Interventional - Drug
The objective of the ENRICH-AF study is to evaluate whether edoxaban is superior to standard medical therapy in reducing the risk of stroke in high-risk atrial fibrillation patients with previous intracranial hemorrhage.
Patients who fulfill all inclusion and none of the exclusion criteria after giving informed consent will be randomly allocated 1:1 to either edoxaban 60 mg (dose adjusted to 30 mg) daily or standard medical therapy (either no antithrombotic therapy or antiplatelet monotherapy). Randomization will be stratified by center and by qualifying intracranial hemorrhage subtype (subdural vs. non-subdural). The study is event-driven and thus, all patients will be treated (or followed-up in case of premature discontinuation of study medication) until 123 confirmed primary efficacy outcomes have occurred.
The primary efficacy objective is to evaluate whether edoxaban (60/30 mg daily) compared to standard of care (either no antithrombotic therapy or antiplatelet monotherapy) reduces the risk of stroke (composite of ischemic, hemorrhagic and unspecified stroke) in high-risk atrial fibrillation patients with previous intracranial hemorrhage.
The primary safety objective is to document the incidence of clinically relevant major bleeding.ENRICH-AF Protocol - Download PDF
Interventional - Drug
Randomized, open, blinded end-point
2019 - 2023
Ashkan Shoamanesh is the founding Director, Hemorrhagic Stroke Research Program and Scientist, at PHRI, Assistant Professor of Medicine (Neurology), McMaster University, and Director, Stroke Fellowship Program at Hamilton Health Sciences and McMaster. He is the inaugural Marta and Owen Boris Chair in Stroke Research and Care at McMaster. His research is focused on improving the clinical care of patients with stroke or who are at risk for stroke resulting from blood vessel rupture and bleeding into the brain.He is the founding Chair of the Canadian Hemorrhagic Stroke Trials Initiative (CoHESIVE) and leads as principal investigator the global phase III ENRICH-AF trial investigating optimal stroke prevention in intracranial hemorrhage survivors with atrial fibrillation in 22 countries.
He has been awarded the most prestigious early career awards in stroke granted by the American Heart/Stroke Association (2015 Mordecai Y.T. Globus and 2019 Robert G. Siekert New Investigator Awards in Stroke), American Academy of Neurology (2020 Michael S. Pessin Stroke Leadership Prize), and Heart and Stroke Foundation of Canada (2019 Henry J.M. Barnett Scholarship – recognizing the highest ranked National New Investigator in cerebrovascular disease research), amongst other notable awards, including the 2019 International Stroke Conference Paul Dudley White International Scholar Award and the 2014 European Stroke Conference Young Investigator Award.
Robert Hart is Professor of Medicine (Neurology) at McMaster University and a vascular neurologist at Hamilton Health Sciences. After completing a fellowship in cerebrovascular disease at the Oregon Health Sciences University, he spent most of his career at the University of Texas Health Science Center in San Antonio before relocating to McMaster University in September 2011.
He has a long-standing interest in stroke, stroke research, and clinical trials. He has directed several randomized clinical trials serving as the principal investigator of the NIH/NINDS-sponsored Stroke Prevention in Atrial Fibrillation (SPAF) I, II and III trials (1987-2000) and co-principal investigator of the NIH/NINDS-sponsored Secondary Prevention of Small Subcortical Strokes (SPS3) randomized trials (2001-2013). Antithrombotic therapies to prevent stroke in atrial fibrillation and especially novel oral anticoagulants are areas of special interest. He has published more than 250 articles in peer-reviewed journals.
Stuart Connolly is a Professor of Medicine at McMaster University and a cardiac electrophysiologist at Hamilton Health Sciences. He became a faculty member at McMaster University in 1983 and was awarded a full professorship in 1994. He was also appointed as the inaugural holder of the Salim Yusuf Chair in Cardiology at McMaster University.
He has published more than 270 scientific articles in the field, and is currently a member of the editorial boards for a number of prominent cardiology journals, including Heart, the American Heart Journal and the Journal of Pacing and Electrophysiology. His main research interests are focused on the evaluation of treatments for heart rhythm disorders. His academic career has been largely devoted to the design and execution of controlled clinical trials in this area.
He holds a Masters degree from Fordham University, New York, and an MD from McGill University in Montreal. He received his specialist training in cardiology at the University of Toronto and at Stanford University.
Aristeidis Katsanos is a neurologist at Hamilton Health Sciences, and a stroke/vascular neurology fellow at McMaster University/HHS. His academic focus is on the evidence-based evaluation of novel therapeutic approaches on acute stroke treatment and secondary stroke prevention. His research study on optimal blood pressure management after endovascular stroke treatment (DETECT) is supported by the New Investigator Fund from HHS.
He obtained his MD and PhD degrees from the University of Ioannina in Greece. After finishing his training in neurology, he completed a research fellowship at the Ruhr University of Bochum in Germany granted by the European Academy of Neurology. Aristeidis has actively participated in numerous research projects and international collaborations and serves in the editorial board of several academic medical journals, including Stroke.
Danielle de Sa Boasquevisque is a Research Fellow at PHRI, supervised by Ashkan Shoamanesh, and is pursuing a Masters in Health Research Methodology at McMaster University. At PHRI, she is a co-Investigator in the ENRICH-AF trial and Project Officer for the CATIS-ICAD trial.
She obtained her MD from Federal University of Espirito Santo in Brazil and has completed internal medicine and neurology training in Sao Paulo, Brazil. In 2018, she completed her MSc in Neuroscience at Albert Einstein Institute/Sao Paulo, Brazil where she studied safety of transcranial direct current stimulation in patients after ischemic stroke. She also pursued a two-year clinical Stroke fellowship at McMaster University from 2018 to 2020.
Danielle has research interests in vascular neurology including acute stroke, neuro-rehabilitation, intracranial atherosclerotic disease and intracerebral hemorrhage. She is currently implementing an ICH cohort study and performing systematic review regarding ICH related outcomes.
Associate Program Manager
Amanda Taylor is an Associate Program Manager who currently coordinates trials in stroke, and has experience conducting trials in acute coronary syndrome and arrhythmia. Amanda joined PHRI in 2007. She holds a Bachelor of Science Degree (Honours) in Neurobiology from Brock University.
Senior Research Coordinator
Kevin Reeh has worked in research since 2008; starting with PHRI in 2014, Kevin began with the COMPASS trial study team. Kevin continues to coordinate global randomized multicenter trials in his current role with ENRICH-AF. Kevin has bachelor degrees in the Biological Sciences and Health Sciences, as well as a Masters of Science.
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