- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02344069
Pilot Randomized Trial of Fibrinogen in Trauma Haemorrhage
Effect of Immediate, Pre-emptive Fibrinogen Concentrate in Patients With Trauma Haemorrhage Needing Haemostatic Resuscitation - a Randomized, Controlled, Double-blinded Investigator-initiated Pilot Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Objective To assess the efficacy and safety of an immediate pre-emptive first-line treatment with fibrinogen concentrate in patients with trauma haemorrhage in need of haemostatic resuscitation.
Hypothesis Immediate, pre-emptive first-line treatment of fibrinogen concentrate in trauma patients with ongoing critical haemorrhage will increase the clot strength.
Background Trauma haemorrhage remains a leading cause of morbidity and mortality. Fibrinogen is an essential endogenous component of haemostasis and the plasma level is associated to bleeding, transfusion and outcome.
Trial rationale Fibrinogen concentrate is widely used to correct acquired hypofibrinogenaemia, recommended by several international guidelines including in trauma, but evidence is lacking regarding the treatment safety and efficacy.
Trial population The trial population are patients' ≥ 18 years admitted to the Trauma Centre at Rigshospitalet with immediate need for blood transfusion at arrival and an expected need for haemostatic resuscitation with multiple transfusions during the initial resuscitation. Estimated 30-day mortality is 20 % in the population. Patients included in the trial will be temporarily incompetent because of acute, severe illness related to the ongoing critical bleeding needing multiple transfusion and immediate intervention to control bleeding.
Trial design This is a single centre, randomized (1:1, active:placebo), placebo controlled, double-blind investigator-initiated phase II trial in patients with traumatic, critical bleeding, investigating the safety and efficacy of immediate and pre-emptive administration of fibrinogen concentrate (Riastap®) or placebo as i.v infusion in 40 patients. All patients will receive standard of care including damage control surgery, radiological interventions and haemostatic resuscitation as part of their treatment at Rigshospitalet.
Patients considered to be included in the trial will be temporarily incompetent because of the acute, critical bleeding related to trauma, so scientific guardians will co-sign the informed consent form. Next-of-kin and the patients' general practitioner or the patients will co-sign as soon as possible.
During the study blood samples will be taken at different time points. Patients will be observed and assessed continuously throughout the first 72 hours. During the extended follow up period at day 30, contact will be made with the patients to follow up on safety events and establish potential mortality.
Investigational product Immediate intravenous administration as a single dose of fibrinogen concentrate (Riastap®, CSL Behring), when haemostatic resuscitation is deemed necessary by the clinician. The aim is to give the intervention < 1 hour of arrival, and the intervention should, when possible, be given prior to blood products.
Placebo and blinding Saline 0.9% will be used as placebo. The volume of placebo to be administered is equal to the volume active drug administered. The content (Riastap® or placebo) will be provided in opaque syringes and infusion sets (yellow-coloured) to disguise the content of the allocation to the treatment team.
Outcome measures
Primary outcome measure:
• Thrombelastograph (TEG®) Functional Fibrinogen (FF) maximum amplitude (MA) in mm at 15 min post intervention
Secondary outcome measures:
- TEG® FF MA in mm at 2, 6, 24 and 72 hours post intervention
- TEG® MA in mm at 15 min., 2, 6, 24 and 72 hours post intervention
- Transfusion requirements (Red blood cells (RBC) or fresh frozen plasma (FFP) or platelets (PLT)) at 2, 6, 24, 72 hours and in total at day 30
- Total use of haemostatic therapy (i.e. use of coagulation factor concentrates and tranexamic acid) in the first 24 and 72 hours, omitted from this is active treatment (intervention)
- Time to intervention or placebo
- Time to FFP and PLT transfusion
- Percentage of patients receiving intervention or placebo < 1 hour of arrival
- Time to surgical control of bleeding as noted by the surgeon
- Severe adverse reactions at day 30, defined as symptomatic thromboembolism at day 30 and anaphylaxis at day 30
- 24-hour and 30-day mortality
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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-
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Copenhagen, Denmark
- Rigshospitalet, Copenhagen University Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Trauma patient received directly from the scene of the accident AND
- Age ≥ 18 years AND
- Initiated order of transfusion of at least one blood component within the 1st hour of arrival AND
- Predicted to need transfusion package therapy during the initial resuscitation (first 2 hours) AND
- Consent obtainable from patient or scientific guardians (independent physicians and/or next of kin
Exclusion Criteria:
- Duration of > 2 hours from time of accident to arrival at trauma centre OR
- Known anticoagulant treatment (vitamin K antagonist, dabigatran, rivaroxiban, apixaban) OR
- Severe isolated traumatic brain injury OR
- Moribund patient with devastating injuries and expected to die within one hour of admission OR
- Withdrawal from active therapy OR
- Previously, within 30 days, included in a randomized trial, if known at the time of enrolment OR
- Known body weight < 55 kg OR
- Any blood product prior to inclusion
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Saline 0.9%
|
Saline 0.9% as a injection
Other Names:
|
Active Comparator: Fibrinogen
Immediate intravenous administration as a single dose of fibrinogen concentrate (Riastap®, CSL Behring), when haemostatic resuscitation is deemed necessary by the clinician.
|
Human fibrinogen concentrate as a injection
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
TEG® Functional Fibrinogen maximum amplitude 15 min
Time Frame: 15 min after intervention
|
Thrombelastograph (TEG®) Functional Fibrinogen (FF) maximum amplitude (MA) in mm
|
15 min after intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
TEG® Functional Fibrinogen maximum amplitude 2 hours
Time Frame: 2 hours after intervention
|
Thrombelastograph (TEG®) Functional Fibrinogen (FF) maximum amplitude (MA) in mm
|
2 hours after intervention
|
TEG® Functional Fibrinogen maximum amplitude 6 hours
Time Frame: 6 hours after intervention
|
Thrombelastograph (TEG®) Functional Fibrinogen (FF) maximum amplitude (MA) in mm
|
6 hours after intervention
|
TEG® Functional Fibrinogen maximum amplitude 24 hours
Time Frame: 24 hours after intervention
|
Thrombelastograph (TEG®) Functional Fibrinogen (FF) maximum amplitude (MA) in mm
|
24 hours after intervention
|
TEG® Functional Fibrinogen maximum amplitude 72 hours
Time Frame: 72 hours after intervention
|
Thrombelastograph (TEG®) Functional Fibrinogen (FF) maximum amplitude (MA) in mm
|
72 hours after intervention
|
TEG® maximum amplitude 15 min
Time Frame: 15 min after intervention
|
Thrombelastograph (TEG®) maximum amplitude (MA) in mm
|
15 min after intervention
|
TEG® maximum amplitude 2 hours
Time Frame: 2 hours after intervention
|
Thrombelastograph (TEG®) maximum amplitude (MA) in mm
|
2 hours after intervention
|
TEG® maximum amplitude 6 hours
Time Frame: 6 hours after intervention
|
Thrombelastograph (TEG®) maximum amplitude (MA) in mm
|
6 hours after intervention
|
TEG® maximum amplitude 24 hours
Time Frame: 24 hours after intervention
|
Thrombelastograph (TEG®) maximum amplitude (MA) in mm
|
24 hours after intervention
|
TEG® maximum amplitude 72 hours
Time Frame: 72 hours after intervention
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Thrombelastograph (TEG®) maximum amplitude (MA) in mm
|
72 hours after intervention
|
Transfusions requirements
Time Frame: 2, 6, 24, 72 hours and in total at day 30
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Transfusion requirements (Red blood cells (RBC) or fresh frozen plasma (FFP) or platelets (PLT)) at 2, 6, 24, 72 hours and in total at day 30
|
2, 6, 24, 72 hours and in total at day 30
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Total use of haemostatic therapy
Time Frame: 24 hours and 27 hours
|
Total use of haemostatic therapy (i.e.
use of coagulation factor concentrates and tranexamic acid) in the first 24 and 72 hours, omitted from this is active treatment (intervention)
|
24 hours and 27 hours
|
Time to intervention or placebo
Time Frame: No of minutes from arrival, an expected average of 45 minutes
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Time from arrival to active intervention or placebo in minutes
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No of minutes from arrival, an expected average of 45 minutes
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Time to FFP and PLT transfusion
Time Frame: No of minutes from arrival, an expected average of 50 minutes
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Time to FFP and PLT transfusion in minutes
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No of minutes from arrival, an expected average of 50 minutes
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Percentage of patients receiving intervention or placebo < 1 hour of arrival
Time Frame: 60 min from arrival
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Percentage of patients receiving intervention or placebo < 1 hour of arrival
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60 min from arrival
|
Time to surgical control of bleeding
Time Frame: No of minutes from arrival, an expected average of 120 minutes
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Time to surgical control of bleeding as noted by the surgeon
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No of minutes from arrival, an expected average of 120 minutes
|
Thromboembolism day 30
Time Frame: 30 days
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Symptomatic thromboembolism at day 30 (Severe adverse reaction)
|
30 days
|
Anaphylaxis day 30
Time Frame: 30 days
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Anaphylaxis day 30 (Severe adverse reaction)
|
30 days
|
24-hour mortality
Time Frame: 24 hours from arrival
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Mortality in the first 24 hours
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24 hours from arrival
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30-day mortality
Time Frame: 30 days from arrival
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Mortality in the first 30 days
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30 days from arrival
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Jakob Stensballe, MD, PhD, Rigshospitalet, Denmark
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRooF-iTH
- 2014-003978-16 (EudraCT Number)
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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