Detecting Hypercoagulability in Morbidly Obese and Non Obese Parturients Following Cesarean Section Delivery

November 7, 2018 updated by: Corniche Hospital

Thromboelastometry (ROTEM) For Detecting Hypercoagulability in Morbidly Obese and Non Obese Parturients Following Cesarean Section Delivery: An Observational Study

Investigators hypothesized that the impact of surgery in terms of inducing a hypercoagulable state is more evident in morbidly obese pregnant women as opposed to their non-obese counterparts. The aim of this study is to investigate the change in coagulation status of morbidly obese and non-obese pregnant women following cesarean section delivery using thromboelastometry. This observational study would also make it possible to calculate the sample size for a future prospective controlled clinical trial to compare the incidence of Hypercoagulability in morbidly obese parturients as opposed to their non-obese counterparts. To the best of our knowledge, no other work has been done any in this area.

Study Overview

Status

Completed

Conditions

Detailed Description

Following institutional ethical committee approval, 20 morbidly obese (BMI>40) and 20 non-obese (BMI < 30) parturients undergoing elective low segment cesarean section (LSCS) delivery under spinal subarachnoid block will be recruited into the study. A written informed consent will be obtained from all parturients prior to inclusion. All patients will receive an information sheet at the preoperative assessment visit to inform them about this study. Patients with a history of past or current thromboembolism will be excluded from the study as well as those with liver disease and those already on anticoagulant/anti-platelet therapy for repeated miscarriage or other indications. History of thromboembolism is defined as an arterial or deep venous thrombosis, catheter thrombosis, or pulmonary embolism diagnosed by ultrasound or spiral computed tomography (CT). Preoperative baseline full blood count and clotting profile will be done. Parturients with abnormal platelet count or coagulation results and those who will need conversion to general anesthesia will be excluded.

Data and sample collection Preoperative BMI, co-existing morbidities and laboratory test results including INR, PTT and platelet count as well as operative time and postoperative clinical or radiological evidence of thromboembolism will be recorded. A blood sample will be collected for ROTEM analysis prior to establishing the block (baseline), immediately after surgery and 8 hours later.

ROTEM analysis

Coagulability will be assessed using the ROTEM thromboelastometry analyzer (The ROTEM® delta, Tem Systems Inc.®, Munich, Germany). Extrinsic rotational thromboelastometry (EXTEM), intrinsic rotational thromboelastometry (INTEM) and FIBTEM will be measured for each blood sample. Clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) will be recorded. Total clot strength will be assessed by "G" value as calculated according to the formula: (5000xMCF)/100-MCF and expressed as dynes/cm2 . G has been shown to be valuable in diagnosing hypo- and hypercoagulability . In non-obstetric cohorts, hypercoagulability was defined as a G value of ≥ 11.7 dynes/cm2 and hypocoagulability as a G value of <5.0 dynes/cm2 (values provided by manufacturer).

Study Type

Observational

Enrollment (Actual)

40

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

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 45 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Sampling Method

Non-Probability Sample

Study Population

Term pregnant women presenting for elective cesarean section under spinal anaesthesia

Description

Inclusion Criteria:

  • pregnant women at term presenting for cesarean section under spinal anaesthesia with BMI less than 30 and more than 40

Exclusion Criteria:

  • Patients with BMI between 30 and 40 BMI
  • Patients with a history of past or current thromboembolism.
  • Patients with history of liver disease and those on anticoagulant/anti-platelet therapy
  • Patients who requires perioperative blood transfusion
  • Patients having General anaesthesia

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

Cohorts and Interventions

Group / Cohort
morbidly obese pregnant
Term pregnant women with BMI more than 40
non obese pregnant
Term pregnant women with BMI less than 30

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Calculated clot strength using EXTEM Maximum Clot Firmness (G value for EXTEM)
Time Frame: 8 hours
"G" value will be calculated according to the formula: (5000xMCF)/100-MCF and expressed as dynes/cm2
8 hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
EXTEM clotting time and clot formation time in seconds.
Time Frame: 8 hours
measured ROTEM thromboelastometry variables
8 hours
EXTEM maximum clot firmness in millimeters
Time Frame: 8 hours
measured ROTEM thromboelastometry variable
8 hours
INTEM clotting time and clot formation time in seconds.
Time Frame: 8 hours
measured ROTEM thromboelastometry variables
8 hours
INTEM maximum clot firmness in millimeters
Time Frame: 8 hours
measured ROTEM thromboelastometry variable
8 hours
FIBTEM maximum clot firmness in millimeters
Time Frame: 8 hours
measured ROTEM variable
8 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Corniche Hospital

Investigators

  • Principal Investigator: Mohamed Samy Abdel Raheem, FRCA, Consultant Anaesthetist
  • Principal Investigator: Tarek Ansari, FFARCSI, Consultant Anaesthetist
  • Principal Investigator: Waleed Riad, MD, Consultant Anaesthetist

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 (Actual)

November 15, 2016

Primary Completion (Actual)

September 30, 2017

Study Completion (Actual)

October 30, 2017

Study Registration Dates

First Submitted

January 17, 2016

First Submitted That Met QC Criteria

March 23, 2016

First Posted (Estimate)

March 24, 2016

Study Record Updates

Last Update Posted (Actual)

November 8, 2018

Last Update Submitted That Met QC Criteria

November 7, 2018

Last Verified

November 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ch23031401

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

No plan

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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