- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01283321
RiaSTAP vs. Conventional Transfusion in Patients Having Heart Valve Surgery (RiaCT)
RiaSTAP vs. Conventional Transfusion for Patients Undergoing Valve Replacement Surgery: RiaCT
Heart surgery involving valve replacement often involves the use of the heart-lung machine for over 90 minutes, and bleeding tendency is frequently seen. Conventionally, platelet transfusion has been the primary therapy to treat bleeding after this type of procedure. More recently, perioperative supplementation of purified fibrinogen (RiaSTAP, CSL Behring) was shown to reduce bleeding and blood product use (plasma or platelets) after heart surgery. The objective of this trial is to demonstrate the clinical equivalency and economic utility of using fibrinogen concentrate, RiaSTAP for the mitigation of post-operative bleeding in patients in lieu of platelet transfusion.
Purified fibrinogen concentrate has been approved by FDA, and it has been used for the treatment of acute bleeding episodes in patients with low fibrinogen due to hereditary causes (e.g., afibrinogenemia). Compared to the transfusion of platelets which may be associated with volume overload, bacterial/viral infection, immunological effects and excess blood clotting, purified fibrinogen has several advantages. First, it contains no liquid plasma allowing for low volume infusion. Several viral inactivation/reduction steps are used to prepare the fibrinogen concentrate, increasing its viral safety. No antibodies or white blood cells are contained in the fibrinogen concentrate; therefore transfusion reactions are rare. Although platelet transfusion is widely used after heart surgery, there has been no randomized study to endorse this practice. In this study, patients undergoing heart valve replacement will be randomized to receive either platelet (1 unit) transfusion or fibrinogen concentrate (4g) after heparin anticoagulation is reversed. Subjects will be treated only if there is evidence of significant microvascular bleeding. Fifteen minutes after the initial treatment, subjects will be reevaluated for bleeding. If bleeding continues, subjects will be treated with blood transfusion per institutional standard of care.
The primary endpoints for this study are the hemostatic condition of the surgical field and 24-hour total of blood product transfusion.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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Georgia
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Atlanta, Georgia, United States, 30322
- Emory University Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Willing and able to provide written informed consent
- Age >17 and < 86 years
Patients undergoing planned cardiopulmonary bypass (CPB) for:
- combined coronary artery bypass grafting and valve replacement/repair surgery
- single valve replacement surgery
- mitral valve repair surgery
3. or double valve surgery (aortic and mitral)
- Presence of clinically relevant microvascular bleeding after protamine administration (hemostasis assessment score of 2-3)
Patients should fulfill the following parameters prior to the study intervention:
- Body temperature > 35.0°C
- Blood pH > 7.2
- Hb > 7.0 mg/dL
- Activated clotting time (ACT) < 155 seconds
- CPB time > 60 minutes
Exclusion Criteria:
- Replacement of aorta
- Planned valve replacement without median sternotomy
- Previous valve replacement surgery (previous coronary artery bypass graft (CABG) acceptable)
- History or suspicion of a congenital or acquired coagulation disorder such as hemophilia, von Willebrand disease, and liver disease
- Hemodialysis dependent renal failure
- Liver dysfunction (aspartate aminotransferase (AST) or alanine aminotransferase (ALT) increased ≥ 2-fold above the upper limit of local laboratory normal ranges)
- Known allergy/anaphylaxis to fibrinogen concentrate or apheresis platelet units
- Clopidogrel administration within 5 days of surgery
- Coumadin (warfarin) administration within 5 days of surgery
- Participation in another clinical study in the 4 weeks preceding surgery
- Any indication that a potential subject did not comprehend the study restrictions, procedures, or consequences therein an informed consent cannot be convincingly given
- Life expectancy less than 48 hours
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Group A: RiaSTAP
Human fibrinogen concentrate
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4 g IV once, within 30 minutes of ACT < 155 seconds, post CPB, with evidence of significant microvascular bleeding
Other Names:
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Active Comparator: Group B: apheresis platelets
single apheresis unit
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A single apheresis platelet unit will be administered as an initial therapy within 30 minutes of ACT <155 seconds post CPB with evidence of significant microvascular bleeding.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bleeding Scores
Time Frame: intra-operatively and up to 24 hours postoperatively
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Bleeding scores are scored on a four-point scale.
A visual assessment of surgical field was performed by the senior surgical staff as follows: 0 = excellent hemostasis (dry field), 1 = mild bleeding (oozing), 2 = moderate bleeding (controllable with applied pressure), and 3 = severe bleeding (multiple diffuse bleeding sites).
If the visual bleeding scale was 2 to 3, the subjects were randomly assigned to a study intervention using a closed envelope method.
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intra-operatively and up to 24 hours postoperatively
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Number of Participants in Whom Transfusion of Platelet Concentrate is Required During or After Surgery.
Time Frame: Operative period up to 60 minutes
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Operative period up to 60 minutes
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Volume (mL) of Fresh-frozen Plasma (FFP) Transfused-during Surgery and up to 24 Hours After Surgery
Time Frame: Operative period up to 60 minutes and up to 24 hours after surgery
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Operative period up to 60 minutes and up to 24 hours after surgery
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Volume (mL) of Platelets Transfused- During Surgery and up to 24 Hours After Surgery
Time Frame: Operative period up to 60 minutes and up to 24 hours after surgery
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Operative period up to 60 minutes and up to 24 hours after surgery
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Median Blood Loss (mL) at 12 Hours After Surgery
Time Frame: From end of surgery to 12 hours after surgery
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From end of surgery to 12 hours after surgery
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Gautam Sreeram, MD, Emory University
- Principal Investigator: Kenichi Tanaka, MD, MSc, University of Maryland
Publications and helpful links
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00036062
- RiaCT 2010 (Other Identifier: Other)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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