RECRUITING

Apixaban in Thrombocytopenia

Conditions

Deep Vein Thrombosis Pulmonary Embolism and Thrombosis Thrombocytopenia Recurrent Venous Thromboembolism Venous Thromboembolism Pulmonary Embolism Thromboembolism

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

This study is being done to determine the feasibility and safety of using a novel dose adjusted apixaban for the management of participants with cancer-associated venous thromboembolism (blood clot) or and thrombocytopenia (low number of platelets in the blood). Investigators are also looking to see if participants on this treatment have fewer bleeding episodes. The name of the study drug involved in this study is: -Apixiban (a type of anticoagulant)

Official Title

ADAPTiON: Apixaban Dose Adjustment in Patient with Thrombocytopenia in ONcology

Quick Facts

Study Start:2025-02-28

Study Completion:2028-07-01

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT06886516

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
* Active malignancy defined as histologically confirmed diagnosis within last 6 months or received any cancer directed therapy within the last 6 months. * Radiologically confirmed newly diagnosed symptomatic deep vein thrombosis or pulmonary embolism within 28 days of enrollment. Includes proximal lower-limb DVT or symptomatic PE. Upper extremity or catheter-associated thrombosis will be included, as will distal lower extremity DVTs. * Platelet count \< 75,000/ml (prior to platelet transfusion) within 28 days of VTE diagnosis. * Platelet count responsive to transfusion if previously administered (defined as an average platelet increase of at least 10,000/ml over the last 3 transfusions. * No evidence of active hemorrhage. * No recent history of major hemorrhage (requiring transfusion, hospitalization or intervention) within the last 12 months. * No known brain metastases. * Age ≥18 years. Because no dosing or adverse event data are currently available on the use of apixaban in participants \<18 years of age, children are excluded from this study, but will be eligible for future pediatric trials. * ECOG performance status ≤2 * Participants must have adequate organ and marrow function as defined below: * Total bilirubin ≤ institutional upper limit of normal (ULN) * AST(SGOT)/ALT(SGPT) ≤3 × institutional ULN * Glomerular filtration rate (GFR) ≥25 mL/min/1.73/m2 * Human immunodeficiency virus (HIV)-infected participants on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial. * For participants with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated. * Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. For participants with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load. * The effects of apixaban on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of apixaban administration. * Ability to understand and the willingness to sign a written informed consent document.	* Participants who are receiving any other investigational agents. * Participants who have had a thrombectomy, insertion of a caval filter, or require a fibrinolytic agent. * Participants that have index events with severe clot burden defined as bilateral proximal lower extremity deep vein thrombosis and saddle embolism or pulmonary embolism with hemodynamic compromise. * Participants with acute myeloid leukemia or myelodysplastic syndrome or who are undergoing or have undergone allogeneic stem cell transplant. * Participants with luminal gastrointestinal malignancy or genitourinary cancer. * Presence of known or prior brain metastasis, given the increased risk of life-threatening intracranial hemorrhage with anticoagulant use. While screening for brain metastases is not standard of care in this population, investigators may obtain brain imaging if clinically indicated prior to initiation of anticoagulation. Imaging is not mandated in order to participate in this study. * History of allergic reactions attributed to compounds of similar chemical or biologic composition to apixaban. * Participants receiving any medications or substances that are inhibitors or inducers of CYP3A/P-gp are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product. * Participants on aspirin (\>100 mg/day), dual antiplatelet therapy, or receiving chronic treatment with NSAIDS * Participants with uncontrolled intercurrent illness. * Participants at high risk of bleeding such as: * Unresected luminal/mucosal GI and GU cancers * Active gastric or duodenal cancer * History of major bleeding (based on ISTH criteria) in the past 12 months * Any prior history of Intracranial hemorrhage (microhemorrhage is not included) * Clinical or laboratory concern for ongoing DIC (prolonged PT/APTT or low fibrinogen) * Severe renal disease (CKD Stage IV or higher) or liver disease (Child Pugh B/C) * Participants with pre-planned major surgery within the study period * Participants with psychiatric illness/social situations that would limit compliance with study requirements. * Pregnant women are excluded from this study because apixaban has the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with apixaban, breastfeeding should be discontinued if the mother is treated with apixaban. * Participant must be able to swallow pills.

Inclusion Criteria

Exclusion Criteria

* Active malignancy defined as histologically confirmed diagnosis within last 6 months or received any cancer directed therapy within the last 6 months.
* Radiologically confirmed newly diagnosed symptomatic deep vein thrombosis or pulmonary embolism within 28 days of enrollment. Includes proximal lower-limb DVT or symptomatic PE. Upper extremity or catheter-associated thrombosis will be included, as will distal lower extremity DVTs.
* Platelet count \< 75,000/ml (prior to platelet transfusion) within 28 days of VTE diagnosis.
* Platelet count responsive to transfusion if previously administered (defined as an average platelet increase of at least 10,000/ml over the last 3 transfusions.
* No evidence of active hemorrhage.
* No recent history of major hemorrhage (requiring transfusion, hospitalization or intervention) within the last 12 months.
* No known brain metastases.
* Age ≥18 years. Because no dosing or adverse event data are currently available on the use of apixaban in participants \<18 years of age, children are excluded from this study, but will be eligible for future pediatric trials.
* ECOG performance status ≤2
* Participants must have adequate organ and marrow function as defined below:
* Total bilirubin ≤ institutional upper limit of normal (ULN)
* AST(SGOT)/ALT(SGPT) ≤3 × institutional ULN
* Glomerular filtration rate (GFR) ≥25 mL/min/1.73/m2
* Human immunodeficiency virus (HIV)-infected participants on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
* For participants with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
* Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. For participants with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
* The effects of apixaban on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of apixaban administration.
* Ability to understand and the willingness to sign a written informed consent document.

* Participants who are receiving any other investigational agents.
* Participants who have had a thrombectomy, insertion of a caval filter, or require a fibrinolytic agent.
* Participants that have index events with severe clot burden defined as bilateral proximal lower extremity deep vein thrombosis and saddle embolism or pulmonary embolism with hemodynamic compromise.
* Participants with acute myeloid leukemia or myelodysplastic syndrome or who are undergoing or have undergone allogeneic stem cell transplant.
* Participants with luminal gastrointestinal malignancy or genitourinary cancer.
* Presence of known or prior brain metastasis, given the increased risk of life-threatening intracranial hemorrhage with anticoagulant use. While screening for brain metastases is not standard of care in this population, investigators may obtain brain imaging if clinically indicated prior to initiation of anticoagulation. Imaging is not mandated in order to participate in this study.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to apixaban.
* Participants receiving any medications or substances that are inhibitors or inducers of CYP3A/P-gp are ineligible. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product.
* Participants on aspirin (\>100 mg/day), dual antiplatelet therapy, or receiving chronic treatment with NSAIDS
* Participants with uncontrolled intercurrent illness.
* Participants at high risk of bleeding such as:
* Unresected luminal/mucosal GI and GU cancers
* Active gastric or duodenal cancer
* History of major bleeding (based on ISTH criteria) in the past 12 months
* Any prior history of Intracranial hemorrhage (microhemorrhage is not included)
* Clinical or laboratory concern for ongoing DIC (prolonged PT/APTT or low fibrinogen)
* Severe renal disease (CKD Stage IV or higher) or liver disease (Child Pugh B/C)
* Participants with pre-planned major surgery within the study period
* Participants with psychiatric illness/social situations that would limit compliance with study requirements.
* Pregnant women are excluded from this study because apixaban has the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with apixaban, breastfeeding should be discontinued if the mother is treated with apixaban.
* Participant must be able to swallow pills.

Contacts and Locations

Study Contact

Rushad Patell, MD

CONTACT

617-667-9179

rpatell@bidmc.harvard.edu

Fernanda De Queiroz Silva, MD

CONTACT

617-667-9920

fdequeir@bidmc.harvard.edu

Principal Investigator

Rushad Patell, MD

PRINCIPAL_INVESTIGATOR

Beth Israel Deaconess Medical Center

Study Locations (Sites)

Beth Israel Deaconess Medical Center

Boston, Massachusetts, 02215

United States

Collaborators and Investigators

Sponsor: Rushad Patell

Rushad Patell, MD, PRINCIPAL_INVESTIGATOR, Beth Israel Deaconess Medical Center

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2025-02-28

Study Completion Date2028-07-01

Study Record Updates

Study Start Date2025-02-28

Study Completion Date2028-07-01

Terms related to this study

Keywords Provided by Researchers

Venous Thromboembolism
Deep Vein Thrombosis
Pulmonary Embolism
Thrombocytopenia
Thromboembolism
Recurrent Venous Thromboembolism

Additional Relevant MeSH Terms

Deep Vein Thrombosis
Pulmonary Embolism and Thrombosis
Thrombocytopenia
Recurrent Venous Thromboembolism