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CompletedNCT02798471Updated Feb 28, 2025Results posted

Hokusai Study in Pediatric Patients With Confirmed Venous Thromboembolism (VTE)

A Phase 3 interventional study of Edoxaban and Standard of Care in Venous Thromboembolism (VTE), Pulmonary Embolism and Deep Vein Thrombosis (DVT), sponsored by Daiichi Sankyo. Completed at 140 sites in 34 countries. Open to participants aged 1 Day to 17 Years. Per ClinicalTrials.gov, last updated 2025-02-28.

Sponsored by Daiichi Sankyo · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
290
Allocation
Randomized
Ages
1 Day to 17 Years
Sex
All
01

Study summary

This is an event driven Phase 3, prospective, randomized, open-label, blinded endpoint evaluation (PROBE) parallel group study in subjects with confirmed VTE. This study is designed to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of edoxaban and to compare the efficacy and safety of edoxaban against standard of care in pediatric subjects with confirmed VTE.

Read the detailed description

The objective is to demonstrate the non-inferiority of edoxaban to standard of care (SOC; including low molecular weight heparin (LMWH), vitamin K antagonist (VKA), or synthetic pentasaccharide (SP) Xa inhibitors) in the treatment and secondary prevention of VTE in pediatric subjects with regard to the composite efficacy endpoint (ie, symptomatic recurrent VTE, death as result of VTE, and no change or extension of thrombotic burden) during the first 3-month treatment period.

02

Conditions studied

  • Venous Thromboembolism (VTE)
  • Pulmonary Embolism
  • Deep Vein Thrombosis (DVT)

Keywords

  • Pediatric
  • Venous thrombolism
  • 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 290 is above the median of 150 across 381 interventional studies indexed under Pulmonary Embolism.

Browse Pulmonary Embolism studies →

Lead sponsor

Daiichi Sankyo is the lead sponsor of 316 studies on the registry; 35 are open to participants now.

Of its 51 completed or terminated interventional studies of FDA-regulated products, 38 (75%) have results posted.

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

04

Who can participate

Ages eligible
1 Day to 17 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Male or female pediatric subjects between birth (defined as 38 weeks gestational age) and less than 18 years of age at the time of consent.
  2. Pediatric subjects with the presence of documented VTE confirmed by appropriate diagnostic imaging and requiring anticoagulant therapy for at least 90 days.
  3. Subjects must have received at least 5 days of heparin therapy prior to randomization to treat the newly identified index VTE. In addition, prior to being randomized to edoxaban or SOC, subjects initially treated with VKA are recommended to have an international normalized ratio (INR) \< 2.0.
  4. Subject and/or parent(s)/legal guardian(s) or legally acceptable representative is informed and provides signed consent for the child to participate in the study.
  5. Female subjects who have menarche must test negative for pregnancy at Screening and must consent to avoid becoming pregnant by using an approved contraception method throughout the study.

Exclusion criteria

Exclusion Criteria:

  1. Subjects with active bleeding or high risk of bleeding contraindicating treatment with LMWH, SP Xa inhibitors, VKAs, or direct oral anticoagulants (DOACs; identified high risk of bleeding during prior experimental administration of DOACs).
  2. Subjects who have been or are being treated with thrombolytic agents, thrombectomy or insertion of a caval filter for the newly identified index VTE.
  3. Administration of antiplatelet therapy is contraindicated in both arms except for low dose aspirin defined as 1-5 mg/Kg/day with maximum of 100 mg/day.
  4. Administration of rifampin is prohibited during the study and subjects on concomitant use of rifampin are excluded.
  5. Subjects with hepatic disease associated with coagulopathy leading to a clinically relevant bleeding risk (aPTT > 50 seconds or international normalized ratio [INR] > 2.0 not related to anticoagulation therapy) or alanine aminotransferase (ALT) > 5 × the upper limit of normal (ULN) or total bilirubin > 2 × ULN with direct bilirubin > 20% of the total at Screening Visit.
  6. Subjects with glomerular filtration rate (GFR) \< 30% of normal for age and size as determined by the Schwartz formula.
  7. Subjects with stage 2 hypertension defined as blood pressure (BP) systolic and/or diastolic confirmed > 99th percentile + 5 mmHg.
  8. Subject with thrombocytopenia \< 50 × 109/L at Screening Visit. Subjects with a history of heparin-induced thrombocytopenia may be enrolled in the study at the Investigator's discretion.
  9. Life expectancy less than the expected study treatment duration (3 months).
  10. Subjects who are known to be pregnant or breastfeeding.
  11. Subjects with any condition that, as judged by the Investigator, would place the subject at increased risk of harm if he/she participated in the study, including contraindicated medications.
  12. Subjects who participated in another clinical study or treated with an experimental therapy with less than a 30 day washout period prior to identifying the qualifying index VTE.
05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
290 participants (actual)

Study arms

  • Experimental
    Edoxaban

    Edoxaban treatment will be dispensed to the participant on a monthly visit schedule. Edoxaban will be started orally at the age/weight/renal function appropriate dose, depending on the results of the ongoing U157 study (NCT02303431) for the Treatment Period.

    Drug: Edoxaban

  • Experimental
    Standard of Care

    Standard of Care (SOC) treatment will be dispensed to the participant on a monthly visit schedule.

    Drug: Standard of Care

Interventions

  • DrugEdoxaban

    15 or 30 mg tablets for participants 12 years of age to \<18, and 60 mg edoxaban suspension for oral administration to participants under 12 years of age

  • DrugStandard of Care

    Standard of care could include low molecular weight heparin (LMWH), vitamin K antagonist (VKA), or synthetic pentasaccharide (SP) Xa inhibitors.

    Also known as: Warfarin/heparin, Enoxaparin, Fondaparinux

06

What researchers measure

Primary outcomes

  1. Number of Participants With Symptomatic Recurrent Venous Thromboembolism During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    Diagnosis of recurrent venous thromboembolism (VTE) requires the confirmation by diagnostic imaging and at least one of the symptoms of VTE from such areas as lower or upper extremity, catheter related thrombosis, pulmonary embolism, or sinovenous thrombosis.

    Time frame: Randomization to Month 3

  2. Number of Participants Who Died as a Result of VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    Death from venous thromboembolism (VTE) is based on objective diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out.

    Time frame: Randomization to Month 3

  3. Number of Participants With No Change or Extension of Thrombotic Burden During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    No change or extension of thrombotic burden as assessed by quantitative diagnostic imaging of the index qualifying VTE thrombus at baseline and at Month 3. Imaging criteria for VTE included: - Abnormal compression ultrasonography where compression had been normal or, if non-compressible during screening, an increase in diameter of the thrombus during full compression; - An extension of the echogenic intra-luminal thrombus or absence of flow in the central venous system on Doppler ultrasonography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect, or an extension of non-visualization of veins in the presence of a sudden cut-off on venography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect on computed tomography angiogram (CTA).

    Time frame: Randomization to Month 3

Secondary outcomes

  1. Number of Participants With Symptomatic Recurrent Venous Thromboembolism During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    Diagnosis of recurrent venous thromboembolism (VTE) requires the confirmation by diagnostic imaging and at least one of the symptoms of VTE from such areas as lower or upper extremity, catheter related thrombosis, pulmonary embolism, or sinovenous thrombosis.

    Time frame: From randomization up to Month 12

  2. Number of Participants With Symptomatic Recurrent VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Individual Component of Primary Efficacy Endpoint)

    Diagnosis of recurrent venous thromboembolism (VTE) requires the confirmation by diagnostic imaging and at least one of the symptoms of VTE from such areas as lower or upper extremity, catheter related thrombosis, pulmonary embolism, or sinovenous thrombosis.

    Time frame: Randomization to Month 3

  3. Number of Participants Who Died as a Result of VTE During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    Death from venous thromboembolism (VTE) is based on objective diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out.

    Time frame: From randomization up to Month 12

  4. Number of Participants Who Died as a Result of VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Individual Component of Primary Efficacy Endpoint)

    Death from venous thromboembolism (VTE) is based on objective diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out.

    Time frame: Randomization to Month 3

  5. Number of Participants With No Change or Extension of Thrombotic Burden During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    No change or extension of thrombotic burden as assessed by quantitative diagnostic imaging of the index qualifying VTE thrombus. Imaging criteria for VTE included: - Abnormal compression ultrasonography where compression had been normal or, if non-compressible during screening, an increase in diameter of the thrombus during full compression; - An extension of the echogenic intra-luminal thrombus or absence of flow in the central venous system on Doppler ultrasonography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect, or an extension of non-visualization of veins in the presence of a sudden cut-off on venography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect on computed tomography angiogram (CTA).

    Time frame: From randomization up to Month 12

  6. Number of Participants With Adjudicated Individual Component of Primary Efficacy Endpoints During the Main Treatment Period Following Edoxaban or Standard of Care Treatment

    Diagnosis of recurrent VTE requires the confirmation imaging and ≥1 symptom of VTE. Death from VTE is based on diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out. No change or extension of thrombotic burden (quantitative diagnostic imaging) of the index qualifying VTE thrombus. Imaging criteria for VTE: - Abnormal compression ultrasonography where compression had been normal or, if non-compressible during screening, an increase in diameter of the thrombus during full compression; - An extension of the echogenic intra-luminal thrombus or absence of flow in the central venous system on Doppler ultrasonography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect, or an extension of non-visualization of veins in the presence of a sudden cut-off on venography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect on computed tomography angiogram (CTA).

    Time frame: Randomization to Month 3

  7. Number of Participants Reporting Adjudicated All-Cause Mortality During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated)

    All-cause mortality is defined as death due to any cause. Adjudicated data are reported for overall all-cause mortality, all-cause mortality by the primary cause of death, and primary cause of death further described by additional specifications.

    Time frame: From randomization up to Month 12

  8. Number of Participants With Deep Vein Thrombosis, Catheter-related Thrombosis, Sino-venous Thrombosis, and Pulmonary Embolism During the Main, Extension, and Overall Treatment Periods Following Edoxaban or Standard of Care Treatment

    Deep vein thrombosis was assessed by ultrasonography or magnetic resonance venography (MRV), catheter-related thrombosis was assessed by ultrasonography or echocardiography, sino-venous thrombosis was assessed by brain MRI, and pulmonary embolism was assessed by nuclear ventilation/perfusion (V/Q) scanning.

    Time frame: From randomization up to Month 12

  9. Number of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    Any bleeding event defined as major and clinically relevant non-major bleeding (CRNM) events was reported. Major bleeding was defined as defined as a composite of any of the following: fatal bleeding; and/or symptomatic bleeding in critical area or organ such as intracranial, intra-spinal, intraocular, retroperitoneal, intra-articular, pulmonary, or pericardial, or intramuscular with compartment syndrome; and/or bleeding that causes a decrease in hemoglobin of at least 2 g/dL or more, or leading to transfusion of the equivalent of two or more units of whole blood or red blood cells. CRNM was defined as acute or sub-acute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following: a hospital admission for bleeding; a physician-guided medical or surgical treatment for bleeding or a change in antithrombotic therapy (including interruption or discontinuation of study drug).

    Time frame: Randomization to Month 3

  10. Number of Participants With All Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    All bleeding events included major bleeding defined as a composite of any of the following: fatal bleeding; and/or symptomatic bleeding in critical area or organ such as intracranial, intra-spinal, intraocular, retroperitoneal, intra-articular, pulmonary, or pericardial, or intramuscular with compartment syndrome; and/or bleeding that causes a decrease in hemoglobin of at least 2 g/dL or more, or leading to transfusion of the equivalent of two or more units of whole blood or red blood cells (RBCs), clinically relevant non-major bleeding defined as acute or sub-acute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following: a hospital admission for bleeding; a physician-guided medical or surgical treatment for bleeding or a change in antithrombotic therapy (including interruption or discontinuation of study drug), nuisance bleeding, or a combination of bleeding events.

    Time frame: From randomization up to Month 12

  11. Number of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

    Any bleeding event defined as major and clinically relevant non-major bleeding (CRNM) events was reported. Major bleeding was defined as defined as a composite of any of the following: fatal bleeding; and/or symptomatic bleeding in critical area or organ such as intracranial, intra-spinal, intraocular, retroperitoneal, intra-articular, pulmonary, or pericardial, or intramuscular with compartment syndrome; and/or bleeding that causes a decrease in hemoglobin of at least 2 g/dL or more, or leading to transfusion of the equivalent of two or more units of whole blood or red blood cells. CRNM was defined as acute or sub-acute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following: a hospital admission for bleeding; a physician-guided medical or surgical treatment for bleeding or a change in antithrombotic therapy (including interruption or discontinuation of study drug).

    Time frame: From randomization up to Month 12

07

Results

Posted Mar 6, 2023

Participant flow

A total of 290 participants who met all inclusion criteria and no exclusion criteria were randomized to receive either edoxaban or standard of care treatment; 286 patients received at least 1 dose of study drug (modified intent-to-treat population).

Participant flow — Overall Study
MilestoneEdoxabanStandard of Care
Started147143
Modified intent-to-treat population145141
Completed128119
Not completed1924
Withdrew: Adverse event72
Withdrew: Physician decision37
Withdrew: Death23
Withdrew: Lost to follow-up01
Withdrew: Other53
Withdrew: Subject withdrew consent06
Withdrew: Data entry error (reported as study completion and study discontinuation)20
Withdrew: Randomized, but not treated02

Outcome measures

PrimaryNumber of Participants With Symptomatic Recurrent Venous Thromboembolism During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

Diagnosis of recurrent venous thromboembolism (VTE) requires the confirmation by diagnostic imaging and at least one of the symptoms of VTE from such areas as lower or upper extremity, catheter related thrombosis, pulmonary embolism, or sinovenous thrombosis.

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants With Symptomatic Recurrent Venous Thromboembolism During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With Symptomatic Recurrent Venous Thromboembolism During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)52
Statistical analysis
  • Edoxaban vs Standard of Care · Regression, Cox · p = 0.9694 · Hazard ratio (hr): 1.01 · 95% CI 0.594 to 1.719
PrimaryNumber of Participants Who Died as a Result of VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

Death from venous thromboembolism (VTE) is based on objective diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out.

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants Who Died as a Result of VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Pulmonary embolism (PE) with or without deep vein thrombosis (DVT)01
Fatal PE00
Non-fatal PE01
Deep vein thrombosis (DVT) only51
Fatal DVT00
Non-fatal DVT40
Unexplained death which VTE cannot be ruled out11
PrimaryNumber of Participants With No Change or Extension of Thrombotic Burden During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

No change or extension of thrombotic burden as assessed by quantitative diagnostic imaging of the index qualifying VTE thrombus at baseline and at Month 3. Imaging criteria for VTE included: - Abnormal compression ultrasonography where compression had been normal or, if non-compressible during screening, an increase in diameter of the thrombus during full compression; - An extension of the echogenic intra-luminal thrombus or absence of flow in the central venous system on Doppler ultrasonography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect, or an extension of non-visualization of veins in the presence of a sudden cut-off on venography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect on computed tomography angiogram (CTA).

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants With No Change or Extension of Thrombotic Burden During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With No Change or Extension of Thrombotic Burden During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)2129
SecondaryNumber of Participants With Symptomatic Recurrent Venous Thromboembolism During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

Diagnosis of recurrent venous thromboembolism (VTE) requires the confirmation by diagnostic imaging and at least one of the symptoms of VTE from such areas as lower or upper extremity, catheter related thrombosis, pulmonary embolism, or sinovenous thrombosis.

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants With Symptomatic Recurrent Venous Thromboembolism During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With Symptomatic Recurrent Venous Thromboembolism During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)72
SecondaryNumber of Participants With Symptomatic Recurrent VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Individual Component of Primary Efficacy Endpoint)

Diagnosis of recurrent venous thromboembolism (VTE) requires the confirmation by diagnostic imaging and at least one of the symptoms of VTE from such areas as lower or upper extremity, catheter related thrombosis, pulmonary embolism, or sinovenous thrombosis.

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants With Symptomatic Recurrent VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Individual Component of Primary Efficacy Endpoint)
ParticipantsEdoxabanStandard of Care
Symptomatic VTE41
Pulmonary embolism (PE) with or without deep vein thrombosis (DVT)01
Deep vein thrombosis (DVT) only40
SecondaryNumber of Participants Who Died as a Result of VTE During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

Death from venous thromboembolism (VTE) is based on objective diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out.

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants Who Died as a Result of VTE During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Pulmonary embolism (PE) with or without deep vein thrombosis (DVT)11
Fatal PE00
Non-fatal PE11
Deep vein thrombosis (DVT) only61
Fatal DVT00
Non-fatal DVT50
Unexplained death which VTE cannot be ruled out11
SecondaryNumber of Participants Who Died as a Result of VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Individual Component of Primary Efficacy Endpoint)

Death from venous thromboembolism (VTE) is based on objective diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out.

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants Who Died as a Result of VTE During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Individual Component of Primary Efficacy Endpoint)
ParticipantsEdoxabanStandard of Care
Death as a result of VTE11
Unexplained death which VTE cannot be ruled out11
SecondaryNumber of Participants With No Change or Extension of Thrombotic Burden During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

No change or extension of thrombotic burden as assessed by quantitative diagnostic imaging of the index qualifying VTE thrombus. Imaging criteria for VTE included: - Abnormal compression ultrasonography where compression had been normal or, if non-compressible during screening, an increase in diameter of the thrombus during full compression; - An extension of the echogenic intra-luminal thrombus or absence of flow in the central venous system on Doppler ultrasonography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect, or an extension of non-visualization of veins in the presence of a sudden cut-off on venography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect on computed tomography angiogram (CTA).

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants With No Change or Extension of Thrombotic Burden During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With No Change or Extension of Thrombotic Burden During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)3547
SecondaryNumber of Participants With Adjudicated Individual Component of Primary Efficacy Endpoints During the Main Treatment Period Following Edoxaban or Standard of Care Treatment

Diagnosis of recurrent VTE requires the confirmation imaging and ≥1 symptom of VTE. Death from VTE is based on diagnostic testing, autopsy or death which cannot be attributed to documented cause for which VTE cannot be ruled out. No change or extension of thrombotic burden (quantitative diagnostic imaging) of the index qualifying VTE thrombus. Imaging criteria for VTE: - Abnormal compression ultrasonography where compression had been normal or, if non-compressible during screening, an increase in diameter of the thrombus during full compression; - An extension of the echogenic intra-luminal thrombus or absence of flow in the central venous system on Doppler ultrasonography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect, or an extension of non-visualization of veins in the presence of a sudden cut-off on venography. - An extension of an intraluminal filling defect, or a new intraluminal filling defect on computed tomography angiogram (CTA).

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants With Adjudicated Individual Component of Primary Efficacy Endpoints During the Main Treatment Period Following Edoxaban or Standard of Care Treatment
ParticipantsEdoxabanStandard of Care
Symptomatic recurrent VTE41
PE with or without DVT01
DVT only40
Death as a result of VTE11
Unexplained death which VTE cannot be ruled out11
No change or extension of thrombotic burden2129
SecondaryNumber of Participants Reporting Adjudicated All-Cause Mortality During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated)

All-cause mortality is defined as death due to any cause. Adjudicated data are reported for overall all-cause mortality, all-cause mortality by the primary cause of death, and primary cause of death further described by additional specifications.

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants Reporting Adjudicated All-Cause Mortality During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated)
ParticipantsEdoxabanStandard of Care
Participants with adjudicated all-cause mortality during treatment period23
Participants with adjudicated all-cause mortality occurring after treatment period10
Venous thromboembolism (VTE)-related death11
Venous thromboembolism (VTE)-related death: Unexplained death which VTE cannot be ruled out11
Other known causes of death12
Other known causes of death: Cancer01
Other known causes of death: Infectious disease01
Other known causes of death: Other10
SecondaryNumber of Participants With Deep Vein Thrombosis, Catheter-related Thrombosis, Sino-venous Thrombosis, and Pulmonary Embolism During the Main, Extension, and Overall Treatment Periods Following Edoxaban or Standard of Care Treatment

Deep vein thrombosis was assessed by ultrasonography or magnetic resonance venography (MRV), catheter-related thrombosis was assessed by ultrasonography or echocardiography, sino-venous thrombosis was assessed by brain MRI, and pulmonary embolism was assessed by nuclear ventilation/perfusion (V/Q) scanning.

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants With Deep Vein Thrombosis, Catheter-related Thrombosis, Sino-venous Thrombosis, and Pulmonary Embolism During the Main, Extension, and Overall Treatment Periods Following Edoxaban or Standard of Care Treatment
ParticipantsEdoxabanStandard of Care
Main Treatment: Participants with DVT only40
Main Treatment: Participants with catheter-related thrombosis10
Main Treatment: Participants with cerebral sino-venous DVT thrombosis00
Main Treatment: Participants with PE with or without DVT01
Extension Treatment: Participants with DVT10
Extension Treatment: Participants with catheter-related thrombosis00
Extension Treatment: Participants with sino-venous DVT thrombosis10
Extension Treatment: Participants with PE10
Overall Treatment: Participants with DVT50
Overall Treatment: Participants with catheter-related thrombosis10
Overall Treatment: Participants with sino-venous DVT thrombosis10
Overall Treatment: Participants with PE11
SecondaryNumber of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

Any bleeding event defined as major and clinically relevant non-major bleeding (CRNM) events was reported. Major bleeding was defined as defined as a composite of any of the following: fatal bleeding; and/or symptomatic bleeding in critical area or organ such as intracranial, intra-spinal, intraocular, retroperitoneal, intra-articular, pulmonary, or pericardial, or intramuscular with compartment syndrome; and/or bleeding that causes a decrease in hemoglobin of at least 2 g/dL or more, or leading to transfusion of the equivalent of two or more units of whole blood or red blood cells. CRNM was defined as acute or sub-acute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following: a hospital admission for bleeding; a physician-guided medical or surgical treatment for bleeding or a change in antithrombotic therapy (including interruption or discontinuation of study drug).

Time frame:
Randomization to Month 3
Reported as:
Count of participants · Participants
Number of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Main Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)35
SecondaryNumber of Participants With All Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

All bleeding events included major bleeding defined as a composite of any of the following: fatal bleeding; and/or symptomatic bleeding in critical area or organ such as intracranial, intra-spinal, intraocular, retroperitoneal, intra-articular, pulmonary, or pericardial, or intramuscular with compartment syndrome; and/or bleeding that causes a decrease in hemoglobin of at least 2 g/dL or more, or leading to transfusion of the equivalent of two or more units of whole blood or red blood cells (RBCs), clinically relevant non-major bleeding defined as acute or sub-acute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following: a hospital admission for bleeding; a physician-guided medical or surgical treatment for bleeding or a change in antithrombotic therapy (including interruption or discontinuation of study drug), nuisance bleeding, or a combination of bleeding events.

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants With All Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With All Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)2524
SecondaryNumber of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)

Any bleeding event defined as major and clinically relevant non-major bleeding (CRNM) events was reported. Major bleeding was defined as defined as a composite of any of the following: fatal bleeding; and/or symptomatic bleeding in critical area or organ such as intracranial, intra-spinal, intraocular, retroperitoneal, intra-articular, pulmonary, or pericardial, or intramuscular with compartment syndrome; and/or bleeding that causes a decrease in hemoglobin of at least 2 g/dL or more, or leading to transfusion of the equivalent of two or more units of whole blood or red blood cells. CRNM was defined as acute or sub-acute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following: a hospital admission for bleeding; a physician-guided medical or surgical treatment for bleeding or a change in antithrombotic therapy (including interruption or discontinuation of study drug).

Time frame:
From randomization up to Month 12
Reported as:
Count of participants · Participants
Number of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)
ParticipantsEdoxabanStandard of Care
Number of Participants With Major and Clinically Relevant Non-Major Bleeding Events (On Treatment) During the Overall Treatment Period Following Edoxaban or Standard of Care Treatment (Adjudicated Composite)85

Adverse events

Collected over Treatment-emergent adverse events were collected from the date the Informed Consent Form was signed up to Month 12.. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Edoxaban3/145 (2.1%)44/145 (30.3%)51/145 (35.2%)
Standard of Care3/141 (2.1%)37/141 (26.2%)46/141 (32.6%)
Most frequent serious events
Showing 10 of 106
Most frequent serious events
EventEdoxabanStandard of Care
Febrile neutropeniaBlood and lymphatic system disorders6/1456/141
PneumoniaInfections and infestations4/1450/141
ThrombocytopeniaBlood and lymphatic system disorders2/1453/141
HeadacheNervous system disorders2/1453/141
Urinary tract infectionInfections and infestations3/1450/141
VomitingGastrointestinal disorders2/1452/141
CellulitisInfections and infestations0/1452/141
GastroenteritisInfections and infestations1/1452/141
Rhinovirus infectionInfections and infestations0/1452/141
DehydrationMetabolism and nutrition disorders1/1452/141
Most frequent other events
Most frequent other events
EventEdoxabanStandard of Care
HeadacheNervous system disorders20/14514/141
VomitingGastrointestinal disorders16/1459/141
PyrexiaGeneral disorders12/14511/141
EpistaxisRespiratory, thoracic and mediastinal disorders12/14510/141
Upper respiratory tract infectionInfections and infestations9/1458/141
NasopharyngitisInfections and infestations8/1453/141

Baseline characteristics

Baseline demographic characteristics were reported in the Randomized Analysis Set.

Age, Categorical
Age, Categorical(Participants)EdoxabanStandard of CareTotal
<=18 years147143290
Between 18 and 65 years000
>=65 years000
Age, Continuous
Age, Continuous(years)EdoxabanStandard of CareTotal
Mean10.9 ± 5.9911.1 ± 6.0311.0 ± 6.0
Sex: Female, Male
Sex: Female, Male(Participants)EdoxabanStandard of CareTotal
Female7070140
Male7773150
Race (NIH/OMB)
Race (NIH/OMB)(Participants)EdoxabanStandard of CareTotal
American Indian or Alaska Native101
Asian242650
Native Hawaiian or Other Pacific Islander011
Black or African American91019
White9387180
More than one race15823
Unknown or Not Reported51116
Region of Enrollment
Region of Enrollment(participants)EdoxabanStandard of CareTotal
Singapore246
United States241741
Czechia8513
Malaysia123
Thailand7815
Portugal3710
Russia112
Netherlands336
South Korea639
El Salvador505
Panama101
Brazil4711
Guatemala549
Bulgaria314
Chile112
France145
Croatia516
Hungary121123
Ukraine404
India358
Spain4610
Lebanon459
Canada4913
Turkey131730
Norway235
Taiwan538
Israel6713
Germany538
Colombia5611
08

Study locations

140 sites
  • Banner University Medical Center
    Tucson, Arizona 85724, United States
  • Children's Hospital Los Angeles
    Los Angeles, California 90027, United States
  • UCLA Medical Center CAR
    Los Angeles, California 90095, United States
  • Stanford University Medical Center
    Stanford, California 94305, United States
  • University of Miami Miller School of Medicine
    Miami, Florida 33136, United States
  • University of South Florida
    Tampa, Florida 33606, United States
  • Rush University Medical Center
    Chicago, Illinois 60612, United States
  • Advocate Children's Hospital-Oak Lawn
    Oak Lawn, Illinois 60453, United States
  • Indiana Hemophilia and Thrombosis Center
    Indianapolis, Indiana 46260, United States
  • University of Louisville
    Louisville, Kentucky 40202, United States
  • Spectrum Health Helen DeVos Children's Hospital Grand Rapids
    Grand Rapids, Michigan 49503, United States
  • Children's Hospital & Clinics of Minnesota
    Minneapolis, Minnesota 55404, United States
  • Washington University School of Medicine
    Saint Louis, Missouri 63110, United States
  • University North Carolina- Chapel Hill
    Chapel Hill, North Carolina 27517, United States
  • Levine Children's Hospital Charlotte
    Charlotte, North Carolina 28204, United States
  • The Presbyterian Hospital
    Charlotte, North Carolina 28210, United States
  • East Carolina University
    Greenville, North Carolina 27858, United States
  • University of Oklahoma Health Sciences Center
    Oklahoma City, Oklahoma 73104, United States
  • Hasbro Children's Hospital
    Providence, Rhode Island 02903, United States
  • Le Bonheur Childrens Hospital
    Memphis, Tennessee 38105, United States
  • St. Jude Children's Research Hospital
    Memphis, Tennessee 38105, United States
  • Children's Hospital of Wisconsin
    Milwaukee, Wisconsin 53226, United States
  • Hospital Italiano Regional del Sur
    Buenos Aires, B8001HXM, Argentina
  • Sanatorio Allende
    Cordoba, X5000JHQ, Argentina
  • Hospital Erasto Gaertner - Liga Paranaense de Combate ao Câncer
    Curitiba, Paraná 81520-060, Brazil
  • IMIP - Instituto de Medicina Integral Professor Fernando Figueira
    Pernambuco, Recife 50070-550, Brazil
  • Hospital São Vicente de Paulo
    Passo Fundo, Rio Grande Do Sul 99010-080, Brazil
  • Hospital da Cidade de Passo Fundo
    Passo Fundo, Rio Grande Do Sul 99010-260, Brazil
  • Instituto de Cardiologia do Rio Grande do Sul
    Pôrto Alegre, Rio Grande Do Sul 90620-001, Brazil
  • Hospital de Câncer de Barretos - Fundação Pio XII
    Barretos, São Paulo 14784-400, Brazil
  • Centro de Hematologia e Hemoterapia - Hemocentro de Campinas - UNICAMP
    Campinas, São Paulo 13083-878, Brazil
  • Centro Multidisciplinar de Estudos Clínicos - CEMEC
    Santo André, São Paulo 09190-510, Brazil
  • Santa Casa de Votuporanga
    Votuporanga, São Paulo 15500-003, Brazil
  • Hospital Samaritano
    São Paulo, 01232-010, Brazil
  • Hospital da Luz Amico Saude LTDA
    São Paulo, 04013-060, Brazil
  • Hospital Infantil Pequeno Príncipe
    São Paulo, 04013-060, Brazil
  • GRAACC - Grupo de Apoio ao Adolescente e à Criança com Câncer
    São Paulo, 04039-001, Brazil
  • UNIFESP - Universidade Federal de São Paulo
    São Paulo, 04039-032, Brazil
  • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
    São Paulo, 05403-000, Brazil
  • HMCG - Hospital e Maternidade Dr. Christovão da Gama
    São Paulo, 09030-010, Brazil
  • UMHAT "Sv. Georgi", EAD
    Plovdiv, 4000, Bulgaria
  • MHAT - "National Heart Hospital" EAD
    Sofia, 1309, Bulgaria
  • MHAT 'Tokuda Hospital Sofia', EAD
    Sofia, 1407, Bulgaria
  • Medical Center for Specialized Ambulatory Medical Assistance for Children's Diseases
    Sofia, 1612, Bulgaria
  • Edmonton Clinic Health Academy
    Edmonton, Alberta T6G 2B7, Canada
  • CancerCare Manitoba
    Winnipeg, Manitoba R3E 0V9, Canada
  • McMaster Children's Hospital
    Hamilton, Ontario L8N 3Z5, Canada
  • Hospital El Carmen Dr. Luis Valentin Ferrada
    Maipu, 9251521, Chile
  • Clinica Las Condes
    Santiago, 7591047, Chile
  • Clinical Hospital Centre Rijeka
    Rijeka, 51000, Croatia
  • General Hospital Zadar
    Zadar, 23000, Croatia
  • Children's Hospital Zagreb
    Zagreb, 10 000, Croatia
  • University Hospital Centre Zagreb, University of Zagreb School of Medicine
    Zagreb, 10000, Croatia
  • Fakultni nemocnice Brno
    Brno, 613 00, Czechia
  • CTC Hodonin s.r.o.
    Hodonin, 69501, Czechia
  • Dětská klinika Fakultní nemocnice
    Hradec Králové, 500 05, Czechia
  • University Hospital Pilsen, CZ
    Plzen, 305 99, Czechia
  • Ålborg Universitetshospital
    Aalborg, 9000, Denmark
  • Hospital Nacional de Niños Benjamín Bloom
    San Salvador, Salvador, El Salvador
  • Clinical Hospital Centre Cavale Blanche BREST
    Brest, Finistere 29200, France
  • Groupe Hospitalier Sud - Hôpital Haut-Lévêque
    Pessac, Gironde 33600, France
  • Hôpital des enfants, CHU Toulouse
    Toulouse, Haute Garonne 31059, France
  • CHU Rennes - Hopital Sud
    Rennes, Ille Et Vilaine 35203, France
  • CHU Angers - Hôpital Hôtel Dieu
    Angers, 49100, France
  • CHU Clermont Ferrand - Hôpital d'Estaing
    Clermont-Ferrand, 63003, France
  • CHU Arnaud de Villeneuve
    Montpellier, 34295, France
  • Universitaetsklinikum Essen
    Essen, Nordrhein Westfalen 45122, Germany
  • Charite - Campus Virchow-Klinikum
    Berlin, 13353, Germany
  • Unidad de Cirugía Cardiovascular de Guatemala (UNICAR)
    Guatemala, Guatemala
  • Unidad Nacional de Oncología Pediátrica (UNOP)
    Guatemala, Guatemala
  • Semmelweis University 2nd Department of Pediatrics
    Budapest, 1094, Hungary
  • Central Hospital of Southern Pest - National Institute of Hematology and Infectious Diseases
    Budapest, H-1097, Hungary
  • Debreceni Egyetem Klinikai Kozpont
    Debrecen, 4032, Hungary
  • University of Szeged, Department of Pediatrics
    Szeged, 6720, Hungary
  • Sir Ganga Ram Hospital
    New Delhi, Delhi 110060, India
  • Shree Krishna Hospital & Medical Research Centre, H M Patel Centre for Medical Care and Education
    Karamsad, Gujarat 388325, India
  • Nirmal Hospital
    Surat, Gujarat 395002, India
  • Jain Institute of Vascular Sciences
    Bangalore, Karnataka 560052, India
  • M. S. Ramaiah Medical College and Hospital
    Bangalore, Karnataka 560054, India
  • Government Medical College and Hospital
    Nagpur, Maharashtra 440003, India
  • Christian Medical College
    Ludhiana, Punjab 141008, India
  • Institute of Child Health
    Kolkata, West Bengal 700017, India
  • Indraprastha Apollo Hospitals
    Delhi, 110076, India
  • Rambam Medical Center
    Haifa, 3109601, Israel
  • Shaare Zedek Medical Center
    Jerusalem, 9103102, Israel
  • Hadassah ein Kerem
    Jerusalem, 91120, Israel
  • Chaim Sheba Medical Center
    Ramat Gan, 52621, Israel
  • Strathmore University Medical Centre
    Nairobi, 59857-00200, Kenya
  • Seoul National University Bundang Hospital
    Seongnam-si, Gyeonggi-do 13620, Korea, Republic of
  • Seoul National University Hospital
    Seoul, 3080, Korea, Republic of
  • Severance Hospital, Yonsei University
    Seoul, 3722, Korea, Republic of
  • Samsung Medical Center
    Seoul, 6351, Korea, Republic of
  • American University of Beirut Medical Center
    Beirut, 1107 2020, Lebanon
  • Saint George University Hospital Medical Center
    Beirut, 166378, Lebanon
  • Hotel Dieu de France Hospital
    Beirut, 166830, Lebanon
  • Hospital Raja Perempuan Zainab II
    Kota Bharu, Kelantan 15586, Malaysia
  • Erasmus MC Sophia
    Rotterdam, 3000 CB, Netherlands
  • Oslo University Hospital
    Oslo, 15-274, Norway
  • INDICASAT AIP Site 7871
    Panamá, 0843-01103, Panama
  • INDICASAT AIP Site 7872
    Panamá, 0843-01103, Panama

Showing the first 100 of 140 sites across 34 countries.

09

References and documents

Publications

  • Hokusai-VTE Investigators; Buller HR, Decousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, Raskob GE, Schellong SM, Schwocho L, Segers A, Shi M, Verhamme P, Wells P. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013 Oct 10;369(15):1406-15. doi: 10.1056/NEJMoa1306638. Epub 2013 Aug 31. PubMed 23991658 ↗

Study documents

  • Protocol and statistical analysis plan · Jun 8, 2021

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — De-identified individual participant data (IPD) and applicable supporting clinical trial documents may be available upon request at https://vivli.org/. In cases where clinical trial data and supporting documents are provided pursuant to our company policies and procedures, Daiichi Sankyo will continue to protect the privacy of our clinical trial participants. Details on data sharing criteria and the procedure for requesting access can be found at this web address: https://vivli.org/ourmember/daiichi-sankyo/

Supporting information: Study protocol, Sap, Csr

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Feb 28, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02798471
Lead sponsor
Daiichi Sankyo
Responsible party
Sponsor
First posted
Jun 14, 2016
Start date
Mar 27, 2017
Primary completion
May 24, 2022
Completion
May 24, 2022
Results posted
Mar 6, 2023
Last update
Feb 28, 2025

Study contacts

Global Clinical Leader
study director · Daiichi Sankyo

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Feb 2025. You cannot join it, but the record below documents what was studied.

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