Atrial Fibrillation
Conditions
Keywords
Apixaban, Pharmacokinetic, Pharmacodynamic, Cardioembolic stroke, Ischemic stroke
Brief summary
The purpose of this study is to assess pharmacokinetics and pharmacodynamics of Apixaban and clinical outcome of Apixaban in Thai patients with nonvalvular atrial fibrillation with varying degree of creatinine clearance
Detailed description
This study is divided into two parts. The first part is a multiple dose pharmacokinetic and pharmacodynamics study of Apixaban in patient with stable renal function. The primary purpose of this study is to provide a clear understanding of the effect of creatinine clearance on pharmacokinetics and pharmacodynamics of Apixaban among Thai patients with nonvalvular atrial fibrillation. To assess the pharmacokinetics and pharmacodynamics of Apixaban, This study will enroll 30 subjects who meet the inclusion criteria. The second part of this study will retrospectively determine the occurrent of clinical outcome between patients who were prescribed apixaban dose concordant and discordant to the drug leaflet. A total of 241 subjects will be recruited. The follow up period will begin from the time of initiation of apixaban until occurrent of stoke, transient ischemic attack, systemic embolism, bleeding, or death.
Interventions
None listed
Sponsors
Thammasat University
Chulalongkorn University
Study design
Observational model
OTHER
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Part I Inclusion Criteria: * Patients with nonvalvular atrial fibrillation * Patients who is receiving a stable dose of apixaban for primary or secondary prevention of stroke, transient ischemic attack, and systemic embolism.
Exclusion criteria
* Pregnant or lactating * End stage renal disease patients who required chronic renal replacement therapy to sustained life * History of acute kidney injury within the previous 3 months * Severe hepatic impairment (Child-Pugh class C) * Any gastrointestinal disorder that could impact the absorption of study drug * CYP3A4 Moderate/Strong Inhibitors: ketoconazole, itraconazole, voriconazole, posaconazole, ritonavir, naproxen, clarithromycin, rifampicin, phenytoin, carbamazepine, phenobarbital, diltiazem, and St.John's Wort Part II Inclusion Criteria: * Patients with nonvalvular atrial fibrillation * Patients who was prescribed apixaban for primary or secondary prevention of stroke, transient ischemic attack, and systemic embolism.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Steady state area under the concentration-time curve from pre-dose to 12 hours post-dose (AUC(0-12)) of Apixaban | pre-dose to 12 hours post-dose | AUC(0-12) is measured by plasma concentration of apixaban over time. The mean are reported in nanogram hours per milliliter (ng\*h/mL). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with event of major or nonmajor (International Society on Thrombosis and Hemostasis [ISTH]) bleeding during the follow up period | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed until July 31, 2020 | ISTH major bleeding criteria is defined as a bleeding event that was: clinically overt bleeding accompanied by a decrease in hemoglobin (Hgb) of 2 g/dL or more, and/or a transfusion of 2 or more units of packed red blood cells; bleeding that occurred in at least 1 of the following critical sites: intracranial, intraspinal, intraocular (within the corpus of the eye; a conjunctival bleed is not an intraocular bleed), pericardial, intra-articular, intramuscular with compartment syndrome, and retroperitoneal; bleeding that was fatal. ISTH nonmajor bleeding is defined as clinically overt, that satisfies none of the additional criteria required for the event to be adjudicated as a major bleeding event, that led to either hospital admission for bleeding, physician-guided medical or surgical treatment for bleeding, or a change in antithrombotic therapy. |
| Number of participants with first event of stroke, transient ischemic attack, systemic embolism (SE), or all-cause death during the follow up period | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed until July 31, 2020 | Diagnosis of stroke is defined as the nontraumatic focal neurological deficit lasting at least 24 hours, and includes ischemic stroke, hemorrhagic stroke, ischemic stroke with hemorrhagic conversion, stroke of uncertain type, and retinal ischemic event (embolism, infarction). Diagnosis of SE is defined as a 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. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Steady state Anti-Xa activity | pre-dose to 12 hours post-dose | Anti-Xa activity will be measured by chromogenic anti-Xa activity assay |
| Steady-state maximum observed plasma concentration of Apixaban | pre-dose to 12 hours post-dose | Maximum observed drug concentration in plasma after administration (Cmax) of apixaban at steady-state |
| Steady-state minimum observed plasma concentration of Apixaban | pre-dose to 12 hours post-dose | Minimum observed drug concentration in plasma after administration (Cmin) of apixaban at steady-state |
| Steady state elimination of half-life of Apixaban | pre-dose to 12 hours post-dose | Mean terminal phase plasma t½ of apixaban at steady-state |
Countries
Thailand
Outcome results
None listed