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Venous ThromboembolismPhase 3RIVACASTNCT06195540

RIVAroxaban Versus Low-molecular Weight Heparin in Patients With Lower Limb Trauma Requiring Brace or CASTing

A Phase 3 study testing Rivaroxaban 10 MG and Low Heparin Molecular Weight in people with Venous Thromboembolism and Deep Vein Thrombosis, run by University Hospital, Angers at 37 sites in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Lower limb trauma requiring immobilization is a very frequent condition that is associated with an increased risk of developing venous thromboembolism (VTE). The TRiP(cast) score has been developed to provide individual VTE risk stratification and help in thromboprophylactic anticoagulation decision. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Rivaroxaban 10 MG and Low Heparin Molecular Weight
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,424 participants
Where
37 sitesFrance
Study dates
19 Jul 2024to 19 Nov 2028
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 aged 18 or over ;
  • Consultation in an emergency department of a participating centre;
  • Trauma to the lower limb requiring rigid or semi-rigid orthopaedic immobilisation;
  • Expected duration of orthopaedic immobilisation of at least 2 weeks;
  • TRiP(cast) score ≥ 7 ;
  • Patient affiliated to or benefiting from a social security scheme;
  • Patient with prior informed consent.

Who cannot join

  • Patient that have to be hospitalized after emergency department for other reason than lower limb trauma
  • Active bleeding or high risk of bleeding,
  • Known contraindication to rivaroxaban or LMWH;
  • Taking any anticoagulant or antiplatelet agent before the trauma (only antithrombotic authorised: aspirin < 325mg/d);
  • Pregnant or breastfeeding woman;
  • Any factor making 3-month follow-up impossible; 6. Patient subject to a legal protection measure, Imprisonment 7. Participation in any interventional study which modifies patient care or could influence study evaluation criteria

Trial locations and contacts

37 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Delphine Douillet, Doctor contact

0241353637

Delphine.Douillet@chu-angers.fr

Cindy Augereau, Mrs contact

0241354143

Cindy.Augereau@chu-angers.fr

37 sites in 1 country

France37 sites, 31 recruiting
  • Agen-Nerac Hospital, Emergency Department

    Agen, 47923

    Active, not recruiting
  • Angers University Hospital, Emergency department

    Angers, 49000

    Delphine Douillet, Doctor, 0241353637, Delphine.Douillet@chu-angers.fr

    Recruiting
  • Argenteuil hospital, Emergency department

    Argenteuil, 95100

    Catherine Le Gall, Doctor, 0134232425, catherine.legall@ch-argenteuil.fr

    Recruiting
  • Arpajon Hospital, Emergency Department

    Arpajon, 91294

    Withdrawn
  • Caen University hospital, Emergency department

    Caen, 14000

    Withdrawn
  • Tours University Hospital, Emergency department

    Chambray-lès-Tours, 37170

    Withdrawn
  • Cholet Hospital, Emergency department

    Cholet, 49300

    Caroline Soulie, Doctor, 0241496985, caroline.soulie-chavignon@ch-cholet.fr

    Recruiting
  • Clermont-Ferrand University Hospital, Emergency department

    Clermont-Ferrand, 63000

    Romain Durif, Doctor, 0473751940, rdurif@chu-clermontferrand.fr

    Recruiting
  • Simone Veil Hospital, Emergency Department

    Eaubonne, 95600

    Hiba Boussaha, Doctor, 01 34 06 61 15 ext. +33, Hiba.boussaha@ch-simoneveil.fr

    Recruiting
  • Eure-Seine Hospital, Emergency Departement

    Évreux, 27015

    Active, not recruiting
  • Grenoble University Hospital, Emergency Department

    Grenoble, 38000

    Damien Viglino, Professor, 0476766784, dviglino@chu-grenoble.fr

    Recruiting
  • La Roche sur Yon Hospital

    La Roche-sur-Yon, 85000

    Iona MAITRE, Doctor, 0251446205, iona.maitre@ght85.fr

    Not yet recruiting
  • La Rochelle Hospital, Adult emergency departement

    La Rochelle, 17000

    Maxime Jonchier, Doctor, 0546465050, maxime.jonchier@gmail.com

    Recruiting
  • Le Mans Hospital, Emergency department

    Le Mans, 72000

    Cyrielle Houalard, Doctor, 0243434343, cyrielle.houalard@gmail.com

    Recruiting
  • Limoges University hospital, Emergency department

    Limoges, 87000

    Thomas Lafon, Doctor, 0555056254, thomas.LAFON@chu-limoges.fr

    Recruiting
  • Edouard Herriot University Hospital, Emergency Department

    Lyon, 69000

    Karim Tazarourte, Professor, 0472110040, karim.tazarourte@chu-lyon.fr

    Recruiting
  • Marseille University Hospital, Emergency department

    Marseille, 13005

    Thibault Markarian, Doctor, 0413429700, thibault.markarian@ap-hm.fr

    Recruiting
  • Melun Hospital, Emergency Department

    Melun, 77000

    Damien Herve du Penhoat, Doctor, +33164716000, damien.herve-du-penhoat@ghsif.fr

    Recruiting
  • Montpellier University Hospital, emergency department

    Montpellier, 34000

    Mustapha Sebbane, Professor, 0467337974, m-sebbane@chu-montpellier.fr

    Recruiting
  • Nancy University Hospital, Emergency department

    Nancy, 54000

    Tahar CHOUIHED, Professor, 0383851496, t.chouihed@chru-nancy.fr

    Not yet recruiting
  • Nantes University Hospital, Emergency department

    Nantes, 44000

    François Javaudin, Doctor, 0240083333, Francois.JAVAUDIN@chu-nantes.fr

    Recruiting
  • Nice University Hospital, Emergency department

    Nice, 06000

    Withdrawn
  • Niort Hospital, Emergency Department

    Niort, 79000

    Mathieu Violeau, Doctor, 0549783015, mathieu.violeau@ch-niort.fr

    Recruiting
  • Lariboisière hospital, emergency department

    Paris, 75010

    Anthony Chauvin, Professor, 0149956565, anthony.chauvin@aphp.fr

    Not yet recruiting
  • Saint-Antoine Hospital, Emergency department

    Paris, 75012

    Pierre-Clément Thiebault, Doctor, 0149282743, pierre-clement.thiebaud@aphp.fr

    Recruiting
  • La Pitié-Salpétrière Hospital, Emergency Department

    Paris, 75013

    Yonathan Freund, Doctor, 01 42 16 00 00, yonathan.freund@aphp.fr

    Not yet recruiting
  • Cochin Hospital, Emergency department

    Paris, 75014

    Florence Dumas, Doctor, 0158412707, florence.dumas@aphp.fr

    Recruiting
  • St-Joseph Hospital, Emergency Department

    Paris, 75014

    Camille Gerlier, Doctor, 01 44 12 80 23, cgerlier@ghpsj.fr

    Recruiting
  • HEGP, Emergency Department

    Paris, 75015

    Richard Chocron, Doctor, 0156095876, richard.chocron@gmail.com

    Recruiting
  • Bichat Hospital, Adult Emergency department

    Paris, 75018

    Donia Bouzid, Doctor, 0140258080, donia.bouzid@aphp.fr

    Recruiting
  • South Lyon University Hospital, Emergency department

    Pierre-Bénite, 69495

    Marion Douplat, Doctor, 0478862854, marion.douplat@chu-lyon.fr

    Recruiting
  • Poitiers University Hospital, Emergency department

    Poitiers, 86000

    Jérémy Guenezan, Doctor, 0549444444, jeremy.guenezan@chu-poitiers.fr

    Recruiting
  • Rennes University Hospital, Emergency department

    Rennes, 35000

    Vincent Levrel, Doctor, 0299284321, Vincent.LEVREL@chu-rennes.fr

    Recruiting
  • Rouen University Hospital, Emergency Department

    Rouen, 76000

    Mélanie Roussel, Doctor, 0232881879, melanie.roussel@chu-rouen.fr

    Not yet recruiting
  • Strasbourg University Hospital, Emergency Department

    Strasbourg, 67000

    Pierrick Le Borgne, Doctor, 0388128690, pierrick.leborgne@chru-strasbourg.fr

    Recruiting
  • Toulouse University Hospital, Emergency Department

    Toulouse, 31000

    Xavier Dubucs, Doctor, 0561775919, xavier.dubucs@gmail.com

    Recruiting
  • Vannes Hospital, Emergency Department

    Vannes, 56000

    Bertrand Boulanger, Doctor, +33297014141, bertrand.boulanger@ghba.fr

    Recruiting

Other trials in France

About this study

Official title: RIVACAST : RIVAroxaban Versus Low-molecular Weight Heparinin Patients With Lower Limb Trauma Requiring Brace or CASTing

Lower limb trauma requiring immobilization is a very frequent condition that is associated with an increased risk of developing venous thromboembolism (VTE). The TRiP(cast) score has been developed to provide individual VTE risk stratification and help in thromboprophylactic anticoagulation decision. The recent CASTING study had confirmed that patients with a TRiP(cast) score <7 have a very low risk of VTE and could be safely manage without prophylactic treatment. Conversely, patients with a score ≥ 7 have a high-risk of VTE and require a prophylactic anticoagulant treatment. Low molecular weight heparins (LMWH) have been shown to be effective in this indication. However, in the CASTING study, the 3-month symptomatic VTE rate was 2.6% in this subgroup despite LMWH prophylactic treatment. This result suggests that LMWH are not sufficiently effective in this particular subgroup of high-risk patients. Direct oral anticoagulants, and in particular rivaroxaban, may be an effective and safe alternative to LMWH. In the PRONOMOS study, comparing LMWH with rivaroxaban in patients who had undergone non-major lower limb surgery, the relative risk of symptomatic VTE was 0.25 (95% CI = 0.09 - 0.75) in favor of rivaroxaban 10mg. No significant increase in bleeding was found. In addition, as LMWH treatment requires subcutaneous daily injections, the use of rivaroxaban may positively impact patients' quality of life as well as being effective in medico-economic terms.

The aims of this study are to demonstrate that rivaroxaban is at least as effective, easier to use and more efficient than LMWH in patients with trauma to the lower limb requiring immobilisation and deemed to be at risk of venous thromboembolism (TRiP(cast) score ≥ 7). High-risk patients are randomized to receive either rivaroxaban or LMWH. They are followed up at 45 days and 90 days to assess the occurrence of thrombotic events or bleeding, as well as their satisfaction with the treatment received.

Being tested
Rivaroxaban 10 MG, Low Heparin Molecular Weight
Keywords
Emergency department, direct oral anticoagulant, rivaroxaban, Low-Molecular-weight heparin, randomized control trial, Prevent VTE
Medical subject headings
Venous Thromboembolism, Venous Thrombosis, Pulmonary Embolism, Emergencies

What participants receive

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

  • Rivaroxaban 10 MGDrug

    Administration of rivaroxaban 10 mg once daily to prevent venous thromboembolic events in patients with trauma to a lower limb.

    Consecutive patients with lower limb trauma and a TRiP(cast) score ≥ 7 are assessed for possible participation in the study. At the inclusion visit, if the patient meets the study's selection criteria, the investigator provides oral and written information (information letter written in a language the patient can understand) and answers any questions the patient may have. Depending on randomisation, the patient will receive either LMWH or rivaroxaban. The dose is rivaroxaban 10 mg orally once a day (no dosage adjustment).

    Treatment is started in the emergency department and continued at home for the duration of the immobilisation (i.e. until mobilisation with weight-bearing). The duration of treatment will be determined by the physician.

  • Low Heparin Molecular WeightDrug

    Administration of standard prophylactic anticoagulant treatment with LMWH for the duration of immobilisation (i.e. until full mobilisation with weight-bearing). Consecutive patients with lower limb trauma and a TRiP(cast) score ≥ 7 are assessed for possible participation in the study. At the inclusion visit, if the patient meets the study's selection criteria, the investigator provides oral and written information (information letter written in a language the patient can understand) and answers any questions the patient may have. Depending on randomisation, the patient will receive either LMWH or rivaroxaban. The dose of LMWH is free, given according to local practices and national recommendations.

    Treatment is started in the emergency department and continued at home for the duration of the immobilisation (i.e. until mobilisation with weight-bearing). The duration of treatment will be determined by the physician.

Study groups in NCT06195540
Study groupRoleWhat they receive
Rivaroxaban armExperimentalNot described
Receives: Drug: Rivaroxaban 10 MG
Low-molecular-weight heparin armActive comparatorTreatment with LMWH is the standard-of-care in this population of lower limb trauma patients at risk of thrombosis. The control group is therefore the group of patients who receive prophylactic anticoagulant treatment with LMWH for the duration of immobilization (i.e. until full mobilization with weight-bearing).
Receives: Drug: Low Heparin Molecular Weight

What is being measured

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

  1. Rate of symptomatic venous thromboembolic events (45 days non-inferiority)

    The primary endpoint is the rate of symptomatic venous thromboembolic events (including deep vein thrombosis and/or pulmonary embolism and/or PE-related death) within 45 days (+/- 5 days) of inclusion.

    Symptomatic VTE is defined as follows:

    • Deep venous thrombosis (DVT) of the lower limbs: DVT confirmed by a non-compressible venous segment on compression ultrasound or by a filling defect on CT venography. Symptomatic proximal and distal DVTs will be taken into account.
    • Symptomatic pulmonary embolism documented by thoracic angioscan, high probability planar lung scan, SPECT scan, pulmonary angiography or by the combination of documented proximal deep vein thrombosis and thoracic symptomatology suggestive of pulmonary embolism.
    • PE-related deaths according to the ISTH (International Society of Thrombosis and Haemostasis) definition All events will need to be confirmed by the randomisation group's blinded clinical events adjudication committee.

    Measured: 45 days

Secondary outcomes (5)
  1. Patient self reported treatment satisfaction

    The outcome is patient self-reported treatment satisfaction using the Anti-Clot Treatment Scales (ACTS) assessed at 45 days (+/- 5 days).

    Measured: 45 days

  2. Rate of symptomatic venous thromboembolic events (90 days superiority)

    This secondary outcome is the cumulative rate of symptomatic venous thromboembolism (i.e., deep venous thrombosis and/or pulmonary embolism) within the 90 days (± 7 days) after the inclusion.

    The definition of symptomatic VTE is the same as the primary outcome.

    Measured: 90 days

  3. Cumulative rates of major bleeding and of non-major clinically relevant bleeding (90 days)

    The cumulative rates of major bleeding and of non-major clinically relevant bleeding at 90 days (± 7 days).

    Major bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) criteria and includes:

    • Any bleeding resulting in death
    • Symptomatic bleeding in a critical organ including intracranial, intraspinal, intraocular, retroperitoneal, intra-articular, pericardial bleeding and muscle bleeding resulting in compartment syndrome,
    • Symptomatic bleeding resulting in a decrease in the haemoglobin concentration of at least 2g/dL or resulting in the transfusion of at least two packs of blood red cells.

    Clinically Relevant Non-Major Bleeding is defined as:

    • Any bleeding requiring hospitalisation or a medical intervention including temporary withholding of anticoagulant treatment to stop the bleeding.

    Measured: 90 days

  4. Incremental cost-utility ratio (rivaroxaban efficiency 45 days)

    The incremental cost-utility ratio (costs per quality-adjusted life year (QALY) gained) assessed at 45 days after inclusion. Health-related quality of life will be collected using EQ-5D-5L self-administered questionnaires at each scheduled follow-up at 45 days (±/- 5). Resources consumed will be taken from french national Health Data System.

    Measured: 45 days

  5. Incremental cost-utility ratio (rivaroxaban efficiency 90 days)

    The incremental cost-utility ratio (costs per quality-adjusted life year [QALY] gained) assessed at 90 days after inclusion. Health-related quality of life will be collected using EQ-5D-5L self-administered questionnaires at each scheduled follow-up at at 90 days (± 7). Resources consumed will be taken from french national Health Data System.

    Measured: 90 days

Timeline

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

  1. First posted8 Jan 2024
  2. Study start19 Jul 2024
  3. Primary completion19 Nov 2028 (estimated)
  4. Study completion19 Nov 2028 (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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
1,424 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06195540
Sponsor's protocol ID
49RC21_0376
Other IDs
2023-509905-62-00, 2023
Acronym
RIVACAST
Status last verified
Jun 2026
First submitted
22 Dec 2023
Last updated
25 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Rivaroxaban 10 MG and Low Heparin Molecular Weight in people with Venous Thromboembolism and Deep Vein Thrombosis, run by University Hospital, Angers at 37 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 7 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: looking for participants now, as of the sponsor's last update on 25 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 37 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.

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?

Contact Delphine Douillet, Doctor (0241353637, Delphine.Douillet@chu-angers.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of symptomatic venous thromboembolic events (45 days non-inferiority) (time frame: 45 days). 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 25 Jun 2026.

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