- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02655653
Efficacy of Tranexamic Acid and Epsilon-aminocaproic Acid in Reducing Bleeding and Transfusions in Cardiac Surgery
A Randomized, Double-blinded Trial Comparing the Efficacy of Tranexamic Acid and Epsilon-aminocaproic Acid in Reducing Bleeding and Transfusions in Cardiac Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a single center double blinded randomized controlled study comparing the effectiveness of epsilon-aminocaproic acid (EACA) and tranexamic acid (TA) in reducing 24hour blood transfusion and chest tube drainage. From October 2008 to September 2011, patients greater than 18 years of age, scheduled for cardiac surgery requiring CPB were consented. Eligible operations included; coronary artery bypass graft surgery (CABG), a heart valve repair/replacement, or a concomitant CABG and valve surgery were enrolled.
Consented patients were randomized into one of the two groups using a 1:1 randomization sequence generated by a computer program. Randomization sequence and the study drugs were kept in a locked box and were opened only by unblinded study personnel who were not involved in the clinical care of the patient. This person prepared the study drug following the instructions of the study protocol, resulting in preparations of EACA and TA that contained equi-potent similar volumes of the drug in the syringe, in order to ensure blinding. Antifibrinolytic study drug was administered following anesthetic induction. EACA was administered as a bolus loading dose of 150 mg/ kg followed by a maintenance infusion of 15 mg/ kg /hr. TA was administered as a bolus dose of 30 mg /kg followed by a 16 mg/ kg/hour maintenance infusion. Maintenance infusion of both drugs was discontinued when the patient arrived in the cardiac surgical intensive care unit. In addition to routine blood sampling ( standard of care in the investigators hospital), patients had thromboelastogram(TEG) and D-dimer levels drawn at the following time points: post incision but prior to initial antifibrinolytic load, immediately following the antifibrinolytic loading dose, and post-protamine reversal of heparin.
The primary endpoint was the amount of chest tube drainage and the amount of blood products used in the first 24 hours following surgery (surrogate measurement for blood loss) was measured at 4, 8, 12 and 24 hours after surgery. The incidence of packed red blood cells (PRBC), fresh frozen plasma (FFP), cryoprecipitate and platelets administered during the first 24 hours after surgery was collected. Additionally, patients were monitored for any complications during their stay in the hospital and up to 30 days post-operatively. Complications included renal dysfunction (defined as the need for at least 1 hemodialysis or doubling of pre-surgical creatinine levels), stroke and seizures (clinically diagnosed), myocardial infarction (new Q waves in two electrocardiogram leads), cardiac arrest, respiratory failure, re-operation and death. Monitoring of the patients prior to discharge involved chart review during their stay in the hospital; if a post-operative complication was suspected, the complication was confirmed using Montefiore Medical Center's Carecast Database, which contained independent results such as MRI's, CT scans, or labs. Additionally, computer records of the patients were searched to determine if there were documented complications in the 30-day post-operative time period.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Informed consent obtained before any trial-related activities
- Subjects scheduled to undergo cardiac surgery requiring cardiopulmonary bypass
Exclusion Criteria:
- Vulnerable patient populations (unable to consent)
- Religious or other prohibitive reason for not receiving blood transfusion
- History of allergy to epsilon-aminocaproic acid or tranexamic acid
- Pregnant or breast-feeding (if applicable)
- The participation in another clinical or device trial that would affect the patient's coagulation profile
- Cardiac or cardiopulmonary transplantation procedure
- Any history of stroke and/or non-coronary thrombotic disorders (DVT, PE)
- Clinical signs consistent with non-coronary thrombotic disease
- Known congenital deficiency of Protein C, Protein S, Antithrombin and homozygous Factor V Leiden
- Known congenital bleeding disorders
- Weight < 50 kg
- Weight > 150 kg
- Acute renal failure or creatinine > 2.0 mg/dL
- Current surgery including any implantable ventricular assist device requiring CPB including ECMO (extracorpeal membrane oxygenation)
- Current surgery including the aortic arch and/or descending thoracic aorta
- Any changes to the planned surgery, which result int he patient not requiring CPB or meeting exclusion criteria
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Epsilon-aminocaproic acid (EACA)
Epsilon-aminocaproic acid administered following anesthetic induction: EACA was administered as a bolus loading dose of 150 mg/ kg followed by a maintenance infusion of 15 mg/ kg /hr.
|
Following anesthetic induction, Epsilon-aminocaproic acid was administered as a bolus loading dose of 150 mg/ kg followed by a maintenance infusion of 15 mg/ kg /hr.
Maintenance infusion of both drugs was discontinued when the patient arrived in the cardiac surgical intensive care unit.
In addition to routine blood sampling ( standard of care in our hospital), patients had thromboelastogram(TEG) and D-dimer levels drawn at the following time points: post incision but prior to initial antifibrinolytic load, immediately following the antifibrinolytic loading dose, and post-protamine reversal of heparin.
|
Experimental: Tranexamic acid (TA)
Tranexamic Acid administered following induction: TA was administered as a bolus dose of 30 mg /kg followed by a 16 mg/ kg/hour maintenance infusion.
|
Following anesthetic induction, Tranexamic Acid was administered as a bolus dose of 30 mg /kg followed by a 16 mg/ kg/hour maintenance infusion.
Maintenance infusion of both drugs was discontinued when the patient arrived in the cardiac surgical intensive care unit.
In addition to routine blood sampling ( standard of care in our hospital), patients had thromboelastogram(TEG) and D-dimer levels drawn at the following time points: post incision but prior to initial antifibrinolytic load, immediately following the antifibrinolytic loading dose, and post-protamine reversal of heparin.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Chest Tube Drainage
Time Frame: 4 hours, 8 hours, 12 hours, 24 hours
|
Chest tube drainage are collected from the nursing records, every 4th hourly the amount fluid collected is reported in the collection sheets.
|
4 hours, 8 hours, 12 hours, 24 hours
|
Median Amount of Blood Products Used
Time Frame: 24 hours after surgery
|
Four types of blood products may be given through blood transfusions: whole blood, red blood cells, platelets, and plasma
|
24 hours after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Diagnosis of Renal Dysfunction Post-operation
Time Frame: Within 30 days after surgery
|
Confirmed diagnosis of renal dysfunction and hospitalization for the same within 30 days after the surgery
|
Within 30 days after surgery
|
Diagnosis of Myocardial Infarction Post-operation
Time Frame: Within 30 days after surgery
|
Confirmed diagnosis of myocardial infraction and hospitalization for the same within 30 days after the surgery
|
Within 30 days after surgery
|
Number of Participants Who Have Confirmed Diagnosis of Respiratory Arrest
Time Frame: Within 30 days after surgery
|
Confirmed diagnosis of respiratory arrest and hospitalization for the same within 30 days after the surgery
|
Within 30 days after surgery
|
Number of Participants With Confirmed Diagnosis of Stroke
Time Frame: Within 30 days after surgery
|
Confirmed diagnosis of stroke and hospitalization for the same within 30 days after the surgery
|
Within 30 days after surgery
|
Number of Participants With Confirmed Diagnosis of Seizure
Time Frame: Within 30 days after surgery
|
Confirmed diagnosis of seizure and hospitalization for the same within 30 days after the surgery
|
Within 30 days after surgery
|
Reoperation
Time Frame: Within 30 days after surgery
|
Confirmed diagnosis of reopeartion and hospitalization for the same within 30 days after the surgery
|
Within 30 days after surgery
|
Mortality Within 30 Days Post-operation
Time Frame: Within 30 days after surgery
|
Within 30 days after surgery
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Demographics
Time Frame: Baseline
|
Measurements taken as a composite.
BMI, Sex, Age are to be determined to ensure that the subjects' characteristics were comparable between the Epsilon-aminocaproic Acid and Tranexamic Acid groups.
|
Baseline
|
Type of Surgery
Time Frame: Intraoperative
|
Intraoperative
|
|
Intraoperative Characteristics
Time Frame: Intraoperative
|
Measurements are taken as a composite to determine that the subjects' characteristics are comparable between the Epsilon-aminocaproic Acid and Tranexamic Acid groups.
Measurements include temperature, Heparin dose, protamine given, time of surgery, time of cardiopulmonary bypass, and aortic clamp time.
|
Intraoperative
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jonathan D Leff, MD, Montefiore Medical Center
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
- 08-08-291
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
product manufactured in and exported from the U.S.
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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