- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01359878
Fibrinogen Concentrate as Initial Treatment for Postpartum Haemorrhage: A Randomised Clinically Controlled Trial (FIB-PPH)
Fibrinogen Concentrate as Initial Treatment for Postpartum Haemorrhage - A Randomised Clinically Controlled Trial
Severe maternal bleeding is a serious complication of birth and causes 125.000 deaths worldwide each year. The investigators aim to investigate if early treatment with fibrinogen concentrate versus saline can reduce the incidence of blood transfusion in women with postpartum haemorrhage.
A low level of fibrinogen has been associated with increased blood loss and transfusion requirements in different clinical settings including obstetrical bleeding. Early up-front treatment with fibrinogen may reduce incidence of transfusion by securing optimal haemostatic capacity in women with postpartum haemorrhage.
The investigators plan to enrol 245 patients on four hospitals in the Capital Region of Denmark during a two year period.
As safety measure the investigators plan to use TEG®/Functional Fibrinogen/Rapid-TEG as haemostatic monitoring of all participants during the trial: Baseline test is taken at inclusion before administration of fibrinogen concentrate/placebo. Further tests are taken immediately after intervention, 4 hours and 24 hours after. Baseline test is blinded to the providers of treatment - the rest is clinically available.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Experimental design Design: We plan to conduct a randomised double-blinded clinically controlled trial: The participants are assigned to either 1) placebo (100 ml of isotonic saline) i.v. or 2) the intervention drug: 2 g of fibrinogen concentrate (Haemocomplettan, CSL Behring) i.v. We intend to use a fixed dose for all patients randomized to the intervention group without prior measurement of the fibrinogen level. This strategy is primarily based on the clinical urgency since the treatment is required to be administered as early as possible.
Materials and duration of study Patients will be included during a two year period at the four largest hospitals in the Capital Region: Rigshospitalet, Hvidovre, Hillerød and Herlev if they fulfil the following eligibility criteria Plan of trial execution In order to secure the ethical aspect "Time for reflection" we will provide all pregnant women who appear in the centres during the trial period with written information on the trial during their midwife evaluation. Only 1,75% of these women are estimated to meet the inclusion criteria postpartum.
Intensive haemostatic monitoring Haemostatic blood samples including thrombelastography (TEG®), functional fibrinogen-assay for TEG®, Rapid-TEG, fibrinogen-level, d-Dimer, INR (international normalized ratio), platelet count and Antithrombin III will be drawn 15 minutes after the intervention is given, 4 hours and 24 hours later. The samples taken after the intervention are fully available for evaluation by the clinicians responsible for the patient. The patient will be observed with blood pressure, pulseoximetry, ECG and possible side effects or re-bleeding will be evaluated.
Follow up The patients will remain hospitalized for a minimum of 24 hours. We will contact all participants by phone six weeks after the intervention. Upon discharge from the hospital, all included patients receive information-material addressing possible late side effects and a contact number.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
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Capital Region
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Copenhagen, Capital Region, Denmark, 2100
- Juliane Marie Centre, Rigshospitalet
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Herlev, Capital Region, Denmark, 2730
- University Hospital of Herlev
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Hilleroed, Capital Region, Denmark, 3400
- University Hospital of Hilleroed
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Hvidovre, Capital Region, Denmark, 2650
- University Hospital of Hvidovre
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Informed consent from participant.
- Women who develop PPH defined as bleeding from uterus and/or the birth canal within 24 hours postpartum.
- Age ≥ 18 years.
- If vaginal birth: indication of one of the following procedures at the operation theatre with anaesthetic assistance: a) Estimated blood loss ≥ 500 ml and indication of manual removal of placenta or b) Indication of manual exploration of the uterus due to continuous bleeding after the birth of placenta.
- If birth by Caesarean section: A perioperative blood loss ≥ 1000 ml.
Exclusion Criteria:
- Patients with known inherited deficiencies of coagulation.
- Patients in anti-thrombotic treatment prepartum due to increased risk of thrombosis.
- Patients with a pre-pregnancy weight <45 kg.
- Patients who refuse to receive blood transfusion.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Isotonic Saline
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Isotonic saline in equivalent volume - 100 ml
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Experimental: Fibrinogen Concentrate
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2 gram intra venous
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Incidense of transfusion with allogenic blood products
Time Frame: During hospital stay or until 6 weeks postintervention
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During hospital stay or until 6 weeks postintervention
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Severe Postpartum Haemorrhage (PPH)
Time Frame: During hospital stay or until 6 weeks postintervention
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Development of "Severe PPH" defined as: "Decrease of haemoglobin (Hb) of > 2,5 mmol/L, transfusion of at least 4 Red Blood Cell (RBC) units, haemostatic intervention (angiographic embolization, surgical arterial ligation or hysterectomy) or death.
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During hospital stay or until 6 weeks postintervention
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Estimated blood loss
Time Frame: During hospital stay During hospital stay or until 6 weeks postintervention
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During hospital stay During hospital stay or until 6 weeks postintervention
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Total amount of blood transfused
Time Frame: During hospital stay During hospital stay or until 6 weeks postintervention
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During hospital stay During hospital stay or until 6 weeks postintervention
|
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The development of re-bleeding
Time Frame: Untill follow-up 6 weeks postintervention
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Defined as bleeding reoccuring after primary haemostasis, and requiring surgical procedures or intervention
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Untill follow-up 6 weeks postintervention
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Hemoglobin level below 3,6 mmol/L
Time Frame: During hospital stay or until 6 weeks postintervention
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During hospital stay or until 6 weeks postintervention
|
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Side-effects including thromboembolic complications
Time Frame: Untill 6 weeks postintervention
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Safety measures/ Potential known side effects such as: Fever, headache, nausea, vomiting, allergic reactions, anaphylaxis and thrombo-embolic complications (deep venous thrombosis, acute myocardial infarct and lung embolus.
All suspected unexpected serious adverse reactions will also be reported in accordance with the Good Clinical Practice (GCP) and the Danish Medicines Agency guidelines.
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Untill 6 weeks postintervention
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Anne J. Wikkelsoe, MD, Department of Anaesthesiology, University Hospital of Herlev, Denmark
- Study Chair: Ann M. Møller, MD, DmSc, Department of Anaesthesiology, University Hospital of Herlev, Denmark
- Study Chair: Jakob Stensballe, MD, PhD, Blood Bank of Danish Capital Region, Rigshospitalet
- Study Chair: Jens Langhoff-Roos, MD, DmSc, Department of Obstetrics, Juliane Marie Centre, Rigshospitalet
- Study Chair: Arash Afshari, MD, Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet, Denmark
- Study Chair: Hellen McKinnon Edwards, M.D., Dep. of Anaesthesiology, Herlev
Publications and helpful links
General Publications
- Wikkelso AJ, Edwards HM, Afshari A, Stensballe J, Langhoff-Roos J, Albrechtsen C, Ekelund K, Hanke G, Secher EL, Sharif HF, Pedersen LM, Troelstrup A, Lauenborg J, Mitchell AU, Fuhrmann L, Svare J, Madsen MG, Bodker B, Moller AM; FIB-PPH trial group. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth. 2015 Apr;114(4):623-33. doi: 10.1093/bja/aeu444. Epub 2015 Jan 13.
- Wikkelsoe AJ, Afshari A, Stensballe J, Langhoff-Roos J, Albrechtsen C, Ekelund K, Hanke G, Sharif HF, Mitchell AU, Svare J, Troelstrup A, Pedersen LM, Lauenborg J, Madsen MG, Bodker B, Moller AM. The FIB-PPH trial: fibrinogen concentrate as initial treatment for postpartum haemorrhage: study protocol for a randomised controlled trial. Trials. 2012 Jul 17;13:110. doi: 10.1186/1745-6215-13-110.
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2009-017736-41 (EudraCT Number)
- 1002168 (Other Identifier: The Central Danish National Ethics Comitee)
- 2612-4233 (Other Identifier: The Danish Medicines Agency)
- 2007-58-0015-00911 (Other Identifier: The Danish Data Protection Agency)
- H-3-2010-004 (Other Identifier: The ethical comitee of Capital Region)
- 2009-315 (Other Identifier: The monitoring Unit of Good Clinical Practice, Copenhagen University)
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