CClinicalTrials.gg
CompletedNCT00439777Updated Feb 27, 2014Results posted

Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Pulmonary Embolism - The EINSTEIN PE Study

A Phase 3 interventional study of Rivaroxaban (Xarelto, BAY59-7939) and Enoxaparin overlapping with and followed by VKA in Pulmonary Embolism, sponsored by Bayer. Completed at 305 sites in 39 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2014-02-27.

Sponsored by Bayer · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
4,833
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This is a multicenter, randomized, open-label, assessor-blind, event-driven, non-inferiority program for efficacy with a study treatment duration of 3, 6 or 12 months in patients with confirmed acute symptomatic pulmonary embolism (PE) with or without symptomatic Deep-Vein Thrombosis (DVT) (Einstein-PE).

Read the detailed description

Within the US 'Johnson \& Johnson Pharmaceutical Research \& Development, L.L.C.' is sponsor.

02

Conditions studied

  • Pulmonary Embolism
03

In context

Pulmonary Embolism

739 studies on the registry are indexed under Pulmonary Embolism; 159 are open to participants now.

This study's enrollment of 4,833 is above the median of 150 across 381 interventional studies indexed under Pulmonary Embolism.

Browse Pulmonary Embolism studies →

Lead sponsor

Bayer is the lead sponsor of 1,643 studies on the registry; 57 are open to participants now.

Of its 209 completed or terminated interventional studies of FDA-regulated products, 129 (62%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Confirmed acute symptomatic proximal PE with or without symptomatic DVT

Exclusion criteria

Exclusion Criteria:

  • Legal lower age limitations (country specific)
  • Thrombectomy, insertion of a caval filter, or use of a fibrinolytic agent to treat the current episode of DVT and/or PE
  • Other indication for VKA than DVT and/or PE
  • The pre-randomization anti-coagulant treatment (Criteria # 4) has been prolonged from 36 hours to a maximum of 48 hours.
05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
4,833 participants (actual)

Study arms

  • Experimental
    Rivaroxaban (Xarelto, BAY59-7939)

    Participants received 15 mg rivaroxaban (oral) twice daily (b.i.d.) for 3 weeks, followed by 20 mg once daily (o.d.)

    Drug: Rivaroxaban (Xarelto, BAY59-7939)

  • Active comparator
    Enoxaparin/VKA

    Participants received enoxaparin (subcutaneous) 1.0 mg/kg b.i.d. for minimal 5 days, plus vitamin K antagonist (VKA) at individually titrated doses to achieve a target international normalized ratio (INR) of 2.5 (range: 2.0 - 3.0)

    Drug: Enoxaparin overlapping with and followed by VKA

Interventions

  • DrugRivaroxaban (Xarelto, BAY59-7939)

    During the first 3 weeks patients will receive 15 mg rivaroxaban twice-daily. Thereafter, patients will receive rivaroxaban 20 mg once-daily. Rivaroxaban will be administered orally and should be taken with food.

  • DrugEnoxaparin overlapping with and followed by VKA

    Enoxaparin 1.0 mg/kg twice daily with a minimal duration of 5 days. This 5 days treatment could include the period up to 36 hr before randomization if enoxaparin twice-daily was used. VKA should be started as soon as possible but not later than 48 hours after randomization.

06

What researchers measure

Primary outcomes

  1. Percentage of Participants With Symptomatic Recurrent Venous Thromboembolism [VTE] (i.e. the Composite of Recurrent Deep Vein Thrombosis [DVT] or Fatal or Non-fatal Pulmonary Embolism [PE]) Until the Intended End of Study Treatment

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for fatal PE) or unexplained death for which DVT/PE could not be ruled out (for fatal PE), and/or case summaries.

    Time frame: 3-, 6-, or 12-month study treatment period

Secondary outcomes

  1. Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality Until the Intended End of Study Treatment

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for deaths), results/films/images of confirmatory testing, and/or case summaries.

    Time frame: 3-, 6-, or 12-month study treatment period

  2. Percentage of Participants With an Event for Net Clinical Benefit 1 Until the Intended End of Study Treatment

    Net clinical benefit 1: composite of recurrent DVT or non-fatal or fatal PE, and major bleeding. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

    Time frame: 3-, 6-, or 12-month study treatment period

  3. Percentage of Participants With Recurrent PE Until the Intended End of Study Treatment

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

    Time frame: 3-, 6- or 12-month study treatment period

  4. Percentage of Participants With Recurrent DVT Until the Intended End of Study Treatment

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound, venography, results/films/images of confirmatory testing, and/or case summaries.

    Time frame: 3-, 6- or 12-month study treatment period

  5. Percentage of Participants With Clinically Relevant Bleeding, Treatment-emergent (Time Window: Until 2 Days After Last Dose)

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Clinically relevant bleeding included major bleeding (overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of 2 or more units of packed red blood cells or whole blood, occurring in a critical site or contributing to death) and non-major bleeding associated with medical intervention, unscheduled physician contact, (temporary) cessation of study treatment, discomfort for the participants such as pain, or impairment of activities of daily life.

    Time frame: 3-, 6- or 12-month study treatment period

  6. Percentage of Participants With All Deaths

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either autopsy, results/films/images of confirmatory testing, and/or case summaries.

    Time frame: 3-, 6- or 12-month study treatment period

  7. Percentage of Participants With Other Vascular Events, On-treatment (Time Window: Until 1 Day After Last Dose)

    All pre-defined vascular events (ST segment elevation myocardial infarction, non ST segment elevation myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, non-central nervous system systemic embolism or vascular death) were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based results/films/images of confirmatory testing, and/or case summaries.

    Time frame: 3-, 6- or 12-month study treatment period

Other outcomes

  1. Percentage of Participants With the Individual Components of Efficacy Outcomes Until the Intended End of Study Treatment

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death.

    Time frame: 3-, 6- or 12-month study treatment period

  2. Percentage of Participants With Symptomatic Recurrent VTE (i.e. the Composite of Recurrent DVT or Fatal or Non-fatal PE) During Observational Period

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for fatal PE) or unexplained death for which DVT/PE could not be ruled out (for fatal PE), and/or case summaries.

    Time frame: Up to 30 days after the last intake of study medication

  3. Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality During Observational Period

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for deaths), results/films/images of confirmatory testing, and/or case summaries.

    Time frame: Up to 30 days after the last intake of study medication

  4. Percentage of Participants With an Event for Net Clinical Benefit 1 During Observational Period

    Net clinical benefit 1: composite of recurrent DVT or non-fatal or fatal PE, and major bleeding. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

    Time frame: Up to 30 days after the last intake of study medication

  5. Percentage of Participants With Recurrent DVT During Observational Period

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound, venography, results/films/images of confirmatory testing, and/or case summaries.

    Time frame: Up to 30 days after the last intake of study medication

  6. Percentage of Participants With the Individual Components of Efficacy Outcomes During Observational Period

    All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death.

    Time frame: Up to 30 days after the last intake of study medication

07

Results

Posted Jan 24, 2013

Participant flow

Participants with confirmed acute symptomatic pulmonary embolism (PE) with or without symptomatic deep vein thrombosis (DVT) were recruited at specialized study sites.

Treatment Period
Participant flow — Treatment Period
MilestoneRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Started24202413
Participants received treatment24122405
Completed20011954
Not completed419459
Withdrew: Death2921
Withdrew: Study terminated by sponsor125132
Withdrew: Site closed by investigator01
Withdrew: Did not take study treatment78
Withdrew: Adverse event11192
Withdrew: Protocol violation2330
Withdrew: Withdrawal by subject66118
Withdrew: Lack of efficacy14
Withdrew: Lost to follow-up810
Withdrew: Protocol driven decision point13
Withdrew: Physician decision718
Withdrew: Clinical endpoint reached2613
Withdrew: Technical problems31
Withdrew: Participant convenience128
Observational Period
Participant flow — Observational Period
MilestoneRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Started22062197
Completed21652156
Not completed4141
Withdrew: Protocol violation02
Withdrew: Withdrawal by subject95
Withdrew: Lost to follow-up111
Withdrew: Death2720
Withdrew: Study terminated by sponsor31
Withdrew: Protocol driven decision point01
Withdrew: Lack of efficacy10
Withdrew: Technical problems01

Outcome measures

PrimaryPercentage of Participants With Symptomatic Recurrent Venous Thromboembolism [VTE] (i.e. the Composite of Recurrent Deep Vein Thrombosis [DVT] or Fatal or Non-fatal Pulmonary Embolism [PE]) Until the Intended End of Study Treatment

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for fatal PE) or unexplained death for which DVT/PE could not be ruled out (for fatal PE), and/or case summaries.

Time frame:
3-, 6-, or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With Symptomatic Recurrent Venous Thromboembolism [VTE] (i.e. the Composite of Recurrent Deep Vein Thrombosis [DVT] or Fatal or Non-fatal Pulmonary Embolism [PE]) Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Symptomatic Recurrent Venous Thromboembolism [VTE] (i.e. the Composite of Recurrent Deep Vein Thrombosis [DVT] or Fatal or Non-fatal Pulmonary Embolism [PE]) Until the Intended End of Study Treatment2.11.8
Statistical analysis
  • Rivaroxaban (Xarelto, BAY59-7939) vs Enoxaparin/VKA · Regression, Cox · p = 0.0026 · Hazard ratio (hr): 1.12 · 95% CI 0.75 to 1.68The standard error of the log hazard ratio was estimated.
SecondaryPercentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality Until the Intended End of Study Treatment

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for deaths), results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6-, or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality Until the Intended End of Study Treatment4.03.4
Statistical analysis
  • Rivaroxaban (Xarelto, BAY59-7939) vs Enoxaparin/VKA · Regression, Cox · p = 0.33 (Nominal p-value) · Hazard ratio (hr): 1.16 · 95% CI 0.86 to 1.56The standard error of the log hazard ratio was estimated.
SecondaryPercentage of Participants With an Event for Net Clinical Benefit 1 Until the Intended End of Study Treatment

Net clinical benefit 1: composite of recurrent DVT or non-fatal or fatal PE, and major bleeding. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6-, or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With an Event for Net Clinical Benefit 1 Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With an Event for Net Clinical Benefit 1 Until the Intended End of Study Treatment3.44.0
Statistical analysis
  • Rivaroxaban (Xarelto, BAY59-7939) vs Enoxaparin/VKA · Regression, Cox · p = 0.275 (Nominal p-value) · Hazard ratio (hr): 0.85 · 95% CI 0.63 to 1.14The standard error of the log hazard ratio was estimated.
SecondaryPercentage of Participants With Recurrent PE Until the Intended End of Study Treatment

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With Recurrent PE Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Recurrent PE Until the Intended End of Study Treatment1.41.2
Statistical analysis
  • Rivaroxaban (Xarelto, BAY59-7939) vs Enoxaparin/VKA · Regression, Cox · p = 0.55 (nominal p-value) · Hazard ratio (hr): 1.16 · 95% CI 0.70 to 1.93The standard error of the log hazard ratio was estimated.
SecondaryPercentage of Participants With Recurrent DVT Until the Intended End of Study Treatment

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound, venography, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With Recurrent DVT Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Recurrent DVT Until the Intended End of Study Treatment0.70.8
Statistical analysis
  • Rivaroxaban (Xarelto, BAY59-7939) vs Enoxaparin/VKA · Regression, Cox · p = 0.85 (Nominal p-value) · Hazard ratio (hr): 0.94 · 95% CI 0.49 to 1.79The standard error of the log hazard ratio was estimated.
SecondaryPercentage of Participants With Clinically Relevant Bleeding, Treatment-emergent (Time Window: Until 2 Days After Last Dose)

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Clinically relevant bleeding included major bleeding (overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of 2 or more units of packed red blood cells or whole blood, occurring in a critical site or contributing to death) and non-major bleeding associated with medical intervention, unscheduled physician contact, (temporary) cessation of study treatment, discomfort for the participants such as pain, or impairment of activities of daily life.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With Clinically Relevant Bleeding, Treatment-emergent (Time Window: Until 2 Days After Last Dose)
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Clinically Relevant Bleeding, Treatment-emergent (Time Window: Until 2 Days After Last Dose)10.311.4
Statistical analysis
  • Rivaroxaban (Xarelto, BAY59-7939) vs Enoxaparin/VKA · Regression, Cox · p = 0.23 (If the primary efficacy analysis shows that rivaroxaban is non-inferior to the comparator, the principal safety outcome was to be compared between treatment groups to maintain the overall type I error of 0.05 (2-sided) (a closed testing procedure).) · Hazard ratio (hr): 0.90 · 95% CI 0.76 to 1.07The standard error of the log hazard ratio was estimated.
SecondaryPercentage of Participants With All Deaths

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either autopsy, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With All Deaths
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
All post-randomization2.62.1
Treatment-emergent (time window: 2 days)1.20.8
Treatment-emergent (time window: 7 days)1.51.1
SecondaryPercentage of Participants With Other Vascular Events, On-treatment (Time Window: Until 1 Day After Last Dose)

All pre-defined vascular events (ST segment elevation myocardial infarction, non ST segment elevation myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, non-central nervous system systemic embolism or vascular death) were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With Other Vascular Events, On-treatment (Time Window: Until 1 Day After Last Dose)
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Other Vascular Events, On-treatment (Time Window: Until 1 Day After Last Dose)1.51.5
Other pre-specifiedPercentage of Participants With the Individual Components of Efficacy Outcomes Until the Intended End of Study Treatment

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With the Individual Components of Efficacy Outcomes Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Death (PE)0.10.04
Death (PE cannot be excluded)0.30.2
Symptomatic PE and DVT0.00.1
Symptomatic recurrent PE only1.00.8
Symptomatic recurrent DVT only0.70.7
Death (bleeding)0.20.2
Death (cardiovascular)0.40.1
Death (other)1.31.5
Major bleeding1.42.4
Other pre-specifiedPercentage of Participants With Symptomatic Recurrent VTE (i.e. the Composite of Recurrent DVT or Fatal or Non-fatal PE) During Observational Period

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for fatal PE) or unexplained death for which DVT/PE could not be ruled out (for fatal PE), and/or case summaries.

Time frame:
Up to 30 days after the last intake of study medication
Reported as:
Number · Percentage of participants
Percentage of Participants With Symptomatic Recurrent VTE (i.e. the Composite of Recurrent DVT or Fatal or Non-fatal PE) During Observational Period
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Symptomatic Recurrent VTE (i.e. the Composite of Recurrent DVT or Fatal or Non-fatal PE) During Observational Period0.90.7
Other pre-specifiedPercentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality During Observational Period

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound (for DVT), venography (for DVT), spiral computed tomography (CT) scanning (for PE), pulmonary angiography (for PE), ventilation/perfusion lung scan (for PE), lung scintigraphy (for PE), autopsy (for deaths), results/films/images of confirmatory testing, and/or case summaries.

Time frame:
Up to 30 days after the last intake of study medication
Reported as:
Number · Percentage of participants
Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality During Observational Period
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With the Composite Variable Comprising Recurrent DVT, Non-fatal PE and All Cause Mortality During Observational Period2.11.5
Other pre-specifiedPercentage of Participants With an Event for Net Clinical Benefit 1 During Observational Period

Net clinical benefit 1: composite of recurrent DVT or non-fatal or fatal PE, and major bleeding. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
Up to 30 days after the last intake of study medication
Reported as:
Number · Percentage of participants
Percentage of Participants With an Event for Net Clinical Benefit 1 During Observational Period
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With an Event for Net Clinical Benefit 1 During Observational Period1.21.2
Other pre-specifiedPercentage of Participants With Recurrent DVT During Observational Period

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment. Events were assessed based on either compression ultrasound, venography, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
Up to 30 days after the last intake of study medication
Reported as:
Number · Percentage of participants
Percentage of Participants With Recurrent DVT During Observational Period
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With Recurrent DVT During Observational Period0.30.1
Other pre-specifiedPercentage of Participants With the Individual Components of Efficacy Outcomes During Observational Period

All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound, venography, spiral computed tomography scanning, pulmonary angiography, ventilation/perfusion lung scan, lung scintigraphy, autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries. Major bleeding was overt bleeding associated with 2 g/dL or greater fall in hemoglobin, leading to a transfusion of ≥2 units, occurring in a critical site or contributing to death.

Time frame:
Up to 30 days after the last intake of study medication
Reported as:
Number · Percentage of participants
Percentage of Participants With the Individual Components of Efficacy Outcomes During Observational Period
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Death (PE)0.090
Death (PE cannot be excluded)00.05
Symptomatic PE and DVT0.090
Symptomatic recurrent PE only0.50.5
Symptomatic recurrent DVT only0.20.1
Death (bleeding)0.090.09
Death (cardiovascular)0.30.05
Death (other)0.80.7
Major bleeding0.30.5
Post-hocPercentage of Participants With an Event for Net Clinical Benefit 2 Until the Intended End of Study Treatment

Net clinical benefit 2: composite of recurrent DVT or non-fatal or fatal PE, major bleeding (associated with 2 g/dL or greater fall in hemoglobin, leading to transfusion of ≥2 units, occurring in a critical site or contributing to death), cardiovascular death, myocardial infarction, stroke, and non CNS (central nervous system) systemic embolism. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound (DVT), venography (DVT), spiral CT scanning (PE), pulmonary angiography (PE), ventilation/perfusion lung scan (PE), lung scintigraphy (PE), autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
3-, 6- or 12-month study treatment period
Reported as:
Number · Percentage of participants
Percentage of Participants With an Event for Net Clinical Benefit 2 Until the Intended End of Study Treatment
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With an Event for Net Clinical Benefit 2 Until the Intended End of Study Treatment4.54.8
Post-hocPercentage of Participants With an Event for Net Clinical Benefit 2 During Observational Period

Net clinical benefit 2: composite of recurrent DVT or non-fatal or fatal PE, major bleeding (associated with 2 g/dL or greater fall in hemoglobin, leading to transfusion of ≥2 units, occurring in a critical site or contributing to death), cardiovascular death, myocardial infarction, stroke, and non CNS (central nervous system) systemic embolism. Net clinical benefit was considered greater in those participants with fewer composite events. All events were adjudicated and confirmed by a central independent adjudication committee blinded to treatment, based on either compression ultrasound (DVT), venography (DVT), spiral CT scanning (PE), pulmonary angiography (PE), ventilation/perfusion lung scan (PE), lung scintigraphy (PE), autopsy or unexplained death for which DVT/PE could not be ruled out, results/films/images of confirmatory testing, and/or case summaries.

Time frame:
Up to 30 days after the last intake of study medication
Reported as:
Number · Percentage of participants
Percentage of Participants With an Event for Net Clinical Benefit 2 During Observational Period
Percentage of participantsRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Percentage of Participants With an Event for Net Clinical Benefit 2 During Observational Period1.51.4

Adverse events

Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Rivaroxaban (Xarelto, BAY59-7939)—504/2,412 (20.9%)1,053/2,412 (43.7%)
Enoxaparin/VKA—495/2,405 (20.6%)1,065/2,405 (44.3%)
Most frequent serious events
Showing 10 of 603
Most frequent serious events
EventRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
Chest painGeneral disorders21/241227/2405
PneumoniaInfections and infestations22/241221/2405
DyspnoeaRespiratory, thoracic and mediastinal disorders17/241213/2405
AnaemiaBlood and lymphatic system disorders14/24126/2405
SepsisInfections and infestations13/24122/2405
Ischaemic strokeNervous system disorders13/24125/2405
Atrial fibrillationCardiac disorders8/241211/2405
HaematuriaRenal and urinary disorders8/241211/2405
Pleural effusionRespiratory, thoracic and mediastinal disorders9/241211/2405
Acute myocardial infarctionCardiac disorders6/241210/2405
Most frequent other events
Showing 10 of 12
Most frequent other events
EventRivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKA
EpistaxisRespiratory, thoracic and mediastinal disorders229/2412205/2405
HeadacheNervous system disorders196/2412177/2405
NasopharyngitisInfections and infestations188/2412195/2405
Chest painGeneral disorders179/2412181/2405
CoughRespiratory, thoracic and mediastinal disorders160/2412179/2405
Pain in extremityMusculoskeletal and connective tissue disorders172/2412162/2405
DyspnoeaRespiratory, thoracic and mediastinal disorders156/2412147/2405
ConstipationGastrointestinal disorders146/2412141/2405
Back painMusculoskeletal and connective tissue disorders87/2412134/2405
ContusionInjury, poisoning and procedural complications95/2412133/2405

Baseline characteristics

Age, Continuous
Age, Continuous(Years)Rivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKATotal
Mean57.9 ± 17.357.5 ± 17.257.7 ± 17.3
Age, Customized
Age, Customized(Participants)Rivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKATotal
18 - < 40 years410432842
40 - < 60 years7947791573
60 - < 75 years7407541494
≥ 75 years475448923
Sex: Female, Male
Sex: Female, Male(Participants)Rivaroxaban (Xarelto, BAY59-7939)Enoxaparin/VKATotal
Female130912472556
Male111011662276
08

Study locations

305 sites
  • Little Rock, Arkansas 72205, United States
  • Redlands, California 92373, United States
  • Bay Pines, Florida 33744, United States
  • Miami, Florida 33136-1096, United States
  • Miami, Florida 33136, United States
  • Idaho Falls, Idaho 83404, United States
  • Covington, Louisiana 70433, United States
  • Baltimore, Maryland 21215, United States
  • Boston, Massachusetts 02215, United States
  • Chesterfield, Missouri 63017, United States
  • Albuquerque, New Mexico 87108, United States
  • Chapel Hill, North Carolina 27599-7035, United States
  • Greensboro, North Carolina 27401, United States
  • Greensboro, North Carolina 27403, United States
  • Oklahoma City, Oklahoma 73104, United States
  • Camp Hill, Pennsylvania 17011, United States
  • Pittsburgh, Pennsylvania 15224, United States
  • San Antonio, Texas 78229, United States
  • Murray, Utah 84107, United States
  • Salt Lake City, Utah 84132, United States
  • Fredericksburg, Virginia 22401, United States
  • Spokane, Washington 99204, United States
  • Tacoma, Washington 98405, United States
  • Escaldes - Engordany, Andorra
  • Garran, Australian Capital Territory 2605, Australia
  • Gosford, New South Wales 2250, Australia
  • Kogarah, New South Wales 2217, Australia
  • Lismore, New South Wales 2480, Australia
  • St Leonards, New South Wales 2065, Australia
  • Sydney, New South Wales 2031, Australia
  • Sydney, New South Wales 2139, Australia
  • Sydney, New South Wales 2229, Australia
  • Brisbane, Queensland 4029, Australia
  • Redcliffe, Queensland 4020, Australia
  • Southport, Queensland 4215, Australia
  • Woolloongabba, Queensland 4102, Australia
  • Adelaide, South Australia 5042, Australia
  • Woodville South, South Australia 5011, Australia
  • Launceston, Tasmania 7250, Australia
  • Box Hill, Victoria 3128, Australia
  • Clayton, Victoria 3168, Australia
  • Geelong, Victoria 3220, Australia
  • Melbourne, Victoria 3135, Australia
  • Melbourne, Victoria 3181, Australia
  • Fremantle, Western Australia 6160, Australia
  • Perth, Western Australia 6000, Australia
  • Graz, Steiermark 8036, Austria
  • Feldkirch, Vorarlberg 6807, Austria
  • Innsbruck, 6020, Austria
  • Linz, 4010, Austria
  • Wien, 1090, Austria
  • Wien, 1140, Austria
  • Wien, 1171, Austria
  • Aalst, 9300, Belgium
  • Bruxelles - Brussel, 1070, Belgium
  • Bruxelles - Brussel, 1200, Belgium
  • Duffel, 2570, Belgium
  • Genk, 3600, Belgium
  • Gent, 9000, Belgium
  • Hasselt, 3500, Belgium
  • Leuven, 3000, Belgium
  • Liege, 4000, Belgium
  • Lier, 2500, Belgium
  • Namur, 5000, Belgium
  • Yvoir, 5530, Belgium
  • Zottegem, 9620, Belgium
  • Curitiba, Parana 80050-350, Brazil
  • Londrina, Parana 86038440, Brazil
  • Botucatu, Sao Paulo 18618 000, Brazil
  • Sorocaba, Sao Paulo 18031-000, Brazil
  • São Paulo, Sao Paulo 01323-001, Brazil
  • São Paulo, Sao Paulo 04039-004, Brazil
  • São Paulo, Sao Paulo 08270-070, Brazil
  • Rio de Janeiro, Brazil
  • Sao Paulo, 01509-900, Brazil
  • Winnipeg, Manitoba R2H 2A6, Canada
  • London, Ontario N6A 4G5, Canada
  • Ottawa, Ontario K1Y 4E9, Canada
  • Toronto, Ontario M4N 3M5, Canada
  • Toronto, Ontario M6R 1B5, Canada
  • Guangzhou, Guangdong 510080, China
  • Guangzhou, Guangdong 510120, China
  • Guangzhou, Guangdong, China
  • Nanning, Guangxi 530021, China
  • Harbin, Heilongjiang 150086, China
  • Wuhan, Hubei 430022, China
  • Suzhou, Jiangsu 215004, China
  • Shenyang, Liaoning 110016, China
  • Hangzhou, Zhejiang 310016, China
  • Beijing, 100020, China
  • Beijing, 100029, China
  • Beijing, 100037, China
  • Beijing, 100038, China
  • Beijing, 100044, China
  • Beijing, 100730, China
  • Beijing, 100853, China
  • Shanghai, 200001, China
  • Shanghai, 200032, China
  • Shanghai, 200433, China
  • Kladno, 27259, Czech Republic

Showing the first 100 of 305 sites across 39 countries.

09

References and documents

Publications

  • EINSTEIN-PE Investigators; Buller HR, Prins MH, Lensin AW, Decousus H, Jacobson BF, Minar E, Chlumsky J, Verhamme P, Wells P, Agnelli G, Cohen A, Berkowitz SD, Bounameaux H, Davidson BL, Misselwitz F, Gallus AS, Raskob GE, Schellong S, Segers A. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012 Apr 5;366(14):1287-97. doi: 10.1056/NEJMoa1113572. Epub 2012 Mar 26. PubMed 22449293 ↗
  • Prins MH, Lensing AW. Derivation of the non-inferiority margin for the evaluation of direct oral anticoagulants in the treatment of venous thromboembolism. Thromb J. 2013 Jul 6;11(1):13. doi: 10.1186/1477-9560-11-13. PubMed 23829521 ↗
  • Prins MH, Lensing AW, Bauersachs R, van Bellen B, Bounameaux H, Brighton TA, Cohen AT, Davidson BL, Decousus H, Raskob GE, Berkowitz SD, Wells PS; EINSTEIN Investigators. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013 Sep 20;11(1):21. doi: 10.1186/1477-9560-11-21. PubMed 24053656 ↗
  • Wang Y, Wang C, Chen Z, Zhang J, Liu Z, Jin B, Ying K, Liu C, Shao Y, Jing Z, Meng IL, Prins MH, Pap AF, Muller K, Lensing AW; Chinese EINSTEIN Investigators. Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies. Thromb J. 2013 Dec 16;11(1):25. doi: 10.1186/1477-9560-11-25. PubMed 24341332 ↗
  • van Bellen B, Bamber L, Correa de Carvalho F, Prins M, Wang M, Lensing AW. Reduction in the length of stay with rivaroxaban as a single-drug regimen for the treatment of deep vein thrombosis and pulmonary embolism. Curr Med Res Opin. 2014 May;30(5):829-37. doi: 10.1185/03007995.2013.879439. Epub 2014 Jan 22. PubMed 24432872 ↗
  • Ten Cate H, Lensing AWA, Weitz JI, Middeldorp S, Beyer-Westendorf J, Kubitza D, Brighton T, Raskob GE, Mismetti P, Prandoni P, Gebel M, Prins MH. The prothrombin time does not predict the risk of recurrent venous thromboembolism or major bleeding in rivaroxaban-treated patients. Thromb Res. 2018 Oct;170:75-83. doi: 10.1016/j.thromres.2018.08.008. Epub 2018 Aug 15. PubMed 30121419 ↗
  • Di Nisio M, Vedovati MC, Riera-Mestre A, Prins MH, Mueller K, Cohen AT, Wells PS, Beyer-Westendorf J, Prandoni P, Bounameaux H, Kubitza D, Schneider J, Pisters R, Fedacko J, Fontes-Carvalho R, Lensing AW. Treatment of venous thromboembolism with rivaroxaban in relation to body weight. A sub-analysis of the EINSTEIN DVT/PE studies. Thromb Haemost. 2016 Sep 27;116(4):739-46. doi: 10.1160/TH16-02-0087. Epub 2016 Aug 18. PubMed 27535349 ↗
  • Wells PS, Gebel M, Prins MH, Davidson BL, Lensing AW. Influence of statin use on the incidence of recurrent venous thromboembolism and major bleeding in patients receiving rivaroxaban or standard anticoagulant therapy. Thromb J. 2014 Nov 26;12:26. doi: 10.1186/1477-9560-12-26. eCollection 2014. PubMed 25698905 ↗
  • Prins MH, Lensing AW, Brighton TA, Lyons RM, Rehm J, Trajanovic M, Davidson BL, Beyer-Westendorf J, Pap AF, Berkowitz SD, Cohen AT, Kovacs MJ, Wells PS, Prandoni P. Oral rivaroxaban versus enoxaparin with vitamin K antagonist for the treatment of symptomatic venous thromboembolism in patients with cancer (EINSTEIN-DVT and EINSTEIN-PE): a pooled subgroup analysis of two randomised controlled trials. Lancet Haematol. 2014 Oct;1(1):e37-46. doi: 10.1016/S2352-3026(14)70018-3. Epub 2014 Sep 28. PubMed 27030066 ↗
  • Bauersachs RM, Lensing AW, Prins MH, Kubitza D, Pap AF, Decousus H, Beyer-Westendorf J, Prandoni P. Rivaroxaban versus enoxaparin/vitamin K antagonist therapy in patients with venous thromboembolism and renal impairment. Thromb J. 2014 Nov 24;12:25. doi: 10.1186/1477-9560-12-25. eCollection 2014. PubMed 25750589 ↗
  • Cohen AT, Dobromirski M. The use of rivaroxaban for short- and long-term treatment of venous thromboembolism. Thromb Haemost. 2012 Jun;107(6):1035-43. doi: 10.1160/TH11-12-0859. Epub 2012 Feb 28. PubMed 22371186 ↗
10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Feb 27, 2014, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT00439777
Lead sponsor
Bayer
Collaborators
Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
Responsible party
Sponsor
First posted
Feb 26, 2007
Start date
Mar 2007
Primary completion
Sep 2011
Completion
Dec 2011
Results posted
Jan 24, 2013
Last update
Feb 27, 2014

Study contacts

Bayer Study Director
study director · Bayer

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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