Baseline Concentration of Direct Oral Anticoagulant and Incidence of Adverse Event Measure And See (MAS)

Study Overview
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Brief Summary
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The MAS Study is an observational, multicentre, prospective cohort study in Non valvular Atrial fibrillation (NVAF) patients treated with one of the direct oral anticoagulants (DOACs) available in Italy for NVAF patients. The general aim is to deepen the knowledge of DOAC treatment in NVAF patients, by measuring the plasma concentration of anticoagulant drugs and their correlation with any adverse events that may occur during treatment.

Detailed Description
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The MAS Study is an observational, prospective cohort study, double blind, multicentre, international and no Profit. Anticoagulation clinics, affiliated or not to the Italian FCSA, will be asked to take an active part in the study, provided they have the facilities for blood sampling and processing. 4000 consecutive NVAF outpatients, 1000 for each single drug, starting anticoagulation with one of the four DOAC (apixaban, dabigatran, edoxaban, rivaroxaban) will be enrolled at the moment of the first prescription. Patients will receive the type and dosage of DOAC on the base of clinical characteristics at the discretion of the attending physician, as the normal clinical practice, and the study will not influence the decision of the type and dosage of DOAC. The primary study objective is to evaluate the possible relationship between DOAC anticoagulant levels at the trough, measured at steady state (within the first 2-4 weeks of treatment) and occurrence of bleeding and thromboembolic events during the subsequent one year follow up

Official Title
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Baseline DOAC Measurement in Non Valvular Atrial Fibrillation Patients and Incidence of Bleeding or Thromboembolic Complications During Follow-up: a Prospective, Multicenter, Observational Study. The MAS (Measure And See) Study

Conditions
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Atrial Fibrillation, Anticoagulant-induced Bleeding

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: NVAF patients starting DOAC anticoagulation age > 18 years ability to give written informed consent availability, as part of the normal withdrawals, to the blood sampling for the study purpose availability for 12-months follow-up Exclusion Criteria: age < 18 years indication for electrical cardioversion at the moment of drug prescription participation in Phase II or III clinical trials indication for treatment different from NVAF not suitable to give or not giving informed consent not available for blood collection or follow-up

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number and rate of major bleeding events and clinically relevant bleeds (defined according to International Society on Thrombosis and Haemostasis guidelines) | Fatal bleeding; Acute clinically overt bleeding;intracranial, intraspinal, intraocular, pericardial, intra-articular, intramuscular with compartment syndrome, retroperitoneal will be recorded in all patients. | From date of enrollment until the date of first documented event assessed up to 12 months | 
| Number and rate of patients with confirmed thromboembolic and thromboembolic-related dath | Cardiovascular event: transient ischemic attack, stroke. myocardial infarction; the occurrence of deep vein thrombosis with or without pulmonary embolism will be recorded in all patients. | From date of enrollment until the date of first documented event assessed up to 12 months | 
| Number and rate of death patients (overall mortality) | Cardiovascular related death; thromboembolic related dath, bleeding-related death, cancer related death will be recorded in all patients | From date of enrollment until the date of first documented event assessed up to 12 months | 
| Through plasma concentration (ng/ml) of Apixaban, Dabigatran, Edoxaban and Rivaroxaban | Blood sampling is performed at trough level for each anticoagulant drug used after the last dose intake of dabigatran, apixaban, rivaroxaban and edoxaban | 15-20 days after the enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number and rate of patients who discontinued treatment | The treatment withdrawal, either for patients or for physician decision-making will be recorded in all patients | From date of enrollment until the date of first documented event assessed up to 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Atrial Fibrillation, Bleeding event, Thromboembolic event, Plasma concentration of drug