricular function following ST-segment elevation myocardial infarction and up to 20% in dilated cardiomyopathy in observational studies. Likewise, the incidence of atrial thrombus among atrial fibrillation patients treated by vitamin K antagonist (VKA) is between 0.25% and 7%. Despite anticoagulant therapy, intra-cardiac thrombus remains a severe complication associated with a high risk of systemic embolism and subsequent mortality but also bleeding events related to the anticoagulation therapy. The class of non-vitamin K antagonist direct oral anticoagulant (DOA) has emerged in the last decades and has systematically surpassed VKA in the different clinical settings by providing at minimum a similar efficacy and a better safety profile. In the absence of randomized study in the specific clinical setting of intracardiac thrombus, international Guidelines recommend, on the basis of expert opinion, the use of VKA for at least 3 to 6 months in case of left ventricular thrombus and there is no specific recommendation for thrombus management from other cardiac localizations.

In comparison to VKA, the easier management and the large evidence of better safety of DOA make it an interesting anticoagulant strategy. Data for left ventricule thrombosis treatment are limited and only supported by observational cohorts. However, these recent cohorts have shown promising data in this indication reporting similar thrombus regression following DOA in comparison to VKA and similar ischemic outcomes although no head-to-head comparison would be powered.

As a consequence, the multicentric randomized ARGONAUT trial aims to confirm these results and evaluate the impact of DOA compared to VKA on thrombus regression and clinical outcomes among patients with intracardiac thrombus, regardless of the thrombus localization and any underlying heart disease.

Being tested
Vitamin K antagonist, Direct oral anticoagulant
Keywords
anticoagulation therapy, direct oral anticoagulant, stroke, acute coronary syndrome, embolism
Medical subject headings
ST Elevation Myocardial Infarction, Heart Failure, Stroke, Acute Coronary Syndrome, Embolism

What participants receive

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

  • Vitamin K antagonistDrug

    VKA study medications (Warfarin, Fluindione and Acenocoumarol) will be prescribed and supplied in the usual setting of patient care with respect of the international guidelines and recommended dose protocols and will not be specifically supplied for the trial. Anticoagulant treatment will be prescribed for 6 months. The recommended INR target will be [2-3] and [2-2.5] for patients treated with concomitant antiplatelet therapy. Biological monitoring will be performed at discretion of physicians as usual care.

  • Direct oral anticoagulantDrug

    DOA study medications (Apixaban, Rivaroxaban and Dabigatran) will be prescribed and supplied in the usual setting of patient care and will not be specifically supplied for the trial. The usual doses of DOA will be prescribed: dabigatran 150mg twice a day, apixaban 5mg twice a day and rivaroxaban 20mg once a day. The adjusted doses (dabigatran 110mg twice a day, apixaban 2.5mg twice a day and rivaroxaban 15mg once a day) will be prescribed according to clinical practice treatment guidelines.

Study groups in NCT05825573
Study groupRoleWhat they receive
Reference treatmentActive comparatorNot described
Receives: Drug: Vitamin K antagonist
Direct Oral AnticoagulantExperimentalNot described
Receives: Drug: Direct oral anticoagulant

What is being measured

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

  1. Net clinical benefit of DOA in comparison to VKA in patients with intra-cardiac thrombus

    Composite endpoint of all-cause death, myocardial infarction, stroke, acute peripheral emboli, acute pulmonary embolism, thrombus persistence and clinically relevant bleedings (BARC 2 to 5 bleedings)

    Measured: 6 months

Secondary outcomes (22)
  1. All cause death between groups

    Any death documented during the follow-up independently of cause of death

    Measured: 6 months

  2. All cause death between groups

    Any death documented during the follow-up independently of cause of death

    Measured: 12 months

  3. Myocardial infarction occurrence between groups

    All non-fatal MI, excluding MI type 3, which will be captured separately as death

    Measured: 6 months

  4. Myocardial infarction occurrence between groups

    All non-fatal MI, excluding MI type 3, which will be captured separately as death

    Measured: 12 months

  5. Stroke occurrence between groups

    Classified as Transient ischemic attack (TIA), Ischemic Stroke, Haemorrhagic Stroke and Undetermined Stroke

    Measured: 6 months

  6. Stroke occurrence between groups

    Classified as Transient ischemic attack (TIA), Ischemic Stroke, Haemorrhagic Stroke and Undetermined Stroke

    Measured: 12 months

  7. Acute peripheral emboli occurrence between groups

    All acute artery occlusion (limb, renal or digestive artery occlusion confirmed by clinical history consistent with an acute loss of blood flow to a peripheral artery (or arteries), supported by evidence of embolism from surgical specimens, autopsy, angiography, vascular imaging, or other objective testing

    Measured: 6 months

  8. Acute peripheral emboli occurrence between groups

    All acute artery occlusion (limb, renal or digestive artery occlusion confirmed by clinical history consistent with an acute loss of blood flow to a peripheral artery (or arteries), supported by evidence of embolism from surgical specimens, autopsy, angiography, vascular imaging, or other objective testing

    Measured: 12 months

  9. Acute pulmonary embolism occurrence between groups

    Defined as partial or complete occlusion of pulmonary artery or one of its branch confirmed by consistent clinical history and supported by evidence of embolism from surgical specimens, autopsy, angiography or vascular imaging in accordance to international guidelines

    Measured: 6 months

  10. Acute pulmonary embolism occurrence between groups

    Defined as partial or complete occlusion of pulmonary artery or one of its branch confirmed by consistent clinical history and supported by evidence of embolism from surgical specimens, autopsy, angiography or vascular imaging in accordance to international guidelines

    Measured: 12 months

  11. Thrombus persistence between groups

    Defined by cardiac imaging (echocardiography, contrast echocardiography, cardiac CT scan or cardiac MRI) as an increased thrombus dimension, a stable thrombus, or a partial thrombus regression

    Measured: 6 months

  12. Thrombus persistence between groups

    Defined by cardiac imaging (echocardiography, contrast echocardiography, cardiac CT scan or cardiac MRI) as an increased thrombus dimension, a stable thrombus, or a partial thrombus regression

    Measured: 12 months

  13. Clinically relevant bleedings between groups

    International Bleeding Academic Research Consortium (BARC) types 2 to 5

    Measured: 6 months

  14. Clinically relevant bleedings between groups

    International Bleeding Academic Research Consortium (BARC) types 2 to 5

    Measured: 12 months

  15. Systemic embolism between groups

    defined by the composite of stroke, embolic myocardial infarction, peripheral artery occlusion and acute pulmonary embolism

    Measured: 6 months

  16. Systemic embolism between groups

    defined by the composite of stroke, embolic myocardial infarction, peripheral artery occlusion and acute pulmonary embolism

    Measured: 12 months

  17. Cardiovascular death between groups

    Any death due to myocardial infarction, ischemic and haemorrhagic stroke, systemic embolism, sudden death, low-output failure, fatal arrhythmia, cerebrovascular disease, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other cardiovascular cause. All unobserved deaths were assumed to be cardiovascular in nature unless a non-cardiovascular cause could be clearly provided.

    Measured: 6 months

  18. Cardiovascular death between groups

    Any death due to myocardial infarction, ischemic and haemorrhagic stroke, systemic embolism, sudden death, low-output failure, fatal arrhythmia, cerebrovascular disease, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other cardiovascular cause. All unobserved deaths were assumed to be cardiovascular in nature unless a non-cardiovascular cause could be clearly provided.

    Measured: 12 months

  19. Total thrombus recurrence between groups

    Recurrence of thrombus on cardiac imaging control following a total thrombus regression during the follow-up

    Measured: 6 months

  20. Total thrombus recurrence between groups

    Recurrence of thrombus on cardiac imaging control following a total thrombus regression during the follow-up

    Measured: 12 months

  21. Major bleedings between groups

    International Bleeding Academic Research Consortium (BARC) types 3 to 5

    Measured: 6 months

  22. Major bleedings between groups

    International Bleeding Academic Research Consortium (BARC) types 3 to 5

    Measured: 12 months

Timeline

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

  1. First posted24 Apr 2023
  2. Study start15 May 2023
  3. Primary completion5 Feb 2025
  4. Study completionFeb 2026 (estimated)

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
340 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05825573
Sponsor's protocol ID
PHRC-N/2020/BL-01
Acronym
ARGONAUT
Status last verified
Feb 2026
First submitted
11 Apr 2023
Last updated
17 Feb 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Lattuca B, Bouziri N, Kerneis M, Portal JJ, Zhou J, Hauguel-Moreau M, Mameri A, Zeitouni M, Guedeney P, Hammoudi N, Isnard R, Pousset F, Collet JP, Vicaut E, Montalescot G, Silvain J; ACTION Study Group. Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus. J Am Coll Cardiol. 2020 Apr 14;75(14):1676-1685. doi: 10.1016/j.jacc.2020.01.057.

    PubMed 32273033

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Vitamin K antagonist and Direct oral anticoagulant in people with Intracardiac Thrombus and STEMI, run by Centre Hospitalier Universitaire de Nīmes at 35 sites in 2 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 15 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: under way, not looking for participants, as of the sponsor's last update on 17 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 35 sites in France, Reunion. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

Net clinical benefit of DOA in comparison to VKA in patients with intra-cardiac thrombus (time frame: 6 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 NCT05825573, 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 17 Feb 2026.

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