- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00444470
Safety of Tranexamic Acid in Reducing Bleeding in Adults Undergoing Spinal Surgery
Efficacy of Tranexamic Acid in Reducing Blood Loss in Adult Patients Having Major Spine Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Spinal fusion can be associated with significant blood loss requiring allogeneic blood transfusion (ABT). Ongoing concerns about the costs, risks, and availability of allogeneic blood have prompted the implementation of multiple techniques (preoperative erythropoetin, autologous pre-donation, intra-operative blood salvage, and induced hypotension) to reduce the necessity of ABT. However, 28% of patients undergoing spinal fusion at the Toronto Western Hospital still receive ABT. Also, none of these modalities (with the exception of induced hypotension) actually reduce the amount of blood shed from the surgical wound; thus the severity of anemia is largely unaffected. Consequently, many of these patients can suffer from adverse effects of anemia postoperatively as well as potential complications from blood transfusions.
The underlying assumption of the proposed study is that excessive fibrinolysis occurs during spinal fusion surgery. This can result in increased and recurrent blood loss, which can exacerbate the significant amount of bleeding already associated with major spine surgery.
Tranexamic acid - an antifibrinolytic drug blocks the dissolution of hemostatic fibrin, which stabilizes fibrin structures, and thus may decrease blood loss secondary to increased fibrinolysis.
This research proposal will test the following hypotheses:
- Tranexamic acid reduces the estimated perioperative blood loss in adult patients undergoing elective spinal fusion.
- Tranexamic acid reduces the need for blood transfusion in adult patients undergoing elective spinal fusion.
This multi-centered trial will be valuable for establishing the efficacy and safety of tranexamic acid for reducing blood loss and allogeneic blood transfusion in adults having elective spinal fusion. Tranexamic acid is easy to administer, is relatively inexpensive, and has not been associated with significant adverse effects. If it is shown to be efficacious, it can be incorporated into routine clinical practice as part of the multi-modal perioperative blood conservation techniques currently used to reduce perioperative blood loss, transfusion and the risk of allogeneic blood transfusion.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
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Ontario
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Mississauga, Ontario, Canada, L5B 1B8
- Trillium Health Centre
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Toronto, Ontario, Canada, M5B 1W8
- St. Michael's Hospital
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Toronto, Ontario, Canada, M5T 2S8
- Department of Anesthesia and Orthopedics; Toronto Western Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All adult patients (greater than 18 years old) undergoing elective posterior thoracic/lumbar instrumented spinal fusion.
Exclusion Criteria:
- Participation in another clinical trial
- Allergy to TA
- Spinal tumor/Intradural pathology
- Ankylosing spondylitis
- Acquired disturbances of color vision
- Preoperative anemia (Hb <110 in females, Hb <120 in males)
- Refusal of blood products (Jehovah's witnesses)
- Preoperative use of anticoagulant therapy - coumadin, heparin within 5 days of surgery
- Fibrinolytic disorders requiring intraoperative antifibrinolytic treatment
- Hematological disease (thromboembolic events, hemoglobinopathy, coagulopathy or hemolytic disease)
- Preoperative platelet count <150,000/cubic mm, INR>1.4, prolonged PTT
- Significant co-morbidities: Previous MI ; severe ischemic heart disease (NYHA Class III, IV) ; severe pulmonary disease ; chronic renal failure ; hepatic failure ; uncontrolled hypertension
- Pregnancy or lactation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: A
Active drug being tested in this study is Tranexamic Acid
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Eligible patients who have consented to be in the study and have been randomised to be in Arm "A" will receive 10 mg/kg of tranexamic acid, and then a continuous infusion of 1 mg/kg/hr of tranexamic acid.
Other Names:
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Placebo Comparator: B
Normal saline was used as the Placebo
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Eligible patients who have consented to be in the study and have been randomised to be in Arm "B" will receive 10 mg/kg of placebo followed by a continuous infusion of 1 mg/kg/hr of placebo.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Total perioperative blood loss
Time Frame: Measured intraoperatively and 24 hours postoperatively
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Measured intraoperatively and 24 hours postoperatively
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidence of autologous or allogeneic blood transfusion, including red blood cells and coagulation components, i.e., FFP and platelets
Time Frame: Administered during entire hospitalization
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Administered during entire hospitalization
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Other secondary outcomes will include hemoglobin concentration, fatigue and functional recovery, and duration of hospital stay.
Time Frame: Hemoglobin concentration will be measured pre-operatively, intraoperatively and on post-operative days 1-3. Fatigue questionnaire will be completed at the pre-operative admission, post-operative days 3 and 7, and after discharge at 6 weeks.
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Hemoglobin concentration will be measured pre-operatively, intraoperatively and on post-operative days 1-3. Fatigue questionnaire will be completed at the pre-operative admission, post-operative days 3 and 7, and after discharge at 6 weeks.
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Collaborators and Investigators
Investigators
- Principal Investigator: Jean Wong, MD, FRCPC, University Health Network, Toronto
- Study Director: Henry Ahn, MD, FRCPC, Unity Health Toronto
- Study Director: Robert McBroom, MD, FRCPC, Trillium Health Centre
Study record dates
Study Major Dates
Study Start
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- P.S.I. Grant No. 02-69
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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