A Study of the Effectiveness and Safety of Rivaroxaban on Venous Thromboembolic Risk in Patients Following Hospital Discharge

Overview

About this study

The purpose of this study is to evaluate the effectiveness and safety of rivaroxaban compared with placebo in the prevention of symptomatic venous thromboembolism events and related death after hospital discharge in high-risk, medically ill patients.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria

Duration of index hospitalization must have been at least 3 and no more than 10 consecutive days
Must meet venous thromboembolism (VTE) risk criteria with a total modified Improve VTE Risk Score of ≥ 4, or 3 with D-dimer > 2 upper limit of normal (ULN), or 2 with D-dimer > 2 ULN

Exclusion Criteria

Any serious bleeding within 3 months prior to randomization or occurring during index hospitalization
Serious trauma (including head trauma) within 4 weeks before randomization
History of hemorrhagic stroke at any time in the past
Any medical condition that requires chronic use of any parenteral or oral anticoagulation

More information

Publications

Hospital-associated venous thromboembolism (VTE) is a leading cause of premature death and disability worldwide. Evidence-based guidelines recommend that anticoagulant thromboprophylaxis be given to hospitalised medical patients at risk of VTE, but suggest against routine use of thromboprophylaxis beyond the hospital stay. The MARINER study is a randomised, double-blind, placebo-controlled trial to evaluate the efficacy and safety of thromboprophylaxis using rivaroxaban, begun at hospital discharge and continued for 45 days, for preventing symptomatic VTE in high-risk medical patients. Eligible patients are identified using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE VTE) risk score, combined with a laboratory test, D-dimer. The rivaroxaban regimen is 10 mg once daily for patients with CrCl ≥ 50 ml/min, or 7.5 mg once daily for patients with CrCl ≥ 30 ml/min and < 50 ml/min. The primary efficacy outcome is the composite of symptomatic VTE (lower extremity deep-vein thrombosis and non-fatal pulmonary embolism) and VTE-related death. The principal safety outcome is major bleeding. A blinded clinical events committee adjudicates all suspected outcome events. The sample size is event-driven with an estimated total of 8,000 patients to acquire 161 primary outcome events. Study design features that distinguish MARINER from previous and ongoing thromboprophylaxis trials in medically ill patients are: (i) use of a validated risk assessment model (IMPROVE VTE) and D-dimer determination for identifying eligible patients at high risk of VTE, (ii) randomisation at the time of hospital discharge, (iii) a 45-day treatment period and (iv) restriction of the primary efficacy outcome to symptomatic VTE events. Read More on PubMed

Clinical Trials