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Results from RE-SPECT CVT® published - first trial of NOAC in cerebral venous thrombosis

  • Study published in JAMA Neurology investigated Pradaxa® (dabigatran etexilate) in patients with cerebral venous and dural sinus thrombosis (CVT)
  • First exploratory study of a non-vitamin K antagonist oral anticoagulant (NOAC) in this population
  • The study is part of Boehringer Ingelheim’s commitment to advancing thrombosis care

Ingelheim, Germany, 4 September 2019 - Boehringer Ingelheim today announced the publication of primary analysis from RE-SPECT CVT®, the first exploratory, prospective, randomised controlled study of a NOAC in patients with blood clots in the veins or venous sinuses of the brain. The trial investigated the safety and efficacy of Pradaxa® (dabigatran etexilate) and dose-adjusted warfarin in patients with CVT.

The results provide insight into the role of anticoagulation in patients with CVT of mild-moderate severity. In the study, there were no recurrent venous thromboembolism (VTE) events in either treatment group.1 The trial also found that the rate of bleeding was low, with two patients in the warfarin arm (3.3%) and one (1.7%) in the dabigatran arm developing a major bleed. There was no mortality in either treatment arm in this study.1   

“Cerebral venous thrombosis, CVT, which affects predominantly young patients and women, can cause death and disability. Patients who survive the acute phase of CVT may suffer recurrent venous thrombosis. To prevent that, the usual clinical practice is to prescribe vitamin K antagonists (VKAs, such as warfarin). VKAs present limitations in terms of safety, dosing, reversibility and patient preference,” said Professor José M. Ferro, Director of the Department of Neurosciences and Mental Health at the Hospital Santa Maria in Lisbon, Portugal, and Chair of the RE-SPECT CVT Steering Committee. “RE-SPECT CVT was the largest trial performed in patients with CVT to date, enrolling 120 patients. The trial showed that the risk of recurrent VTE in CVT patients of mild to moderate severity under anticoagulant therapy with dabigatran for six months was low and associated with few major or clinically relevant bleeding events.”

The trial forms part of Boehringer Ingelheim’s ongoing commitment to expanding scientific knowledge of thrombosis care. Additionally, it furthers the understanding of the safety profile of dabigatran, which has been documented in the extensive RE-VOLUTION® trial and registry programme.2-24

About the RE-SPECT CVT®study
Randomised evaluation of the safety and efficacy of dabigatran etexilate versus dose adjusted warfarin in patients with cerebral venous thrombosis (RE-SPECT CVT®)1

RE-SPECT CVT® was a prospective, randomised exploratory study assessing the safety and efficacy of dabigatran etexilate and warfarin in patients who suffer from CVT. The open-label study involved 120 patients from nine countries and looked to evaluate the suitability of dabigatran etexilate and warfarin for the treatment and secondary prevention of blood clots in the veins or venous sinuses of the brain. Patients aged ≥ 18 years old with a confirmed diagnosis of CVT (with or without haemorrhagic stroke) were randomised to receive either warfarin or dabigatran etexilate.1

Boehringer Ingelheim
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3.2 billion euros, corresponded to 18.1 per cent of net sales. 

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References

1 Ferro JM. et al. Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous Thrombosis: A Randomized Clinical Trial. JAMA Neurol. Published online September 03, 2019. doi:10.1001/jamaneurol.2019.2764
2 Connolly. SJ. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51. 
3 Connolly SJ. et al. Newly identified events in the RE-LY trial. N Engl J Med. 2010;363:1875-76.
4 Connolly SJ et al. Additional Events in the RE-LY Trial. N Engl J Med. 2014;371:1464–5
5 Connolly SJ et al. The Long-Term Multicenter Observational Study of Dabigatran Treatment in Patients With Atrial Fibrillation (RELY-ABLE) Study. Circulation. 2013;128:237–43
6 Ezekowitz MD et al. Long-term evaluation of dabigatran 150 vs. 110 mg twice a day in patients with non-valvular atrial fibrillation. Europace. 2016;18:973–8
7 Cannon CP et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med. 2017;377:1513–24
8 Calkins H et al. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation. N Engl J Med. 2017;376:1627–36
9 Pollack CV et al. Idarucizumab for Dabigatran Reversal - Full Cohort Analysis. N Engl J Med. 2017;377:431–41
10 Pollack CV et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373:511–20
11 Eriksson BI et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thomb Haemost. 2007;5:2178–85
12 RE-MOBILIZE Writing Committee et al. Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplasty. 2009;24:1–9
13 Eriksson BI et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 2007;370:949–56
14 Eriksson BI et al. Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, double-blind, non-inferiority trial. Thromb Haemost. 2011;105:721–9
15 Schulman S et al. Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism. N Engl J Med. 2009;361:2342–52
16 Schulman S et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129:764–72
17 Schulman S et al. Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism. N Engl J Med. 2013;368:709–18
18 Eikelboom JW et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206–14
19 Diener HC et al. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med 2019; 380:1906-1917.
20 Ferro JM. et al. Randomized evaluation of the safety and efficacy of dabigatran etexilate versus dose adjusted warfarin in patients with cerebral venous thrombosis (RE-SPECT CVT). Presented on Tuesday 10 May at the 2nd European Stroke Organisation Conference 2016, Barcelona, Spain.
21 Ageno W et al. RE-COVERY DVT/PE: Rationale and design of a prospective observational study of acute venous thromboembolism with a focus on dabigatran etexilate. Thromb Haemost. 2017;117:415–21
22 Huisman MV et al. The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2. J Am Coll Cardiol. 2017;69:777–85
23 Huisman MV et al. Design and rationale of Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation: a global registry program on long-term oral antithrombotic treatment in patients with atrial fibrillation.
 Am Heart J.2014;167:329–34
24 Fanikos J et al. RE-VECTO: Idarucizumab drug administration surveillance program results. The Congress on Open Issues in Thrombosis and Hemostasis 2018 jointly with the 9th Russian Conference on Clinical Hemostasiology and Hemorheology. Abstract;68.

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