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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT00235248
Registration number
NCT00235248
Ethics application status
Date submitted
6/10/2005
Date registered
10/10/2005
Date last updated
10/07/2012
Titles & IDs
Public title
Aortic Arch Related Cerebral Hazard Trial (ARCH)
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Scientific title
Prevention of New Vascular Events in Patients With Brain Infarction or Peripheral Embolism and Thoracic Aortic Plaques = 4 mm in Thickness in the Aortic Arch or Descending Aortic Upstream to the Embolized Artery
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Secondary ID [1]
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P991205
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Universal Trial Number (UTN)
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Trial acronym
ARCH
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Brain Infarction
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Transient Ischemic Attack
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Embolism
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Condition category
Condition code
Cardiovascular
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Diseases of the vasculature and circulation including the lymphatic system
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Stroke
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Ischaemic
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Neurological
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Other neurological disorders
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Blood
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Clotting disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Warfarin
Treatment: Drugs - Clopidogrel-aspirin
Experimental: Clopidogrel-aspirin - Clopidogrel-aspirin
Active comparator: Warfarin - Warfarin
Treatment: Drugs: Warfarin
Warfarin
Treatment: Drugs: Clopidogrel-aspirin
Clopidogrel-aspirin
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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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New vascular events assessed every 4 months including stroke, myocardial infarction (MI), peripheral events, and vascular death
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Assessment method [1]
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New vascular events assessed every 4 months including stroke, myocardial infarction (MI), peripheral events, and vascular death
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Timepoint [1]
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every 4 months
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Secondary outcome [1]
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Recurrent brain infarction
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Assessment method [1]
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Recurrent brain infarction
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Timepoint [1]
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during the trial
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Secondary outcome [2]
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brain infarction and transient ischemic attack (TIA)
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Assessment method [2]
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brain infarction and transient ischemic attack (TIA)
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Timepoint [2]
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during the studing
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Secondary outcome [3]
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new vascular events and revascularization procedure
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Assessment method [3]
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new vascular events and revascularization procedure
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Timepoint [3]
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during the trial
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Secondary outcome [4]
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vascular death
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Assessment method [4]
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vascular death
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Timepoint [4]
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during the trial
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Secondary outcome [5]
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death from all causes
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Assessment method [5]
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death from all causes
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Timepoint [5]
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during the trial
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Secondary outcome [6]
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combination of primary end-point and TIA
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Assessment method [6]
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combination of primary end-point and TIA
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Timepoint [6]
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during the trial
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Secondary outcome [7]
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revascularization procedures
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Assessment method [7]
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revascularization procedures
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Timepoint [7]
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during the trial
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Secondary outcome [8]
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urgent rehospitalization for ischemic
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Assessment method [8]
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urgent rehospitalization for ischemic
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Timepoint [8]
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during the trial
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Eligibility
Key inclusion criteria
Patients of both sexes aged = 18 years with the following 4 inclusion criteria:
* One of the 3 following ischemic events in the preceding 6 months:
* Transient ischemic attack (TIA)
* Non-disabling brain infarcts:
* Inclusion within 6 months after onset
* Duration of symptoms and signs greater than 24 hours
* Neurological signs at the time of randomization with a Rankin Scale grade 3 or less
* With normal computed tomography (CT) scan or CT scan showing a brain infarct (even hemorrhagic infarct)
* Peripheral embolism
* Atherosclerotic plaque in the thoracic aorta is defined as wall thickness = 4 mm where the protruding material is the largest, measured at transesophageal echocardiography with multiplane transducer or a plaque less than 4 mm but with mobile component.
* Informed consent signed
* Life expectancy > 3 years
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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
* Other causes of embolism:
* Cardiac: endocarditis, atrial fibrillation, intra-cardiac thrombus, valvular prosthesis, rheumatic valvulopathy, left ventricular aneurysm, or ejection fraction less than 25%
* Atherosclerotic stenosis ipsilateral to the embolic territory: internal carotid artery stenosis greater than 70%, or severe (judgment of the investigator) intracranial stenosis, or scheduled carotid endarterectomy (in that case inclusion is possible 30 days after the procedure)
* Uncommon causes: dissection, vasculitis, procoagulant state, or sickle cell disease
* Other exclusion criteria:
* Intercurrent illness with life expectancy less than 36 months
* Pregnancy and non-menopausal women
* Unwillingness to participate
* Poor medication compliance expected
* Toxicomania
* Absolute indication for anticoagulant therapy (e.g. atrial fibrillation, intracardiac thrombus, prosthetic valve)
* Scheduled for carotid endarterectomy (randomization is possible 30 days after endarterectomy)
* CT scan with an intracranial lesion other than brain infarction (space occupying mass, intracranial hemorrhage)
* Transesophageal echocardiography (TEE) with plaque = 4 mm in thickness distal to the supposed embolized artery (judgement of the investigator).
* Contraindication to clopidogrel, aspirin, and oral anticoagulants
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Study design
Purpose of the study
Prevention
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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
1/02/2002
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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
1/07/2012
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Sample size
Target
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Accrual to date
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Final
350
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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National Stroke Research Institute-Austin Health - Heidelberg Heights
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Recruitment postcode(s) [1]
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Vic 3081 - Heidelberg Heights
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Recruitment outside Australia
Country [1]
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France
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State/province [1]
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Paris
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Funding & Sponsors
Primary sponsor type
Other
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Name
Assistance Publique - Hôpitaux de Paris
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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National Health and Medical Research Council, Australia
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Address [1]
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Country [1]
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Other collaborator category [2]
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Commercial sector/industry
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Name [2]
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Sanofi
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Address [2]
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Country [2]
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Other collaborator category [3]
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Commercial sector/industry
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Name [3]
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Bristol-Myers Squibb
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Address [3]
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Country [3]
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Ethics approval
Ethics application status
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Summary
Brief summary
The ARCH is a controlled trial with a sequential design and with a prospective, randomized, open-label, blinded-endpoint (PROBE) methodology. The objective is to compare the efficacy and tolerance (net benefit) of two antithrombotic strategies in patients with atherothrombosis of the aortic arch and a recent (less than 6 months) cerebral or peripheral embolic event. Hypothesis: The association of clopidogrel 75 mg/d plus aspirin 75 mg/d is 25% more effective than an oral anticoagulant (target International Normalized Ratio \[INR\] 2 to 3) in preventing brain infarction, brain hemorrhage, myocardial infarction, peripheral embolism, and vascular death.
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Trial website
https://clinicaltrials.gov/study/NCT00235248
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Trial related presentations / publications
Amarenco P, Davis S, Jones EF, Cohen AA, Heiss WD, Kaste M, Laouenan C, Young D, Macleod M, Donnan GA; Aortic Arch Related Cerebral Hazard Trial Investigators. Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques. Stroke. 2014 May;45(5):1248-57. doi: 10.1161/STROKEAHA.113.004251. Epub 2014 Apr 3.
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Public notes
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Contacts
Principal investigator
Name
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Pierre Amarenco, Pr, MD, PhD
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Address
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Assistance Publique - Hôpitaux de Paris
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT00235248
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