- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01143909
Transfusion of Fresh Frozen Plasma in Non-bleeding Intensive Care Unit (ICU) Patients (TOPIC)
Transfusion of Fresh Frozen Plasma in Non-bleeding ICU Patients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Rationale: Fresh frozen plasma (FFP) is an effective therapy to correct for a deficiency of multiple coagulation factors during bleeding. In past years, use of FFP has increased, in particular in patients on the Intensive Care Unit (ICU), and has expanded to include prophylactic use in patients with a coagulopathy prior to undergoing an invasive procedure. Retrospective studies suggest that prophylactic use of FFP does not prevent bleeding, but carries the risk of transfusion-related morbidity. However, up to 50% of FFP is administered to non-bleeding ICU patients.
Objective: With the aim to restrict inappropriate FFP transfusions to critically ill patients, a randomized clinical trial will be conducted in a subgroup of ICU patients with a coagulopathy undergoing an invasive procedure. The objective is to assess the effectiveness and costs of prophylactic FFP transfusion (current practice) compared to no prophylactic transfusion, in non-bleeding ICU patients with a coagulopathy, prior to undergoing an invasive procedure (e.g. placement of central venous catheter, tracheostomy, chest tube).
Study design: Prospective, multicentre, randomized, open-label, blinded end point evaluation (PROBE) design.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Amsterdam, Netherlands, 1105 AZ
- Academic Medical Centre - University of Amsterdam
-
Hilversum, Netherlands, 1231 XZ
- Ter Gooi Ziekenhuizen
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Leiden, Netherlands, 2333 XZ
- Leids Universitair Medisch Centrum
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Utrecht, Netherlands, 3582 KE
- Diakonessenhuis
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 18 years and older
- INR >1.5 and <3.0
- undergoing invasive procedure (insertion of a central venous catheter, a chest drain, percutaneous tracheostomy)
Exclusion Criteria:
- clinically overt bleeding at the time of the procedure (excludes minor epistaxis, minor gum bleeding, microscopic hematuria, superficial bruises, or normal menses)
- thrombocytopenia of < 30 x 109/L.
- use of abciximab, tirofiban, ticlopidine or activated protein C
- use of heparin < 1 hour prior to the procedure, or low molecular weight heparin in therapeutic doses < 12 hours prior to procedure
- history of congenital or acquired coagulation factor deficiency or bleeding diathesis
- no informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: No FFP transfusion prior to intervention
Patients with a coagulopathy (INR 1,5-3,0), who are randomized to omitting transfusion of fresh frozen plasma before they undergo an intervention.
|
In the interventional group FFP transfusion is omitted before performing a procedure (e.g.
placement of central venous catheter, tracheostomy, chest tube)
|
No Intervention: FFP transfusion prior to intervention
Patients with a coagulopathy (INR 1,5-3,0), who are randomized to transfusion of fresh frozen plasma before they undergo an intervention.
This is considered standard care.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Procedure-related relevant bleeding, occurring within 24 hours after the procedure.
Time Frame: 24 hours after the procedure
|
Relevant bleeding will be defined using a validated tool for assessment of bleeding in the critically ill. An assessment of bleeding will be standardized and performed by an independent research physician or intensivist blinded to the transfusion strategy 1 and 24 hours after the procedure and when clinically indicated. |
24 hours after the procedure
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
minor bleeding within 24 hours
Time Frame: within 24 hours of the procedure
|
within 24 hours of the procedure
|
|
onset of acute lung injury within 48 hours.
Time Frame: 48 hours within the intervention
|
Lung injury will be evaluated by P/F ratio, change in ventilator settings, chest x-ray and Lung Injury Score.
|
48 hours within the intervention
|
effect of FFP transfusion on coagulation parameters
Time Frame: within 24 hours of transfusion of FFP
|
a range of coagulation parameters will be evaluated to assess efficacy of FFP transfusion in these patients
|
within 24 hours of transfusion of FFP
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evaluation of costs
Time Frame: up to 28 days after inclusion
|
Evaluation of costs in the two different groups will be made.
Length of stay, number of ventilation days, differences in medication use, all will be taken into account.
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up to 28 days after inclusion
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Collaborators and Investigators
Investigators
- Principal Investigator: Nicole P Juffermans, MD, PhD, Academic Medical Centre - University of Amsterdam
Publications and helpful links
General Publications
- Straat M, Muller MC, Meijers JC, Arbous MS, Spoelstra-de Man AM, Beurskens CJ, Vroom MB, Juffermans NP. Effect of transfusion of fresh frozen plasma on parameters of endothelial condition and inflammatory status in non-bleeding critically ill patients: a prospective substudy of a randomized trial. Crit Care. 2015 Apr 15;19(1):163. doi: 10.1186/s13054-015-0828-6.
- Muller MC, Straat M, Meijers JC, Klinkspoor JH, de Jonge E, Arbous MS, Schultz MJ, Vroom MB, Juffermans NP. Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy. J Thromb Haemost. 2015 Jun;13(6):989-97. doi: 10.1111/jth.12908. Epub 2015 Apr 18.
- Muller MC, de Jonge E, Arbous MS, Spoelstra-de Man AM, Karakus A, Vroom MB, Juffermans NP. Transfusion of fresh frozen plasma in non-bleeding ICU patients--TOPIC trial: study protocol for a randomized controlled trial. Trials. 2011 Dec 23;12:266. doi: 10.1186/1745-6215-12-266.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- ZonMw-80823109710069
- NTR2262 (Registry Identifier: Dutch Trial Register)
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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