unexpected clotting of blood in veins
Conditions
Interventions
A urinary pregnancy test will be performed in women of childbearing potential
(WOCBP) at the time of inclusion and at every visit during the study (Week 4,
M3, M6, M9, M12 visits).
A phone call wil
Sponsors
Assistance Publique-Hôpitaux de Paris (APHP) delegated to Recherche Clinique et à lInnovation (DRCI)
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: • Signed Written Informed Consent • Any cancer diagnosed histologically (other than basal-cell or squamous-cell carcinoma of the skin, primary brain tumor or intra-cerebral metastasis) • Active cancer defined as the presence of measurable disease or ongoing (or planned) chemotherapy, radiotherapy, hormonotherapy, targeted therapy, immunotherapy at inclusion. • Objectively documented index event of : symptomatic or incidental proximal lower-limb, iliac, inferior vena cava DVT or symptomatic or incidental PE in a segmental or larger pulmonary artery (1) Proximal DVT is defined as DVT that involves at least the popliteal vein or a more proximal vein, demonstrated by imaging with compression ultrasound (CUS), including grey-scale or color-coded Doppler, or ascending contrast venography or contrast enhanced computed tomography or magnetic resonance imaging. (2) PE has to be demonstrated by imaging as follows: * an intraluminal filling defect in segmental or more proximal branches on contrast enhanced chest computed tomography or on computed tomography pulmonary angiography ; or * an intraluminal filling defect or a sudden cutoff of vessels more than 2.5 mm in diameter on the pulmonary angiogram; or * a perfusion defect of at least 75% of a segment with a local normal ventilation result (high-probability) on ventilation/perfusion lung scan (VPLS) (3) Incidental VTE is defined as proximal DVT or PE detected by imaging incidentally when a patient undergoes imaging studies as standard of care for the management of his or her malignancy or other reasons but not for a VTE suspicion(e.g. cancer diagnosis or staging).• At least 6 months of anticoagulant therapy at therapeutic dosage (whatever the drug and the dosing), or completed assigned clinical trial study treatment, for the treatment of the index event; and patient still receiving anticoagulant treatment after occurrence or the index VTE . • No objectively documented symptomatic recurrence of VTE between the index event and randomization.
Exclusion criteria
Exclusion criteria: • WOCBP who are unwilling or unable to use an acceptable method of birth control [such as oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (condoms)] to avoid pregnancy for the entire study • Women who are pregnant or breastfeeding • Women with a positive pregnancy test on enrollment or prior to investigational product administration • Isolated sub-segmental (incidental or symptomatic) PE without associated DVT • Isolated distal DVT of the legs • Isolated upper-extremity DVT or superior vena cava thrombosis • Isolated visceral thrombosis • Isolated catheter thrombosis • Objectively documented symptomatic recurrence of VTE after the index event under anticoagulant treatment • VTE during anticoagulant treatment given at therapeutic dosage • Subjects with indications for long-term treatment with a VKA, such as: - Mechanical heart valve - Antiphospholipid syndrome • Subjects with indication for long-term anticoagulation with a VKA or a DOAC at therapeutic dosage • Conditions increasing the risk of serious bleeding - intracranial or intraocular bleeding within the 6 months - major surgery within 2 weeks prior to randomization - overt major bleeding at time of randomization • Life expectancy < 12 months • Eastern Cooperative Oncology Group (ECOG) level 3 or 4 • Bacterial endocarditis • Uncontrolled hypertension: systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg • Platelet count < 75,000/mm3 • Hemoglobin < 8g /dl • Creatinine clearance < 30 ml /min based on the Cockcroft Gault equation (see Section 5.7.4) • Acute hepatitis, chronic active hepatitis, liver cirrhosis; or an alanine aminotransferase level 3 times or more and/or bilirubin level 2 times or more higher the upper limit of the normal range • Subjects requiring ASA >165 mg/day at randomization or thienopyridine therapy (clopidogrel, prasugrel, or ticagrelor) • Subjects requiring dual anti-platelet therapy (such as acetylsalicylic acid plus clopidogrel or acetylsalicylic acid plus ticlopidine) at randomization. Subjects who transition from dual antiplatelet therapy to monotherapy prior to randomization will be eligible for the trial • Concomitant use of strong inhibitors of both cytochrome P-450 3A4 and P Glycoprotein (e.g. human immunodeficiency virus protease inhibitors or systemic ketoconazole) or strong inducers of both cytochrome P-450 3A4 and P Glycoprotein (e.g. rifampicin, carbamazepine, or phenytoin) • Prisoners or subjects who are involuntarily incarcerated • Subjects who are compulsorily detained for treatment of either a psychiatric or physical (e.g. infectious disease) illness • Hypersensitivity to apixaban • Subjects participating in another pharmaco therapeutic program with an experimental therapy that is known to affect the coagulation system • Under 18 years old • Patients under legal protection (guardianship; court decision)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary efficacy endpoint is the incidence of an adjudicated composite of recurrent symptomatic VTE (proximal and/or distal DVT and/or symptomatic PE and/or upper limb or CVC thrombosis) or incidental VTE (proximal DVT or PE), or death due to PE during the treatment period. | — |
Secondary
| Measure | Time frame |
|---|---|
| The key secondary outcome is the incidence of adjudicated major and clinically relevant non-major bleeding during the treatment period. Other secondary endpoints: Adjudicated composite of : - Recurrent symptomatic VTE ; - VTE related-death ; - All-cause death: all deaths will be classified as either VTE-related, cancer death (including all deaths due to the underlying cancer), bleeding-related or others, including all deaths due to a clearly documented other cause, such as for example respiratory failure (e.g., terminal emphysema), infections/sepsis, etc. ; - Adjudicated major bleeding. | — |
Countries
Netherlands
Outcome results
None listed