Status: Finalised
First registered on:
18/11/2015
Last updated on:
18/11/2022
1. Study identification
EU PAS Register NumberEUPAS11521
Official titleBenefit and risk of AntiThrombotic Treatments after Orthopaedic Surgery in real-life settings: a cohort study in the SNIIRAM claims and hospitalisation database
Study title acronymATTOS
Study typeOther: Study using the SNIIRAM claims and hospitalisation database
Brief description of the studyEliquis® (apixaban), an antithrombotic agent has obtained market authorization in the indication “Prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective total hip or knee replacement surgery (THR or TKR)”. In this context, the French Transparency Commission requested a cohort study of patients treated in France by Eliquis® under real-life condition. To adress the HAS request, an historical cohort study will be formed using a national healthcare claims (SNIIRAM) linked to the national hospital-discharge summaries database. This cohort will include all adults with an antithrombotic agent reimbursement within one week after discharge for an orthopaedic procedure (THR, TKR and other orthopaedic procedures) between 1 January 2013 and 30 September 2014, and with a 3-year database history and a follow-up of 3 months.
The primary objectives of the study are to estimate the cumulative incidence of VTE (effectiveness) and the cumulative incidence of clinically significant bleeding (safety) in real-life clinical settings in France after a THR, a TKR, and after another orthopaedic procedure over a 3-month post-surgery period, according to the initial antithrombotic treatment. The secondary objectives are to estimate the cumulative incidence of all-cause death after a THR, after a TKR, and after another orthopaedic procedure; to compare cumulative incidence of VTE, of clinically significant bleeding, and of all-cause death over a 3-month post surgery period between Eliquis® and other antithrombotic; to describe the treated population; to describe conditions of Eliquis® use and other antithrombotic treatments; and to assess the impact of each antithrombotic treatment on the healthcare system during the study period. The statistical analysis will be performed separately for THR, TKR, and other orthopaedic procedures, according to the treatment group (first antithrombotic agent dispensed within a week after discharge).
Was this study requested by a regulator?Yes: France
Is the study required by a Risk Management Plan (RMP)?
Not applicable
Regulatory procedure number (RMP Category 1 and 2 studies only)
Other study registration identification numbers and URLs as applicable
2. Research centres and Investigator details
Coordinating study entity
Department/Research grouppharmacoepidemiology
Organisation/affiliationUniversity of Bordeaux
Details of (Primary) lead investigator
Title Dr
Last name BLIN
First name Patrick
Is this study being carried out with the collaboration of a research network?
No
Other centres where this study is being conducted
Not applicable (single centre)
Countries in which this study is being conducted
National study
France
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed17/04/2015
Start date of data collection01/04/201615/06/2016
Start date of data analysis31/05/201615/09/2016
Date of interim report, if expected
Date of final study report31/10/201629/05/2017
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesBristol-Myers Squibb100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name BLIN
First name Patrick
Address line 1Université de Bordeaux – Bâtiment du Tondu – Case 41 – 146 rue Léo Saignat
Address line 2
Address line 3
CityBordeaux
Postcode33076
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)33557574740
Public Enquiries
Title Dr
Last name BLIN
First name Patrick
Address line 1Université de Bordeaux – Bâtiment du Tondu – Case 41 – 146 rue Léo Saignat
Address line 2
Address line 3
CityBordeaux
Postcode33076
CountryFrance
Phone number (incl. country code)33557574675
Alternative phone number
Fax number (incl. country code)33557574740
6. Study drug(s) information
Substance class (ATC Code)B01AF02 (apixaban)
Substance class (ATC Code)B01A (ANTITHROMBOTIC AGENTS)
7. Medical conditions to be studied
Medical condition(s)Yes
Orthopaedic procedure
Venous thrombosis
8. Population under study
Age
Adults (18 - 44 years)
Adults (45 - 64 years)
Adults (65 - 74 years)
Adults (75 years and over)
Sex
Male
Female
9. Number of subjects
Estimated total number of subjects300000
Additional information
180 000 THR and 135 000 TKR are expected in the SNIIRAM database over a 21-month period. The number of other orthopaedic procedure with an antithrombotic agent reimbursement expected will be a result of the study.
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources registered with ENCePP
Data sources not registered with ENCePP
SNIIRAM national claims database, France
Sources of data
Administrative database, e.g. claims database
11. Scope of the study
What is the scope of the study?
Risk assessment
Drug utilisation study
Effectiveness evaluation
Primary scope : Effectiveness evaluation
12. Main objective(s)
What is the main objective of the study?
To estimate the cumulative incidence of VTE (effectiveness) and the cumulative incidence of clinically significant bleeding (safety) in real-life clinical settings in France after a THR, after a TKR, and after another orthopaedic procedure over a 3-month post-surgery period, according to the initial antithrombotic treatment.
Are there primary outcomes?Yes
Primary effectiveness outcome: VTE defined as a main diagnosis of pulmonary embolism or deep vein thrombosis (effectiveness) in hospital-discharge summaries over a 3-month period after index date.
Primary safety outcome: Clinically significant bleeding defined as main diagnosis of bleeding (safety), in hospital-discharge summaries over a 3-month period after index date.
Are there secondary outcomes?Yes
Secondary effectiveness outcome: VTE defined as primary effectiveness criteria or new dispensation of a Low-Molecular-Weight Heparin following a specific examination for pulmonary embolism or VTE, over a 3-month period after index date.
All-cause death defined as any cause of death over 3-month period after index date.
13. Study design
What is the design of the study?
Cohort study
14. Follow-up of patients
Will patients be followed up?Yes
Please describe duration of follow up
3 months of follow-up after hospitalisation for the orthopaedic procedure.
15. Data analysis plan
Please provide a brief summary of the analysis method
Statistical analysis will be performed using SAS® software. A Statistical Analysis Plan will be developed and validated by the Scientific Committee before analysis.
The statistical analysis will be performed separetely for THR, TKR and other orthopaedic procedures, according to the treatment group.
The analysis will describe the cumulative incidence of primary/secondary effectiveness endpoint and primary safety endpoint, the patient and disease characteristics, the conditions of Eliquis® and other antithrombotic agent use, the healthcare consumption; and compared outcomes between Eliquis® and other antithrombotic agents;
For primary outcomes, a more sensitive definition using main, related, or associated diagnosis will be used for sensitivity analysis.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
Not submitted
18. Study Results
Not submitted
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
Comparative effectiveness of direct oral anticoagulants versus low-molecular weight heparins for the prevention of venous thromboembolism after total hip or knee replacement: A nationwide database cohort study.
Blin P, Samama CM, Sautet A, Benichou J, Lignot-Maleyran S, Lamarque S, Lorrain S, Lassalle R, Droz-Perroteau C, Mismetti P, Moore N.
Pharmacol Res. 2019 Mar;141:201-207. doi: 10.1016/j.phrs.2018.12.018. Epub 2018 Dec 21.https://doi.org/10.1016/j.phrs.2018.12.018
19. Other relevant documents
Conflict(s) of interest of
investigator(s)Not submitted
Composition of Steering Group and
ObserversNot submitted
Other documentsNot
submitted
Signed Code of
Conduct Checklist
Not submitted
Signed Code of Conduct Declaration
Not submitted
Signed Checklist for Study
Protocols
Not submitted
