Status: Finalised
First registered on:
23/11/2016
Last updated on:
17/03/2022
1. Study identification
EU PAS Register NumberEUPAS16014
Official titleCharacterising the risk of major bleeding in patients with Non-Valvular Atrial Fibrillation: non-interventional study of patients taking Direct Oral Anticoagulants in the EU
Study title acronym
Study typeObservational study
Brief description of the studyThis study is using longitudinal data collected in 8 electronic health care databases from six EU countries to characterize the risk of major bleeding in Direct Oral Anticoagulant (DOAC) users in a real-world setting to help establish the effectiveness of existing and future risk minimization measures. The research undertaken will focus on targeted clinical and demographic subgroups for which variations in plasma concentrations might affect the safety of the products.
Was this study requested by a regulator?Yes: EMA
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 applicableEMA/2015/27/PH
2. Research centres and Investigator details
Coordinating study entity
Department/Research groupDivision of Pharmacoepidemiology & Clinical Pharmacology
Organisation/affiliationUtrecht Institute for Pharmaceutical Sciences
Details of (Primary) lead investigator
Title Dr
Last name Gardarsdottir
First name Helga
Is this study being carried out with the collaboration of a research network?
Yes
EU PE&PV Research Network
Other centres where this study is being conducted
Multiple centres
In total how many centres are involved in this Study?6
Countries in which this study is being conducted
International study
Denmark
France
Germany
Netherlands
Spain
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed01/09/201601/09/2016
Start date of data collection01/02/201601/01/2008
Start date of data analysis01/02/2017
Date of interim report, if expected09/02/201812/02/2018
Date of final study report15/06/201805/10/2018
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companies
Charities
Government body
Research councils
EU funding schemeEMA tender100
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Gardarsdottir
First name Helga
Address line 1Universiteitsweg 99
Address line 2PO Box 80082
Address line 3
CityUtrecht
Postcode3508 TB
CountryNetherlands
Phone number (incl. country code)31-6-14743867
Alternative phone number
Fax number (incl. country code)31-30-2539166
Public Enquiries
Title Dr
Last name Gardarsdottir
First name Helga
Address line 1Universiteitsweg 99
Address line 2PO Box 80082
Address line 3
CityUtrecht
Postcode3508 TB
CountryNetherlands
Phone number (incl. country code)31-6-14743867
Alternative phone number
Fax number (incl. country code)31-30-2539166
6. Study drug(s) information
Not applicable (disease/epidemiology study)
7. Medical conditions to be studied
Medical condition(s)Yes
Atrial fibrillation
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
Other population
Renal impaired
Hepatic impaired
9. Number of subjects
Estimated total number of subjects700000
Additional information
See Protocol, table 4.1 for an overview of study subjects in each participating database
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
Bavarian Claims databse, Germany
AOK Nordwest, Germany
French Claims Database (EGB), France
General Practioners of Utrecht database, Netherlands
Almere Health Group database, Netherlands
Sources of data
Disease/case registry
Administrative database, e.g. claims database
Routine primary care electronic patient registry
Pharmacy dispensing records
11. Scope of the study
What is the scope of the study?
Risk assessment
Drug utilisation study
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
Objective 1. The risk of major bleeding, such as gastrointestinal bleeding, intracranial bleeding and haemorrhagic stroke, associated with use of DOACs when compared to other oral anticoagulants
Objective 2. The utilization of DOACs in the EU for treatment of NVAF.
Objective 3. Prescribers’ compliance with recommendations included in sections 4.1, 4.3, 4.4, and 4.5 of the SmPC of each DOAC
Are there primary outcomes?Yes
The risk of major bleeding, such as gastrointestinal bleeding, intracranial bleeding and haemorrhagic stroke, associated with use of DOACs
AND
Descriptive analysis of patient characteristics of new DOAC users, the number of patients switching to another antithrombotic agent and treatment duration.
Prescriber compliance with recommendations included in SmPC section 4.1, 4.3, 4.4, and 4
Are there secondary outcomes?Yes
Stroke, including ischaemic stroke and haemorrhagic stroke, and all‐cause mortality
13. Study design
What is the design of the study?
Cohort study
Drug utilisation study
14. Follow-up of patients
Will patients be followed up?Not applicable/no follow-up
15. Data analysis plan
Please provide a brief summary of the analysis method
Descriptive studies: The analysis will be descriptive using information on the index date. Stratified by database, individual DOACs, age group, gender, study period 2008-2015, calendar year: 2008, 2009, 2010, 2011, 2012, 2013, 2014 and 2015, Indication, Renal function
Cohort study: Crude incidence rates of outcomes per 1,000 person years will be estimated, stratified by sex and age groups. Cox proportional hazard regression analysis will be applied to estimate effects (adjusted hazard ratios, HR) of (D)OAC treatment
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
Yes
17. Full protocol
18. Study Results
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
Souverein PC, HA van den Ham, Huerta C, et al. Comparing risk of major bleeding between users of different oral anticoagulants in patients with
nonvalvular atrial fibrillation. Br J Clin Pharmacol. 2020;1–13.https://doi.org/10.1111/bcp.14450
Ibáñez L, Sabaté M, Vidal X, et al.Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008–2015): A cross‐national drug utiliza-tion study.Br J Clin Pharmacol. 2019;85:2524 2539.https://doi.org/10.1111/bcp.14071
Rottenkolber M, Schmiedl S et al. Prescribers' compliance with summary of product characteristics of dabigatran, rivaroxaban and apixaban-A European comparative drug utilization study. Basic Clin Pharmacol Toxicol. 2020 Oct 10. doi: 10.1111/bcpt.13517. Online ahead of print.https://onlinelibrary.wiley.com/doi/10.1111/bcpt.13517
van den Ham HA, Souverein PC, Klungel OH, Platt RW, Ernst P, Dell'Aniello S, Schmiedl S, Grave B, Rottenkolber M, Huerta C, Martín Merino E, León-Muñoz LM, Montero D, Andersen M, Aakjaer M, De Bruin ML, Gardarsdottir H. Major bleeding in users of direct oral anticoagulants in atrial fibrillation: a pooled analysis of results from multiple population-based cohort studies. Pharmacoepidemiol Drug Saf. 2021 Jun 26. doi: 10.1002/pds.5317. PMID: 34173286https://onlinelibrary.wiley.com/doi/10.1002/pds.5317
Sabaté M, Vidal X, Ballarin E, Rottenkolber M, Schmiedl S, Grave B, Huerta C, Martin-Merino E, Montero D, Leon-Muñoz LM, Gasse C, Moore N, Droz C, Lassalle R, Aakjær M, Andersen M, De Bruin ML, Souverein P, Klungel OH, Gardarsdottir H, Ibáñez L. Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Cross-National Comparison in Six European Countries (2008-2015). Front Pharmacol. 2021 Nov 3
PMID: 34803665https://pubmed.ncbi.nlm.nih.gov/34803665/
19. Other relevant documents
Other documents
DescriptionDocumentLatest version
Signed Code of
Conduct Checklist
Submitted
Signed Code of Conduct Declaration
Submitted
Signed Checklist for Study
Protocols
Submitted
