A Multi-center Study of Apixaban(APPROACH)

Study Overview
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Brief Summary
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The aim of the study is to enroll approximately 200 cases from 10 research centers nationwide, completed left atrial appendage occlusion (LAAO) successfully, and give apixaban (5 mg bid) postoperatively.

Official Title
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A Multi-center Observative Study of Apixaban After Left Atrial Appendage Occlusion in Patients With Non-valvular Atrial Fibrillation

Conditions
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Evaluate the Safety and Efficacy of Apixaban

Intervention / Treatment
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* Drug: Oral apixaban


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age between 18 to 85 years; understand the purpose of the trial, sign the informed consent form voluntarily successful surgery (no pericardial effusion, pericardial tamponade, or device displacement during operation; no pericardial effusion before discharge), meet COST standard during operation. In accordance with the indications for left atrial appendage occlusion: CHA2DS2-VAS2 score≥2 points and/or HAS-BLED score≥3 points unable or unwilling to take oral anticoagulants life expectancy≥1 year Exclusion Criteria: History of previous cardiac surgery (valve disease, cardiomyopathy, severe coronary occlusion); Inability to tolerate trans-esophageal echocardiography; Preoperative trans-esophageal echocardiography suggests thrombus in left atrial appendage/left atrial; Patients with severe renal insufficiency (creatinine clearance rate<15ml/min); Patients with liver disease accompanied by abnormal blood coagulation and clinically related bleeding risks; Clinically significant active bleeding; The baseline platelet count is severely reduced: PLT≤50*10^9/L; Severe cardiac insufficiency (preoperative transthoracic echocardiography indicated LVEF <35%; uncontrolled heart failure (NYHA IV)) Allergy or contraindication to anticoagulant drugs such as aspirin, clopidogrel, apixaban, etc .; Serious heart valve disease or other structural abnormalities need do elective surgical treatment; or severe coronary heart disease require limited-term intervention; Less than 45kg or more than 100kg. Take strong CYP3A4 and P-gp inhibitors (including pyrrole antifungal drugs, HIV protease inhibitors, etc.) for systemic treatment; Patients with other diseases besides atrial fibrillation (such as after mechanical valve replacement, spontaneous or recurrent venous thromboembolism, etc.) need anticoagulation treatment; Unsuccessful surgery (serious pericardial tamponade, massive bleeding and other life-threatening complications occur within 3 days after left atrial appendage closure); Pregnancy or lactation; Participating in other uncompleted clinical trials; Investigator considers inappropriate subjects.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Anticoagulant therapy after percutaneous left atrial appendage<br>Oral apixaban | Drug: Oral apixaban<br>* apixaban (5 mg bid) is given until 12 weeks after surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of adverse cardiovascular events | all cause death, stroke, transient ischemic attack, systemic embolism | within 24 weeks after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemorrhagic/ischemic stroke events | Stroke was defined as patients who developed dysarthria, aphasia, or weakness or sensory loss in the contralateral face, arm, or leg and cerebral ischemia and/or infarction. Diagnosis by clinical symptoms and cranial imaging examination. | within 24 weeks after surgery | 
| Bleeding event | Including dermal, mucosal, nasal, oral, gastrointestinal bleeding | within 24 weeks after surgery | 
| Incidence of deaths | All cause deaths (cardiac death, and non cardiac death) | witnin 24 weeks after surgery | 
| Device related thrombosis | Doctors find thrombosis after LAAC by transesophageal echocardiography. | 12 weeks and 24 weeks after surgery | 
| Incidence of cardiovascular disease-related rehospitalization | Cardiovascular disease include pericardial effusion, pericardial tamponade, poor cardiac function | 12 weeks and 24 weeks after surgery | 
| severe adverse events | Severe adverse events include re-inpatient for poor cardiac function and other severe adverse events. | 12 weeks and 24 weeks after surgery |