Key result
The AXAFA-AFNET 5 trial is designed to evaluate whether continuous apixaban is a safe alternative to vitamin K antagonists in 650 patients undergoing atrial fibrillation catheter ablation.
Why the study?
Does continuous apixaban reduce a composite of all-cause death, stroke, and major bleeding events compared to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation?
RCT (n=650)
Open-label, blinded outcome assessment
1:1
Yes
Does continuous apixaban reduce a composite of all-cause death, stroke, and major bleeding events compared to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation?
The AXAFA-AFNET 5 trial is designed to evaluate whether continuous apixaban is a safe and effective alternative to vitamin K antagonists in patients undergoing catheter ablation for atrial fibrillation.
AIMS: Catheter ablation is the most efficacious rhythm control therapy in atrial fibrillation (AF) patients. There is growing evidence that catheter ablation procedures are best performed during continuous oral anticoagulation, but outcomes are variable depending on the anticoagulation strategy or agent chosen. Specifically, there is a need to evaluate the peri-procedural use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients undergoing catheter ablation of AF. The AXAFA-AFNET 5 trial will test whether peri-procedural anticoagulation therapy using apixaban is a safe alternative to vitamin K antagonist (VKA) therapy for patients undergoing catheter ablation of AF. METHODS AND RESULTS: AXAFA-AFNET 5 is a randomized, prospective multi-centre study conducted in Europe and the USA. A total of 650 patients scheduled for AF ablation will be randomized 1:1 to undergo AF ablation on continuous treatment with the NOAC apixaban or with a VKA. Patients can undergo AF ablation after at least 30 days of continuous effective anticoagulation or after exclusion of atrial thrombi by transoesophageal echocardiogram. The trial includes a post-ablation magnetic resonance imaging substudy that will quantify silent brain lesions that can occur in neurologically asymptomatic patients after AF ablation. Patients will be followed on continuous anticoagulation for 3 months after the ablation. The primary outcome parameter of AXAFA-AFNET 5 is a composite of all-cause death, stroke, and major bleeding events. CONCLUSION: The results of AXAFA-AFNET 5 will provide evidence informing about the safety of apixaban in ablation patients and on its efficacy including effects on silent brain lesions. AXAFA - AFNET 5 is an investigator-initiated trial sponsored by AFNET. The trial is supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research) and by Bristol-Myers Squibb/Pfizer Alliance.
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Biase et al. (2016) conducted an RCT in Atrial fibrillation (n=650). Apixaban vs. Vitamin K antagonist (VKA) was evaluated on Composite of all-cause death, stroke, and major bleeding events. The AXAFA-AFNET 5 trial is designed to evaluate whether continuous apixaban is a safe alternative to vitamin K antagonists in 650 patients undergoing atrial fibrillation catheter ablation.
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