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RE-MODEL Dabigatran Etexilate 150mg or 220mg Once Daily (o.d.) Versus (v.s.) Enoxaparin 40mg o.d. for Prevention of Thrombosis After Knee Surgery

RE-MODEL (Thromboembolism Prevention After Knee Surgery). Two Different Dose Regimens of Orally Administered Dabigatran Etexilate Capsules [150 or 220 mg Once Daily Starting With a Half Dose (i.e.75 or 110 mg) on the Day of Surgery] Compared to Subcutaneous Enoxaparin 40 mg Once Daily for 6-10 Days

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00168805
Enrollment
2101
Registered
2005-09-15
Start date
2004-11-30
Completion date
Unknown
Last updated
2014-05-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Arthroplasty, Replacement, Knee, Thromboembolism

Brief summary

A phase III, randomised, parallel-group, double-blind, active controlled study to investigate the ef ficacy and safety of two different dose regimens of orally administered dabigatran etexilate capsule s \[150 or 220 mg once daily starting with a half dose (i.e.75 or 110 mg) on the day of surgery\] comp ared to subcutaneous enoxaparin 40 mg once daily for 6 to 10 days, in prevention of venous thromboem bolism in patients with primary elective total knee replacement surgery. RE-MODEL (Thromboembolism prevention after knee surgery)

Interventions

DRUGenoxaparin

40 mg once daily

DRUGdabigatran etexilate

150 mg once daily

Sponsors

Boehringer Ingelheim
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Inclusion criteria (selected): * Patients (18 years or older) scheduled to undergo a primary, unilateral, elect ive total knee replacement * Written Informed Consent

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants With Total Venous Thromboembolic Event and All-cause Mortality During Treatment PeriodFirst administration until 6-10 daysTotal Venous Thromboembolic Event (VTE) includes both proximal and distal deep vein thrombosis (DVT) (detected by routine bilateral venography), symptomatic DVT (confirmed by venous compression ultrasound, venography or autopsy) and pulmonary embolism (PE) (confirmed by pulmonary V-Q scintigraphy, chest x-ray, pulmonary angiography, spiral CT or autopsy). All of these components and all deaths were centrally adjudicated by the VTE events committee, which was not aware of the treatment allocation of the patients.

Secondary

MeasureTime frameDescription
Number of Participants With Proximal Deep Vein Thrombosis During Treatment PeriodFirst administration until 6-10 daysProximal Deep Vein Thrombosis as adjudicated by the VTE events committee
Number of Participants With Total Deep Vein Thrombosis During Treatment PeriodFirst administration until 6-10 daysTotal Deep Vein Thrombosis as adjudicated by the VTE events committee
Number of Participants With Symptomatic Deep Vein Thrombosis During Treatment PeriodFirst administration until 6-10 daysSymptomatic Deep Vein Thrombosis, confirmed by venous compression ultrasound, venography or autopsy, and as adjudicated by the VTE events committee
Number of Participants With Pulmonary Embolism During Treatment PeriodFirst administration until 6-10 daysPulmonary embolism confirmed by pulmonary V-Q scintigraphy, chest x-ray, pulmonary angiography, spiral CT or autopsy, and as adjudicated by the VTE events committee
Number of Participants Who Died During Treatment PeriodFirst administration until 6-10 daysAll cause death, as adjudicated by the VTE events committee
Number of Participants With Major Venous Thromboembolic Event and Venous Thromboembolic Event-related Mortality During Treatment PeriodFirst administration until 6-10 daysMajor Venous Thromboembolic Event (VTE) is defined as proximal DVT and PE, as adjudicated by the VTE events committee
Number of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodFirst administration until 6-10 daysMajor bleeding events were defined as * fatal * clinically overt associated with loss of haemoglobin \>=20g/L in excess of what was expected * clinically overt leading to the transfusion of \>=2 units packed cells or whole blood in excess of what was expected * symptomatic retroperitoneal, intracranial, intraocular or intraspinal * requiring treatment cessation * leading to re-operation Clinically-relevant was defined as * spontaneous skin hematoma greater than or equal to 25 cm² * wound hematoma greater than or equal to 100 cm² * spontaneous nose bleed lasting longer than 5 min * macroscopic hematuria spontaneous or lasting longer than 24 hours if associated with an intervention * spontaneous rectal bleeding (more than a spot on toilet paper) * gingival bleeding lasting longer than 5 min * any other bleeding event considered clinically relevant by the investigator Minor bleeding events were defined as all other bleeding events that did not fulfil the criteria from above.
Blood TransfusionDay 1Blood transfusion for treated and operated patients on Day of surgery.
Volume of Blood LossDay 1Volume of blood loss for treated and operated patients during surgery.
Laboratory AnalysesFirst administration to end of studyFrequency of patients with possible clinically significant abnormalities.
Number of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Period3 monthsTotal Venous Thromboembolic Event (VTE) includes both proximal and distal deep vein thrombosis (DVT) (detected by routine bilateral venography), symptomatic DVT (confirmed by venous compression ultrasound, venography or autopsy) and pulmonary embolism (PE) (confirmed by pulmonary V-Q scintigraphy, chest x-ray, pulmonary angiography, spiral CT or autopsy).

Countries

Australia, Austria, Belgium, Czechia, Denmark, Finland, France, Germany, Hungary, Italy, Netherlands, Poland, South Africa, Spain, Sweden

Participant flow

Recruitment details

The treatment period is from first administration of study medication, until 3 days after last administration of study medication. Treatment duration is planned for 8 days. The study period is from first administration of study medication until day 84 - 91.

Pre-assignment details

Whilst 2101 patients were enrolled/randomised to treatment prior to surgery in this trial, only 2076 started treatment. Therefore, 25 patients were randomised but not treated (treatment was planned to start post surgery).

Participants by arm

ArmCount
Dabigatran 220mg
qd (once daily) oral
679
Dabigatran 150mg
qd (once daily) oral
703
Enoxaparin
40mg qd (once daily) subcutaneous
694
Total2,076

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyAdverse Event71116
Overall StudyLost to Follow-up121711
Overall StudyOther242122
Overall StudyProtocol Violation12118
Overall StudyWithdrawal by Subject161821
TreatmentAdverse Event252632
TreatmentOther181817
TreatmentProtocol Violation355
TreatmentWithdrawal by Subject378

Baseline characteristics

CharacteristicDabigatran 220mgDabigatran 150mgEnoxaparinTotal
Age, Continuous67.3 Years
STANDARD_DEVIATION 9
67.5 Years
STANDARD_DEVIATION 8.8
68.3 Years
STANDARD_DEVIATION 8.8
67.7 Years
STANDARD_DEVIATION 8.9
Body Mass Index N=(677;702;692;2071)29.9 kg/m^2
STANDARD_DEVIATION 4.9
30.1 kg/m^2
STANDARD_DEVIATION 5
29.8 kg/m^2
STANDARD_DEVIATION 4.9
29.9 kg/m^2
STANDARD_DEVIATION 4.9
Sex: Female, Male
Female
441 Participants451 Participants478 Participants1370 Participants
Sex: Female, Male
Male
238 Participants252 Participants216 Participants706 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
405 / 679438 / 703426 / 694
serious
Total, serious adverse events
31 / 67944 / 70343 / 694

Outcome results

Primary

Number of Participants With Total Venous Thromboembolic Event and All-cause Mortality During Treatment Period

Total Venous Thromboembolic Event (VTE) includes both proximal and distal deep vein thrombosis (DVT) (detected by routine bilateral venography), symptomatic DVT (confirmed by venous compression ultrasound, venography or autopsy) and pulmonary embolism (PE) (confirmed by pulmonary V-Q scintigraphy, chest x-ray, pulmonary angiography, spiral CT or autopsy). All of these components and all deaths were centrally adjudicated by the VTE events committee, which was not aware of the treatment allocation of the patients.

Time frame: First administration until 6-10 days

Population: Full Analysis Set (all patients who had surgery and were randomised, received treatment, had an evaluable venogram for distal and proximal Deep Vein Thrombosis, or had confirmed symptomatic Deep Vein Thrombosis, Pulmonary Embolism, or had died)

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants With Total Venous Thromboembolic Event and All-cause Mortality During Treatment Period183 Participants
Dabigatran 150mgNumber of Participants With Total Venous Thromboembolic Event and All-cause Mortality During Treatment Period213 Participants
EnoxaparinNumber of Participants With Total Venous Thromboembolic Event and All-cause Mortality During Treatment Period193 Participants
Comparison: Risk difference versus Enoxaparinp-value: 0.664895% CI: [-7.3, 4.6]Normal approximation
Comparison: Risk difference versus Enoxaparinp-value: 0.355395% CI: [-3.1, 8.7]Normal approximation
Secondary

Blood Transfusion

Blood transfusion for treated and operated patients on Day of surgery.

Time frame: Day 1

ArmMeasureGroupValue (NUMBER)
Dabigatran 220mgBlood TransfusionPatients with >=1 transfusions242 participants
Dabigatran 220mgBlood TransfusionPatients with >=1 non-autologous transfusions87 participants
Dabigatran 150mgBlood TransfusionPatients with >=1 transfusions253 participants
Dabigatran 150mgBlood TransfusionPatients with >=1 non-autologous transfusions86 participants
EnoxaparinBlood TransfusionPatients with >=1 transfusions265 participants
EnoxaparinBlood TransfusionPatients with >=1 non-autologous transfusions120 participants
Secondary

Laboratory Analyses

Frequency of patients with possible clinically significant abnormalities.

Time frame: First administration to end of study

Population: Treated patients

ArmMeasureGroupValue (NUMBER)
Dabigatran 220mgLaboratory AnalysesAST increase N=(620;645;636)9 participants
Dabigatran 220mgLaboratory AnalysesAST decrease N=(620;645;636)0 participants
Dabigatran 220mgLaboratory AnalysesALT increase N=(621;645;637)16 participants
Dabigatran 220mgLaboratory AnalysesALT decrease N=(621;645;637)0 participants
Dabigatran 220mgLaboratory AnalysesBilirubin increase N=(619;644;635)19 participants
Dabigatran 220mgLaboratory AnalysesBilirubin decrease N=(619;644;635)0 participants
Dabigatran 150mgLaboratory AnalysesBilirubin decrease N=(619;644;635)0 participants
Dabigatran 150mgLaboratory AnalysesAST increase N=(620;645;636)6 participants
Dabigatran 150mgLaboratory AnalysesALT decrease N=(621;645;637)0 participants
Dabigatran 150mgLaboratory AnalysesBilirubin increase N=(619;644;635)23 participants
Dabigatran 150mgLaboratory AnalysesAST decrease N=(620;645;636)0 participants
Dabigatran 150mgLaboratory AnalysesALT increase N=(621;645;637)21 participants
EnoxaparinLaboratory AnalysesAST decrease N=(620;645;636)0 participants
EnoxaparinLaboratory AnalysesALT increase N=(621;645;637)24 participants
EnoxaparinLaboratory AnalysesBilirubin decrease N=(619;644;635)0 participants
EnoxaparinLaboratory AnalysesALT decrease N=(621;645;637)0 participants
EnoxaparinLaboratory AnalysesAST increase N=(620;645;636)9 participants
EnoxaparinLaboratory AnalysesBilirubin increase N=(619;644;635)14 participants
Secondary

Number of Participants Who Died During Treatment Period

All cause death, as adjudicated by the VTE events committee

Time frame: First administration until 6-10 days

Population: Full Analysis Set - op

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants Who Died During Treatment Period1 Participants
Dabigatran 150mgNumber of Participants Who Died During Treatment Period1 Participants
EnoxaparinNumber of Participants Who Died During Treatment Period1 Participants
Comparison: Comparison versus Enoxaparinp-value: 1Fisher Exact
Comparison: Comparison versus Enoxaparinp-value: 1Fisher Exact
Secondary

Number of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment Period

Major bleeding events were defined as * fatal * clinically overt associated with loss of haemoglobin \>=20g/L in excess of what was expected * clinically overt leading to the transfusion of \>=2 units packed cells or whole blood in excess of what was expected * symptomatic retroperitoneal, intracranial, intraocular or intraspinal * requiring treatment cessation * leading to re-operation Clinically-relevant was defined as * spontaneous skin hematoma greater than or equal to 25 cm² * wound hematoma greater than or equal to 100 cm² * spontaneous nose bleed lasting longer than 5 min * macroscopic hematuria spontaneous or lasting longer than 24 hours if associated with an intervention * spontaneous rectal bleeding (more than a spot on toilet paper) * gingival bleeding lasting longer than 5 min * any other bleeding event considered clinically relevant by the investigator Minor bleeding events were defined as all other bleeding events that did not fulfil the criteria from above.

Time frame: First administration until 6-10 days

Population: Treated set

ArmMeasureGroupValue (NUMBER)
Dabigatran 220mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodNone569 Participants
Dabigatran 220mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodMajor10 Participants
Dabigatran 220mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodMinor60 Participants
Dabigatran 220mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodClinically relevant40 Participants
Dabigatran 150mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodMinor59 Participants
Dabigatran 150mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodNone587 Participants
Dabigatran 150mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodClinically relevant48 Participants
Dabigatran 150mgNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodMajor9 Participants
EnoxaparinNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodNone579 Participants
EnoxaparinNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodClinically relevant37 Participants
EnoxaparinNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodMinor69 Participants
EnoxaparinNumber of Participants With Bleeding Events (Defined According to Modified McMaster Criteria) During Treatment PeriodMajor9 Participants
Comparison: Comparison versus Enoxaparinp-value: 0.8209Fisher Exact
Comparison: Comparison versus Enoxaparinp-value: 1Fisher Exact
Secondary

Number of Participants With Major Venous Thromboembolic Event and Venous Thromboembolic Event-related Mortality During Treatment Period

Major Venous Thromboembolic Event (VTE) is defined as proximal DVT and PE, as adjudicated by the VTE events committee

Time frame: First administration until 6-10 days

Population: Full Analysis Set - major (all patients who had surgery and were randomised, received treatment, had an evaluable venogram for proximal Deep Vein Thrombosis, or had confirmed symptomatic Deep Vein Thrombosis, Pulmonary Embolism, or had died by a Venous Thromboembolic Event-related death)

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants With Major Venous Thromboembolic Event and Venous Thromboembolic Event-related Mortality During Treatment Period13 Participants
Dabigatran 150mgNumber of Participants With Major Venous Thromboembolic Event and Venous Thromboembolic Event-related Mortality During Treatment Period20 Participants
EnoxaparinNumber of Participants With Major Venous Thromboembolic Event and Venous Thromboembolic Event-related Mortality During Treatment Period18 Participants
Comparison: Risk difference versus Enoxaparinp-value: 0.37695% CI: [-3.1, 1.2]Normal approximation
Comparison: Risk difference versus Enoxaparinp-value: 0.815195% CI: [-2, 2.6]Normal approximation
Secondary

Number of Participants With Proximal Deep Vein Thrombosis During Treatment Period

Proximal Deep Vein Thrombosis as adjudicated by the VTE events committee

Time frame: First administration until 6-10 days

Population: Full Analysis Set - pDVT (all patients who had surgery and were randomised, received treatment, had an evaluable venogram for proximal Deep Vein Thrombosis, or had confirmed symptomatic Deep Vein Thrombosis)

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants With Proximal Deep Vein Thrombosis During Treatment Period13 Participants
Dabigatran 150mgNumber of Participants With Proximal Deep Vein Thrombosis During Treatment Period18 Participants
EnoxaparinNumber of Participants With Proximal Deep Vein Thrombosis During Treatment Period17 Participants
Comparison: Risk difference versus Enoxaparinp-value: 0.471595% CI: [-2.8, 1.3]Normal approximation
Comparison: Risk difference versus Enoxaparinp-value: 0.932595% CI: [-2.1, 2.3]Normal approximation
Secondary

Number of Participants With Pulmonary Embolism During Treatment Period

Pulmonary embolism confirmed by pulmonary V-Q scintigraphy, chest x-ray, pulmonary angiography, spiral CT or autopsy, and as adjudicated by the VTE events committee

Time frame: First administration until 6-10 days

Population: Full Analysis Set - op

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants With Pulmonary Embolism During Treatment Period0 Participants
Dabigatran 150mgNumber of Participants With Pulmonary Embolism During Treatment Period1 Participants
EnoxaparinNumber of Participants With Pulmonary Embolism During Treatment Period1 Participants
Comparison: Comparison versus Enoxaparinp-value: 1Fisher Exact
Comparison: Comparison versus Enoxaparinp-value: 1Fisher Exact
Secondary

Number of Participants With Symptomatic Deep Vein Thrombosis During Treatment Period

Symptomatic Deep Vein Thrombosis, confirmed by venous compression ultrasound, venography or autopsy, and as adjudicated by the VTE events committee

Time frame: First administration until 6-10 days

Population: Full Analysis Set - op (all patients who are treated and operated)

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants With Symptomatic Deep Vein Thrombosis During Treatment Period1 Participants
Dabigatran 150mgNumber of Participants With Symptomatic Deep Vein Thrombosis During Treatment Period3 Participants
EnoxaparinNumber of Participants With Symptomatic Deep Vein Thrombosis During Treatment Period8 Participants
Comparison: Comparison versus Enoxaparinp-value: 0.0385Fisher Exact
Comparison: Comparison versus Enoxaparinp-value: 0.1414Fisher Exact
Secondary

Number of Participants With Total Deep Vein Thrombosis During Treatment Period

Total Deep Vein Thrombosis as adjudicated by the VTE events committee

Time frame: First administration until 6-10 days

Population: Full Analysis Set - tDVT (all patients who had surgery and were randomised, received treatment, had an evaluable venogram, or had confirmed symptomatic Deep Vein Thrombosis)

ArmMeasureValue (NUMBER)
Dabigatran 220mgNumber of Participants With Total Deep Vein Thrombosis During Treatment Period182 Participants
Dabigatran 150mgNumber of Participants With Total Deep Vein Thrombosis During Treatment Period211 Participants
EnoxaparinNumber of Participants With Total Deep Vein Thrombosis During Treatment Period192 Participants
Comparison: Risk difference versus Enoxaparinp-value: 0.646395% CI: [-7.3, 4.5]Normal approximation
Comparison: Risk difference versus Enoxaparinp-value: 0.37495% CI: [-3.2, 8.6]Normal approximation
Secondary

Number of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Period

Total Venous Thromboembolic Event (VTE) includes both proximal and distal deep vein thrombosis (DVT) (detected by routine bilateral venography), symptomatic DVT (confirmed by venous compression ultrasound, venography or autopsy) and pulmonary embolism (PE) (confirmed by pulmonary V-Q scintigraphy, chest x-ray, pulmonary angiography, spiral CT or autopsy).

Time frame: 3 months

Population: Patients with any data available during follow-up

ArmMeasureGroupValue (NUMBER)
Dabigatran 220mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up PeriodTotal VTE and all-cause mortality4 Participants
Dabigatran 220mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Perioddeath1 Participants
Dabigatran 220mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Periodasymptotic Deep Vein Thrombosis0 Participants
Dabigatran 220mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up PeriodPulmonary Embolism2 Participants
Dabigatran 220mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Periodsymptotic Deep Vein Thrombosis1 Participants
Dabigatran 150mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Periodsymptotic Deep Vein Thrombosis2 Participants
Dabigatran 150mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up PeriodPulmonary Embolism0 Participants
Dabigatran 150mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Perioddeath0 Participants
Dabigatran 150mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up PeriodTotal VTE and all-cause mortality3 Participants
Dabigatran 150mgNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Periodasymptotic Deep Vein Thrombosis1 Participants
EnoxaparinNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Periodasymptotic Deep Vein Thrombosis0 Participants
EnoxaparinNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up PeriodTotal VTE and all-cause mortality2 Participants
EnoxaparinNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Periodsymptotic Deep Vein Thrombosis0 Participants
EnoxaparinNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up Perioddeath2 Participants
EnoxaparinNumber of Participants With Total Venous Thromboembolic Event (VTE) and All-cause Mortality During the Follow-up PeriodPulmonary Embolism0 Participants
Secondary

Volume of Blood Loss

Volume of blood loss for treated and operated patients during surgery.

Time frame: Day 1

ArmMeasureValue (MEAN)Dispersion
Dabigatran 220mgVolume of Blood Loss187 mLStandard Deviation 258
Dabigatran 150mgVolume of Blood Loss190 mLStandard Deviation 250
EnoxaparinVolume of Blood Loss191 mLStandard Deviation 254

Source: ClinicalTrials.gov · Data processed: Mar 26, 2026