Clinical trial NCT01809015: Evaluation of Oral Anticoagulation With Vitamin K Antagonists - The thrombEVAL Study Programme
Official title: A Study Programme for the Evaluation of Oral Anticoagulation Therapy With Vitamin K Antagonists
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Anticoagulant Antagonists, Vitamin K and Other Coagulants Causing Adverse Effects in Therapeutic Use
Atrial Fibrillation
Venous Thromboembolism
Keywords: Oral Anticoagulation
Regular Medical Care
Coagulation Service
Vitamin-K Antagonists
Quality of therapy
Atrial fibrillation
Venous thromboembolism
Bypass surgery
Prosthetic heart valve
Lead sponsor: Johannes Gutenberg University Mainz
Sponsor class: OTHER
Collaborators: name: Ministry of Health, Rhineland-Palatinate, Germany
name: Ministry of Economics, Rhineland-Palatinate, Germany
name: German Federal Ministry of Education and Research
name: Boehringer Ingelheim
name: Daiichi Sankyo Europe, GmbH, a Daiichi Sankyo Company
name: Sanofi
name: IMO Institut GmbH
name: PortaVita BV
name: The German Heart Foundation
name: Bayer
First posted: 2013-03-12
Enrollment: 2318
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: In cohort A, patients of regular medical care are enrolled in the area of Rhineland-Palatinate, Germany. Treatment and management of oral anticoagulation therapy with vitamin K antagonists is performed within primary (ambulatory) care system.

In cohort B, patients are treated with oral anticoagulation in a specialized telemedicine-based coagulation service in the area of Rhinehesse, Germany.

Brief summary: Since decades, oral anticoagulation (OAC) with vitamin K antagonists (VKA) is an established therapy for both prevention and treatment of thromboembolism in daily clinical routine. Increasing life-expectancy, the demographic change and novel oral anticoagulants lead to an increasing complexity of medical therapy. However, data on quality and management of VKA therapy with phenprocoumon in current medical care are limited. Our aim was to investigate the quality of OAC with VKA in current health care and to evaluate the potential for improvements.

The investigator-initiated thrombEVAL study program comprises two cohorts of patients treated with vitamin K antagonists for oral anticoagulation therapy in real-life settings: a multicentre cohort of patients in regular medical care and a multi-local, single centre cohort of patients in a telemedicine-based coagulation service. The study program is expected to enrol a total number of approximately 2,000 to 2,500 patients. Both cohorts build on a detailed clinical assessment of participants and anticoagulation therapy at study enrolment. Subsequently active and passive follow-up investigations are carried out to document and validate complications of the treatment. Primary short-term outcome is the distribution of time in therapeutic range; the primary long-term outcome comprises the composite of stroke, systemic embolism, myocardial infarction, major and clinically-relevant bleeding and death.


Eligibility criteria: Inclusion Criteria

1. Age ≥ 18 years of age at study inclusion
2. Written informed consent by patient or legal guardian, if appointed
3. Cohort A: Pretreatment with oral anticoagulation therapy with vitamin K antagonists (VKA) for at least 4 months in regular medical care including patients with self-management of oral anticoagulation therapy
4. Cohort B: Indication for oral anticoagulation therapy with VKA for at least 3 months (both drug-naive and -experienced patients) at enrolment including patients with self-management of oral anticoagulation therapy.

Exclusion Criteria

1. Contraindication to VKA treatment, e.g. pregnancy or known hypersensitivity
2. Participation in other clinical trial

Primary outcomes:
measure: Time in therapeutic range
timeFrame: Assessment during Year 1 after study enrolment
measure: Hospitalisation
timeFrame: Assessment at year 1 and 2 after study enrolment
measure: Net clinical benefit
timeFrame: Assessment at year 1 and 2
Secondary outcomes:
Other outcomes:
Locations:
city: Mainz
country: Germany
facility: University Medical Center of the Johannes Gutenberg University Mainz
state: Rhineland-Palatinate
Study officials:
affiliation: University Medical Center of Johannes Gutenberg-University Mainz, Germany
name: Philipp S Wild, MD, MSc
role: PRINCIPAL_INVESTIGATOR
affiliation: University Medical Center of Johannes Gutenberg-University Mainz, Germany
name: Thomas F Munzel, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Keller K, Prochaska JH, Coldewey M, Gobel S, Schmitt VH, Hahad O, Ullmann A, Nagler M, Lamparter H, Espinola-Klein C, Munzel T, Wild PS. Atherosclerosis and Its Impact on the Outcomes of Patients with Deep Venous Thrombosis. Life (Basel). 2022 May 14;12(5):734. doi: 10.3390/life12050734.
citation: Eggebrecht L, Ludolph P, Gobel S, Panova-Noeva M, Arnold N, Nagler M, Bickel C, Lauterbach M, Hardt R, Cate HT, Lackner KJ, Espinola-Klein C, Munzel T, Prochaska JH, Wild PS. Cost saving analysis of specialized, eHealth-based management of patients receiving oral anticoagulation therapy: Results from the thrombEVAL study. Sci Rep. 2021 Jan 28;11(1):2577. doi: 10.1038/s41598-021-82076-9.
citation: Michal M, Eggebrecht L, Gobel S, Panova-Noeva M, Nagler M, Arnold N, Lauterbach M, Bickel C, Wiltink J, Beutel ME, Munzel T, Wild PS, Prochaska JH. The relevance of depressive symptoms for the outcome of patients receiving vitamin K antagonists: results from the thrombEVAL cohort study. Eur Heart J Cardiovasc Pharmacother. 2021 Jul 23;7(4):271-279. doi: 10.1093/ehjcvp/pvz085.
citation: Prochaska JH, Gobel S, Nagler M, Knopfler T, Eggebrecht L, Lamparter H, Panova-Noeva M, Keller K, Coldewey M, Bickel C, Lauterbach M, Hardt R, Espinola-Klein C, Ten Cate H, Rostock T, Munzel T, Wild PS. Sustained atrial fibrillation increases the risk of anticoagulation-related bleeding in heart failure. Clin Res Cardiol. 2018 Dec;107(12):1170-1179. doi: 10.1007/s00392-018-1293-4. Epub 2018 Jun 9.
citation: Prochaska JH, Gobel S, Keller K, Coldewey M, Ullmann A, Lamparter H, Schulz A, Schinzel H, Bickel C, Lauterbach M, Michal M, Hardt R, Binder H, Espinola-Klein C, Lackner KJ, Ten Cate H, Munzel T, Wild PS. e-Health-based management of patients receiving oral anticoagulation therapy: results from the observational thrombEVAL study. J Thromb Haemost. 2017 Jul;15(7):1375-1385. doi: 10.1111/jth.13727. Epub 2017 Jun 6.
citation: Keller K, Prochaska JH, Coldewey M, Gobel S, Ullmann A, Junger C, Lamparter H, Ariza L, Bickel C, Lauterbach M, Konstantinides S, Rostock T, Munzel T, Wild PS. History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolism. Thromb Res. 2015 Nov;136(5):899-906. doi: 10.1016/j.thromres.2015.08.024. Epub 2015 Sep 3.
citation: Prochaska JH, Gobel S, Keller K, Coldewey M, Ullmann A, Lamparter H, Junger C, Al-Bayati Z, Baer C, Walter U, Bickel C, ten Cate H, Munzel T, Wild PS. Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL. BMC Med. 2015 Jan 23;13:14. doi: 10.1186/s12916-015-0268-9.
citation: Prochaska JH, Coldewey M, Gobel S, Keller K, Hendelmeier M, Konstantinides S, Munzel T, Wild PS; thrombEVAL Study Group. Evaluation of oral anticoagulation therapy: rationale and design of the thrombEVAL study programme. Eur J Prev Cardiol. 2015 May;22(5):622-8. doi: 10.1177/2047487314527852. Epub 2014 Mar 31.