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Villeurbanne","Villeurbanne","69616",{"type":46,"coordinates":618},[619,620],4.8795,45.76601,{"lat":620,"lon":619},[623,626],{"name":624,"role":34,"phone":26,"phoneExt":26,"email":625},"Mathias BREHON, PH","m.brehon@resamut.fr",{"name":624,"role":57,"phone":26,"phoneExt":26,"email":26},{"type":628,"investigatorFullName":26,"investigatorTitle":26,"investigatorAffiliation":26,"oldNameTitle":26,"oldOrganization":26},"SPONSOR","100454547","phase-3-avajak-apixabanrivaroxaban-versus-aspirin-for-primary-prevention-of-thrombo-embolic-complications-in-jak2v617f-positive-myeloproliferative-neoplasms-100454547",false,"NCT05198960","AVAJAK: Apixaban\u002FRivaroxaban Versus Aspirin for Primary Prevention of Thrombo-embolic Complications in JAK2V617F-positive Myeloproliferative Neoplasms","AVAJAK","Inclusion Criteria:\n\n* Patients with diagnosis of PV or ET or PreMF according to WHO or BSCH criteria (bone marrow biopsy not compulsory).\n* Patients with JAK2V617F mutation (threshold allele burden \\> 1%).\n* Patients considered as \"high-risk\" patients:\n\n  1. based on age (\\> 60-year-old)\n  2. based on thrombotic history (compatible with antithrombotic randomization) but aged ≥ 18-year-old.\n* Length of time from MPN diagnostic to inclusion will not exceed 12 months.\n\nExclusion Criteria:\n\n* Contra-indication to aspirin or DOAC due to allergic situation or recent history of major bleeding.\n* Formal indication of treatment with aspirin or DOAC (thus precluding randomization).\n* Inability to give informed consent.\n* Patients under curatorship\u002Fguardianship\n* Concomitant use of a strong inhibitor or inducer of CYP3A4 (like ruxolitinib).\n* Chronic liver disease or chronic hepatitis.\n* Renal insufficiency with creatinine \\\u003C30 ml\u002Fmn on Cockcroft and Gault Formula\n* Patient considered at high-risk of bleeding: patients with current or recent major or clinical relevant non major bleeding gastrointestinal or cerebral bleedings\n* Planned pregnancy within 24 months\n* No appropriate contraception (estrogen contraception or no contraception) in women of childbearing age or breastfeeding woman\n* PS\\>2 or life expectancy \\\u003C12 months.","ALL","18 Years",{"count":639,"type":640},1308,"ESTIMATED","INTERVENTIONAL",[643],"PHASE3","Philadelphia-negative myeloproliferative neoplasms (MPN) are frequent and chronic myeloid malignancies including Polycythemia Vera (PV), essential thrombocythemia (ET), Primary Myelofibrosis (PMF) and Prefibrotic myelofibrosis (PreMF). These MPNs are caused by the acquisition of mutations affecting activation\u002Fproliferation pathways in hematopoietic stem cells. The principal mutations are JAK2V617F, calreticulin (CALR exon 9) and MPL W515. ET or MFP\u002FPreMF patients who do not carry one of these three mutations are declared as triple-negative (3NEG) cases even if they are real MPN cases.\n\nThese diseases are at high risk of thrombo-embolic complications and with high morbidity\u002Fmortality. This risk varies from 4 to 30% depending on MPN subtype and mutational status.\n\nIn terms of therapy, all patients with MPNs should also take daily low-dose aspirin (LDA) as first antithrombotic drug, which is particularly efficient to reduce arterial but not venous events.\n\nDespite the association of a cytoreductive drug and LDA, thromboses still occur in 5-8% patients\u002Fyear.\n\nAll these situations have been explored in biological or clinical assays. All of them could increase the bleeding risk. We should look at different ways to reduce the thrombotic incidence: Direct Oral Anticoagulants (DOAC)? In the general population, in medical or surgical contexts, DOACs have demonstrated their efficiency to prevent or cure most of the venous or arterial thrombotic events.\n\nAt the present time, DOAC can be used in cancer populations according to International Society on Thrombosis and Haemostasis (ISTH) recommendations, except in patients with cancer at high bleeding risk (gastro-intestinal or genito-urinary cancers). Unfortunately, in trials evaluating DOAC in cancer patients, most patients have solid rather than hematologic cancers (generally less than 10% of the patients, mostly lymphoma or myeloma).\n\nIn cancer patients, DOAC are also highly efficient to reduce the incidence of thrombosis (-30 to 60%), but patients are exposed to a higher hemorrhagic risk, especially in digestive cancer patients.\n\nIn the cancer population, pathophysiology of both thrombotic and hemorrhagic events may be quite different between solid cancers and MPN. If MPN patients are also considered to be cancer patients in many countries, the pathophysiology of thrombosis is quite specific (hyperviscosity, platelet abnormalities, clonality, specific cytokines…) and they are exposed to a lower risk of digestive hemorrhages. It is thus difficult to extend findings from the \"general cancer population\" to MPN patients.\n\nUnfortunately, only scarce, retrospective data regarding the use of DOAC in MPNs are available data.\n\nWe were the first to publish a \"real-life\" study about the use, the impact, and the risks in this population. In this local retrospective study, 25 patients with MPN were treated with DOAC for a median time of 2.1 years. We observed only one thrombosis (4%) and three major hemorrhages (12%, after trauma or unprepared surgery). Furthermore, we have compared the benefit\u002Frisk balance compared to patients treated with LDA without difference.\n\nWith the increasing evidences of efficacy and tolerance of DOAC in large cohorts of patients including cancer patients, with their proven efficacy on prevention of both arterial and venous thrombotic events and because of the absence of prospective trial using these drugs in MPN patients, we propose to study their potential benefit as primary thrombotic prevention in MPN.",[646,647,648,649,650],"Polycythemia Vera","Essential Thrombocythemia","Prefibrotic\u002FEarly Primary Myelofibrosis","JAK2 V617F","High-risk Patients",[652,653,654],"Venous ThromboEmbolism","Arterial Thrombosis","Hemorrhage","2026-03-18",{"date":657,"type":658},"2026-03-20","ACTUAL",{"date":660,"type":658},"2022-07-13",{"date":662,"type":640},"2027-07-13",{"name":5,"class":6},42]