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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT00439777
Registration number
NCT00439777
Ethics application status
Date submitted
23/02/2007
Date registered
26/02/2007
Date last updated
27/02/2014
Titles & IDs
Public title
Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Pulmonary Embolism - The EINSTEIN PE Study
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Scientific title
Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Deep-Vein Thrombosis or Pulmonary Embolism
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Secondary ID [1]
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0
2006-004495-13
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Secondary ID [2]
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11702b
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Pulmonary Embolism
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Condition category
Condition code
Cardiovascular
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0
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Diseases of the vasculature and circulation including the lymphatic system
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Blood
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0
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Clotting disorders
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Respiratory
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0
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0
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Other respiratory disorders / diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Rivaroxaban (Xarelto, BAY59-7939)
Treatment: Drugs - Enoxaparin overlapping with and followed by VKA
Experimental: Rivaroxaban (Xarelto, BAY59-7939) - Participants received 15 mg rivaroxaban (oral) twice daily (b.i.d.) for 3 weeks, followed by 20 mg once daily (o.d.)
Active comparator: Enoxaparin/VKA - Participants received enoxaparin (subcutaneous) 1.0 mg/kg b.i.d. for minimal 5 days, plus vitamin K antagonist (VKA) at individually titrated doses to achieve a target international normalized ratio (INR) of 2.5 (range: 2.0 - 3.0)
Treatment: Drugs: Rivaroxaban (Xarelto, BAY59-7939)
During the first 3 weeks patients will receive 15 mg rivaroxaban twice-daily. Thereafter, patients will receive rivaroxaban 20 mg once-daily. Rivaroxaban will be administered orally and should be taken with food.
Treatment: Drugs: Enoxaparin overlapping with and followed by VKA
Enoxaparin 1.0 mg/kg twice daily with a minimal duration of 5 days. This 5 days treatment could include the period up to 36 hr before randomization if enoxaparin twice-daily was used. VKA should be started as soon as possible but not later than 48 hours after randomization.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Percentage of Participants With Symptomatic Recurrent Venous Thromboembolism [VTE] (i.e. the Composite of Recurrent Deep Vein Thrombosis [DVT] or Fatal or Non-fatal Pulmonary Embolism [PE]) Until the Intended End of Study Treatment
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Assessment method [1]
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All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for fatal PE) or unexplained death for which DVT/PE could not be ruled out (for fatal PE), and/or case summaries.
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Timepoint [1]
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3-, 6-, or 12-month study treatment period
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Secondary outcome [1]
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Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality Until the Intended End of Study Treatment
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Assessment method [1]
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All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for deaths), results/films/images of confirmatory testing, and/or case summaries.
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Timepoint [1]
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3-, 6-, or 12-month study treatment period
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Secondary outcome [2]
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Percentage of Participants With an Event for Net Clinical Benefit 1 Until the Intended End of Study Treatment
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Assessment method [2]
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Net clinical benefit 1: composite of recurrent DVT or non-fatal or fatal PE, and major bleeding. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of =2 units, occurring in a critical site or contributing to death. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.
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Timepoint [2]
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3-, 6-, or 12-month study treatment period
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Secondary outcome [3]
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Percentage of Participants With Recurrent PE Until the Intended End of Study Treatment
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Assessment method [3]
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All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.
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Timepoint [3]
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3-, 6- or 12-month study treatment period
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Secondary outcome [4]
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Percentage of Participants With Recurrent DVT Until the Intended End of Study Treatment
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Assessment method [4]
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All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound, venography, results/films/images of confirmatory testing, and/or case summaries.
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Timepoint [4]
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3-, 6- or 12-month study treatment period
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Secondary outcome [5]
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Percentage of Participants With Clinically Relevant Bleeding, Treatment-emergent (Time Window: Until 2 Days After Last Dose)
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Assessment method [5]
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All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Clinically relevant bleeding included major bleeding (overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of 2 or more units of packed red blood cells or whole blood, occurring in a critical site or contributing to death) and non-major bleeding associated with medical intervention, unscheduled physician contact, (temporary) cessation of study treatment, discomfort for the participants such as pain, or impairment of activities of daily life.
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Timepoint [5]
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3-, 6- or 12-month study treatment period
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Secondary outcome [6]
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Percentage of Participants With All Deaths
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Assessment method [6]
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All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either autopsy, results/films/images of confirmatory testing, and/or case summaries.
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Timepoint [6]
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3-, 6- or 12-month study treatment period
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Secondary outcome [7]
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Percentage of Participants With Other Vascular Events, On-treatment (Time Window: Until 1 Day After Last Dose)
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Assessment method [7]
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All pre-defined vascular events (ST segment elevation myocardial infarction, non ST segment elevation myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, non-central nervous system systemic embolism or vascular death) were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based results/films/images of confirmatory testing, and/or case summaries.
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Timepoint [7]
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3-, 6- or 12-month study treatment period
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Eligibility
Key inclusion criteria
* Confirmed acute symptomatic proximal PE with or without symptomatic DVT
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Legal lower age limitations (country specific)
* Thrombectomy, insertion of a caval filter, or use of a fibrinolytic agent to treat the current episode of DVT and/or PE
* Other indication for VKA than DVT and/or PE
* The pre-randomization anti-coagulant treatment (Criteria # 4) has been prolonged from 36 hours to a maximum of 48 hours.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/03/2007
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
1/12/2011
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Sample size
Target
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Accrual to date
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Final
4833
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,QLD,SA,TAS,VIC,WA
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Recruitment hospital [1]
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- Garran
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- Gosford
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- Kogarah
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- Lismore
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- St Leonards
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- Sydney
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Recruitment hospital [7]
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- Brisbane
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Recruitment hospital [8]
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- Redcliffe
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Recruitment hospital [9]
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- Southport
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Recruitment hospital [10]
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- Woolloongabba
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Recruitment hospital [11]
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- Adelaide
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Recruitment hospital [12]
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- Woodville South
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Recruitment hospital [13]
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- Launceston
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- Box Hill
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- Clayton
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- Geelong
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- Melbourne
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Recruitment hospital [18]
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- Fremantle
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- Perth
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Recruitment postcode(s) [1]
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2605 - Garran
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Recruitment postcode(s) [2]
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2250 - Gosford
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Recruitment postcode(s) [3]
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2217 - Kogarah
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Recruitment postcode(s) [4]
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2480 - Lismore
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Recruitment postcode(s) [5]
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2065 - St Leonards
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Recruitment postcode(s) [6]
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2031 - Sydney
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Recruitment postcode(s) [7]
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2139 - Sydney
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Recruitment postcode(s) [8]
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2229 - Sydney
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Recruitment postcode(s) [9]
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4029 - Brisbane
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Recruitment postcode(s) [10]
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4020 - Redcliffe
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Recruitment postcode(s) [11]
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4215 - Southport
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Recruitment postcode(s) [12]
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4102 - Woolloongabba
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Recruitment postcode(s) [13]
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5042 - Adelaide
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Recruitment postcode(s) [14]
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5011 - Woodville South
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Recruitment postcode(s) [15]
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7250 - Launceston
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Recruitment postcode(s) [16]
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3128 - Box Hill
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Recruitment postcode(s) [17]
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3168 - Clayton
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Recruitment postcode(s) [18]
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3220 - Geelong
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Recruitment postcode(s) [19]
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3135 - Melbourne
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Recruitment postcode(s) [20]
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3181 - Melbourne
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Recruitment postcode(s) [21]
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6160 - Fremantle
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Recruitment postcode(s) [22]
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6000 - Perth
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Recruitment outside Australia
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United States of America
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Arkansas
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United States of America
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California
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United States of America
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Florida
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United States of America
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Idaho
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Louisiana
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United States of America
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Maryland
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United States of America
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Massachusetts
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United States of America
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Missouri
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New Mexico
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North Carolina
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Oklahoma
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Texas
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Utah
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Virginia
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Washington
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Andorra
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Escaldes - Engordany
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Austria
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Steiermark
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Vorarlberg
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Ontario
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Czech Republic
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Usti nad Lebem
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Denmark
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Aarhus C
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Braedstrup
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Frederiksberg
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Tallinn
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Finland
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Tampere
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Turku
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Agen Cedex 9
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Amiens
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Nice
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Orthez
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Paris Cedex 15
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Paris
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Pierre Benite
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Roanne
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France
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Rouen Cedex
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Bayer
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Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
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Summary
Brief summary
This is a multicenter, randomized, open-label, assessor-blind, event-driven, non-inferiority program for efficacy with a study treatment duration of 3, 6 or 12 months in patients with confirmed acute symptomatic pulmonary embolism (PE) with or without symptomatic Deep-Vein Thrombosis (DVT) (Einstein-PE).
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Trial website
https://clinicaltrials.gov/study/NCT00439777
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Trial related presentations / publications
EINSTEIN-PE Investigators; Buller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, Chlumsky J, Verhamme P, Wells P, Agnelli G, Cohen A, Berkowitz SD, Bounameaux H, Davidson BL, Misselwitz F, Gallus AS, Raskob GE, Schellong S, Segers A. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012 Apr 5;366(14):1287-97. doi: 10.1056/NEJMoa1113572. Epub 2012 Mar 26. Prins MH, Lensing AW. Derivation of the non-inferiority margin for the evaluation of direct oral anticoagulants in the treatment of venous thromboembolism. Thromb J. 2013 Jul 6;11(1):13. doi: 10.1186/1477-9560-11-13. Prins MH, Lensing AW, Bauersachs R, van Bellen B, Bounameaux H, Brighton TA, Cohen AT, Davidson BL, Decousus H, Raskob GE, Berkowitz SD, Wells PS; EINSTEIN Investigators. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013 Sep 20;11(1):21. doi: 10.1186/1477-9560-11-21. Wang Y, Wang C, Chen Z, Zhang J, Liu Z, Jin B, Ying K, Liu C, Shao Y, Jing Z, Meng IL, Prins MH, Pap AF, Muller K, Lensing AW; Chinese EINSTEIN Investigators. Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies. Thromb J. 2013 Dec 16;11(1):25. doi: 10.1186/1477-9560-11-25. van Bellen B, Bamber L, Correa de Carvalho F, Prins M, Wang M, Lensing AW. Reduction in the length of stay with rivaroxaban as a single-drug regimen for the treatment of deep vein thrombosis and pulmonary embolism. Curr Med Res Opin. 2014 May;30(5):829-37. doi: 10.1185/03007995.2013.879439. Epub 2014 Jan 22. Ten Cate H, Lensing AWA, Weitz JI, Middeldorp S, Beyer-Westendorf J, Kubitza D, Brighton T, Raskob GE, Mismetti P, Prandoni P, Gebel M, Prins MH. The prothrombin time does not predict the risk of recurrent venous thromboembolism or major bleeding in rivaroxaban-treated patients. Thromb Res. 2018 Oct;170:75-83. doi: 10.1016/j.thromres.2018.08.008. Epub 2018 Aug 15. Di Nisio M, Vedovati MC, Riera-Mestre A, Prins MH, Mueller K, Cohen AT, Wells PS, Beyer-Westendorf J, Prandoni P, Bounameaux H, Kubitza D, Schneider J, Pisters R, Fedacko J, Fontes-Carvalho R, Lensing AW. Treatment of venous thromboembolism with rivaroxaban in relation to body weight. A sub-analysis of the EINSTEIN DVT/PE studies. Thromb Haemost. 2016 Sep 27;116(4):739-46. doi: 10.1160/TH16-02-0087. Epub 2016 Aug 18. Wells PS, Gebel M, Prins MH, Davidson BL, Lensing AW. Influence of statin use on the incidence of recurrent venous thromboembolism and major bleeding in patients receiving rivaroxaban or standard anticoagulant therapy. Thromb J. 2014 Nov 26;12:26. doi: 10.1186/1477-9560-12-26. eCollection 2014. Prins MH, Lensing AW, Brighton TA, Lyons RM, Rehm J, Trajanovic M, Davidson BL, Beyer-Westendorf J, Pap AF, Berkowitz SD, Cohen AT, Kovacs MJ, Wells PS, Prandoni P. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. Lancet Haematol. 2014 Oct;1(1):e37-46. doi: 10.1016/S2352-3026(14)70018-3. Epub 2014 Sep 28. Bauersachs RM, Lensing AW, Prins MH, Kubitza D, Pap AF, Decousus H, Beyer-Westendorf J, Prandoni P. Rivaroxaban versus enoxaparin/vitamin K antagonist therapy in patients with venous thromboembolism and renal impairment. Thromb J. 2014 Nov 24;12:25. doi: 10.1186/1477-9560-12-25. eCollection 2014. Cohen AT, Dobromirski M. The use of rivaroxaban for short- and long-term treatment of venous thromboembolism. Thromb Haemost. 2012 Jun;107(6):1035-43. doi: 10.1160/TH11-12-0859. Epub 2012 Feb 28.
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Contacts
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Results publications and other study-related documents
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Citations or Other Details
Journal
EINSTEIN-PE Investigators; Buller HR, Prins MH, Le...
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Journal
Prins MH, Lensing AW. Derivation of the non-inferi...
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Journal
Prins MH, Lensing AW, Bauersachs R, van Bellen B, ...
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Wang Y, Wang C, Chen Z, Zhang J, Liu Z, Jin B, Yin...
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van Bellen B, Bamber L, Correa de Carvalho F, Prin...
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Results are available at
https://clinicaltrials.gov/study/NCT00439777
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