- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01641549
Surgery Versus Fibrinolytic Therapy for Left-sided Prosthetic Heart Valve Thrombosis (SAFE-PVT)
March 8, 2017 updated by: Dr Ganesan Karthikeyan, All India Institute of Medical Sciences, New Delhi
Surgery Compared to Fibrinolytic Therapy for Symptomatic Patients With Left-sided Prosthetic Heart Valve Thrombosis
Malfunction of mechanical heart valves due to clot formation is a potentially devastating complication.
It often results in heart failure, death or stroke.
This condition occurs frequently in patients with mechanical valves in developing countries because they are unable to monitor and adjust the dose of blood thinning medications.
The best treatment modality for the treatment of patients with this condition is not known.
There is no reliable data from clinical trials to guide treatment and there are no firm guidelines.
Treatment with clot-busting drugs is most commonly used because these drugs (e.g., streptokinase) are readily available, cheap, and easy to use.
However, this treatment is associated with high rates of treatment-related side-effects (death, life-threatening bleeding and stroke).
Moreover, some recent studies suggest that clot-busting drugs may not be as efficacious in restoring valve function, as previously believed.
Emergency surgery is less often used because it is more expensive and the required facilities and manpower are not available at all times at all places.
But there is evidence to suggest that surgery results in better success rates with a lower risk of bleeding and stroke.
Well-designed prospective randomised trials (the "gold-standard" for reliable evidence) comparing the efficacy, safety and cost-effectiveness of the two modalities, are needed to help doctors in developing countries make informed decisions when treating patients with clotted mechanical heart valves.
The investigators propose to perform a randomised controlled trial comparing emergency surgery with treatment with clot-busting agents in patients with clotted mechanical valves.
The study will be conducted over 4 years at a single, university hospital in a developing country.
This study will determine how often patients who are treated with surgery will be discharged from hospital, with completely restored valve function, without having suffered a stroke or life-threatening bleeding, when compared to those who received clot-busting drugs.
The investigators will also find out which of the treatments is safe and cost-effective.
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Detailed Description
Left-sided prosthetic valve thrombosis (PVT) is a potentially devastating complication which can affect patients with mechanical heart valves.
It occurs frequently in developing countries because of poor anticoagulation quality.
The best modality for treating this condition is not known.
Most of the available data is from retrospective studies and case series, and current guidelines are based largely on expert opinion.
Therefore recommendations for treatment vary widely.
Fibrinolytic therapy (FT) is the most commonly used treatment because fibrinolytic agents such as streptokinase are readily available, cheap, and easy to use.
However, FT is associated with high rates of treatment-related adverse effects (death, major bleeding and stroke).
Moreover, recent studies suggest that FT may not be as efficacious in restoring valve function, as previously believed.
Emergency surgery is less often used because it is more expensive and the required facilities and manpower are not available at all times at all places.
A systematic review and meta-analysis of the available literature that the investigators performed, suggests that surgery may result in better success rates with a lower risk of major bleeding, stroke and non-CNS systemic embolism.
Evidence from well designed randomised controlled trials is needed to determine the optimal treatment of left-sided PVT.
The investigators propose to do a single-centre, open-label, randomised controlled trial comparing emergency surgery with FT for the treatment of symptomatic patients with left-sided PVT.
The primary outcome is the occurrence of a complete clinical response, defined as discharge from hospital with completely restored valve function, in the absence of stroke, major bleeding or non-CNS systemic embolism.
The investigators will compare the safety of the two interventions and quality of life at discharge and at 1 year.
The investigators will also assess the cost-effectiveness of surgery compared to FT from a societal perspective in the context of the Indian healthcare system
Study Type
Interventional
Enrollment (Anticipated)
115
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Ganesan Karthikeyan, MD, DM, MSc
- Phone Number: +91-11-26594464
- Email: karthik2010@gmail.com
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110029
- Departments of cardiology and Cardiovascular Surgery, All India Institute of Medical Sciences
-
Contact:
- Ganesan Karthikeyan, MD, DM, MSc
- Phone Number: +91-11-26594464
- Email: karthik2010@gmail.com
-
Principal Investigator:
- Ganesan Karthikeyan, MD, DM, MSc
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 70 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- All patients over 18 years of age with recent-onset (≤2 weeks), objectively diagnosed, symptomatic (NYHA class II-IV) left-sided prosthetic valve dysfunction
Exclusion Criteria:
- Absolute contraindications to FT (any history of intracranial hemorrhage, active bleeding from any site, ischemic stroke in the preceding 3 months, left atrial thrombus on TTE)
- Pregnant patients
- Asymptomatic patients (incidentally detected valve thrombosis)
- Inability to obtain (or refusal to provide) informed consent
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Emergency surgery
Emergency surgery (valve replacement or thrombectomy)
|
Emergency surgery (valve replacement or thrombectomy)
Other Names:
|
Active Comparator: Fibrinolytic therapy
Streptokinase (SK) at a dose of 0.25MU over 30 minutes followed by a 0.1MU/ hour infusion, or other fibrinolytic agent
|
Streptokinase (SK) at a dose of 0.25MU over 30 minutes followed by a 0.1MU/ hour infusion, or other fibrinolytic agent at standard doses
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complete clinical response
Time Frame: In-hospital, average of 10 days
|
The primary outcome is the occurrence of a complete clinical response, defined as discharge from hospital with completely restored valve function, in the absence of stroke, major bleeding or non-CNS systemic embolism.
|
In-hospital, average of 10 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Death, stroke, major bleeding, or non-CNS systemic embolism
Time Frame: In-hospital, average of 10 days
|
A composite of in-hospital death, stroke, major bleeding or non-CNS systemic embolism.
|
In-hospital, average of 10 days
|
Death, recurrent PVT, stroke or non-CNS systemic embolism or persistent abnormal valve function
Time Frame: 1 year
|
A composite of death, recurrent PVT, stroke or non-CNS systemic embolism, and persistent abnormal valve function (or re-do surgery for persistent valve dysfunction)
|
1 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Ganesan Karthikeyan, MD, DM, MSc, All India Institute of Medical Sciences, New Delhi
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Anticipated)
April 1, 2017
Primary Completion (Anticipated)
March 1, 2019
Study Completion (Anticipated)
March 1, 2019
Study Registration Dates
First Submitted
July 10, 2012
First Submitted That Met QC Criteria
July 16, 2012
First Posted (Estimate)
July 17, 2012
Study Record Updates
Last Update Posted (Actual)
March 10, 2017
Last Update Submitted That Met QC Criteria
March 8, 2017
Last Verified
March 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Version 1.01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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