- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02802696
Transfusion-Associated Circulatory Overload Best Eliminated With Lasix
Pre-transfusion Furosemide in Patients at High Risk of Transfusion-associated Circulatory Overload - The Transfusion-Associated Circulatory Overload Best Eliminated With Lasix (TACO-BEL) Study: A Pilot Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigators proposed this pilot study to assist us in determining the feasibility of conducting a definitive multicenter randomized trial across Canada.
Rationale:
The rationale for this study includes: (1) TACO is the leading cause of morbidity and mortality due to transfusion; (2) risk factors for TACO include older age, renal dysfunction and positive fluid balance; (3) furosemide is a diuretic commonly prescribed for fluid overload; (4) furosemide can decrease pulmonary artery pressures; and (5) clinical uncertainty as to the effect of furosemide in preventing TACO. The investigators will enroll 80 patients in this pilot study at two centers.
Hypothesis:
The investigators hypothesize that 80 patients can be enrolled in the trial within a 2-month period
Justification:
If pre-transfusion that furosemide decreases the rate of TACO with red blood cell transfusion, clinical practice worldwide would change. Over 800,000 patients in Canada receive a blood transfusion annually and many are at high risk for TACO and may benefit from this simple, low-cost intervention. This intervention could easily be generalizable worldwide. There are practical challenges related to patient recruitment, adherence to trial protocol and data collection, all of which the TACO-BEL Pilot Trial will seek to measure.
Objectives:
The primary outcome of this trial is to determine the feasibility of performing a large multi-centre, randomized, placebo-controlled trial with concealed allocation and blinded outcome assessment, adequately powered to determine a clinically significant effect of pre-transfusion furosemide on the incidence of transfusion-associated circulatory overload.
Primary outcome measure is the number of patients enrolled within a two-month period
Secondary feasibility outcome measures include:
- Proportion of patients screened meeting eligibility criteria
- Proportion of eligible patients consenting to participate
- Proportion of consenting patients receiving the allocated treatment
- Proportion of treated patients completing follow-up assessment
- Proportion of patients in which blinding was maintained throughout study
Research Method:
Patients meeting inclusion criteria will be identified by reviewing transfusion orders received by the blood transfusion laboratory or by referral from ordering physicians; these patients will then be approached by study personnel to obtain pre-transfusion informed consent. Randomization will be performed by pharmacy at the time of drug preparation. The randomization code will be generated in random blocks of 4 to 6, stratified by center, and renal function at time of randomization (creatinine clearance < 60 and ≥ 60 mL/min) using a computer based randomization program.
Intervention:
Patients will be administered a bolus dose of 20mg furosemide (20mg/2mL) intravenously within 60 minutes prior to the start of the red blood cell transfusion. Patients randomized to placebo will be administered an equal volume of normal saline intravenously immediately within 60 minutes prior to the start of the red blood cell transfusion.
Study Type
Enrollment (Actual)
Phase
- Early Phase 1
Contacts and Locations
Study Locations
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Ontario
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Toronto, Ontario, Canada, M4N 3M5
- SunnyBrook Health Sciences Centre
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Toronto, Ontario, Canada, K1G 4J5
- Canadian Blood Services
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Toronto, Ontario, Canada, M5G 2C4
- University Health Network
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age ≥ 65 years.
- Receiving a single unit red blood cell transfusion
Exclusion Criteria:
- Active bleeding (active visible bleeding, required 2 or more RBC units in the preceding 24 hours, drop in Hb > 20 g/L in the preceding 24 hours);
- Hemodynamically unstable (systolic blood pressure < 90 mmHg or on inotropes);
- Anticipated major surgical procedure within 24 hours of enrolment;
- Presence of hyponatremia (Na < 130 mmol/L);
- Presence of hypokalemia (K < 3.5 mmol/L);
- Dialysis or creatinine clearance < 30 mL/min;
- Order for platelet or plasma transfusion at same time;
- Allergy to furosemide;
- Risk of withholding furosemide felt by attending physician to place patient at excessive risk of harm;
- Previously enrolled in the study;
- Plan for discharge on the day of randomization;
- Unable to provide informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Normal saline
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A single bolus dose of 2 mL normal saline will be given intravenously immediately within 60 minutes prior to the start of the red blood cell transfusion; infusion via minibag is also acceptable.
Other Names:
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Experimental: Furosemide
Diuretic
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A bolus dose of 20mg furosemide (20mg/2mL) will be given intravenously by slow intravenous push within 60 minutes prior to the start of the red blood cell transfusion; infusion via minibag is also acceptable.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Number of patients enrolled
Time Frame: 2 months period
|
2 months period
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients screened meeting eligibility criteria
Time Frame: 2 months
|
2 months
|
|
Proportion of eligible patients consenting to participate
Time Frame: 2 months
|
2 months
|
|
Proportion of patient receiving the allocated treatment
Time Frame: 2 months
|
2 months
|
|
Proportion of treated patients completing follow-up assessment
Time Frame: 2 months
|
2 months
|
|
Proportion of patient in which blinding was maintained throughout study
Time Frame: 2 months
|
2 months
|
|
Vital Signs
Time Frame: Baseline and 6 hours post transfusion
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Change in vital signs immediately post-transfusion and at 6 hours post-transfusion
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Baseline and 6 hours post transfusion
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Positive end-expiratory pressure
Time Frame: Baseline and 6 hours post transfusion
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For patients on mechanical ventilation pre-transfusion, change in positive end-expiratory pressure
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Baseline and 6 hours post transfusion
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Inspiratory oxygen
Time Frame: Baseline and 6 hours post transfusion
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change in fraction of inspiratory oxygen at 6 hours post-transfusion
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Baseline and 6 hours post transfusion
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Incidence of TACO within 6 hours from completion of transfusion
Time Frame: within 6 hours
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within 6 hours
|
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Severity of TACO-graded as per the Public Health Agency of Canada's Transfusion Transmitted Injuries Surveillance System
Time Frame: within 6 hours
|
within 6 hours
|
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Validation of TACO as per criteria adopted from the US Center for Disease Control
Time Frame: within 6 hours
|
within 6 hours
|
|
Change in plasma brain natriuretic peptide(BNP)
Time Frame: Baseline and Day 1
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Baseline and Day 1
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Net fluid balance at 24 hours from start of transfusion- all intravenously-administered fluids (including the transfused blood product and the study intervention)
Time Frame: Within 24 hours
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Within 24 hours
|
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Proportion of patients developing hyponatremia or hypokalemia by Day 1
Time Frame: By Day 1
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By Day 1
|
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Proportion of patients developing hypotension
Time Frame: Within 24 hours
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Within 24 hours
|
|
Proportion of patients developing acute kidney injury
Time Frame: Within 24 hours
|
Within 24 hours
|
|
Need for increased supplemental oxygen is defined as any increase in oxygen flow ≥ 1 L/hr or (fraction of inspired oxygen)FiO2 ≥ 5% of 1 hour duration or longer, prompted by either patient symptoms or a fall in oxygen saturation(SpO2) ≥ 5%
Time Frame: Within 24 hours
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Within 24 hours
|
|
Need for inotropic support is defined as the initiation of a continuous infusion of dopamine, dobutamine, epinephrine, or norepinephrine
Time Frame: Within 24 hours
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Within 24 hours
|
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Need for additional diuretic or vasodilatory therapy is defined by the prescription of non-study furosemide, hydrochlorothiazide, metolazone, or either transdermal or intravenous nitroglycerin
Time Frame: Within 24 hours
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Within 24 hours
|
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Occurrence of acute coronary syndrome or new arrhythmia
Time Frame: within 7 days
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within 7 days
|
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Mortality during hospital stay
Time Frame: Upto 30 days
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Upto 30 days
|
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Length of hospital stay
Time Frame: From date of admission until the date discharge from an acute care hospital or date of death from any cause, whichever came first, assessed up to 30 days.
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From date of admission until the date discharge from an acute care hospital or date of death from any cause, whichever came first, assessed up to 30 days.
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jeannie Callum, MD, Sunny Brook Health Sciences Centre
Publications and helpful links
General Publications
- AABB (2015) AABB Association Bulletin #15-02: Transfusion Associated Circulatory Overload (12/28/15). Vol. 2016,
- Alam A, Lin Y, Lima A, Hansen M, Callum JL. The prevention of transfusion-associated circulatory overload. Transfus Med Rev. 2013 Apr;27(2):105-12. doi: 10.1016/j.tmrv.2013.02.001. Epub 2013 Mar 1.
- Lieberman L, Maskens C, Cserti-Gazdewich C, Hansen M, Lin Y, Pendergrast J, Yi QL, Callum J. A retrospective review of patient factors, transfusion practices, and outcomes in patients with transfusion-associated circulatory overload. Transfus Med Rev. 2013 Oct;27(4):206-12. doi: 10.1016/j.tmrv.2013.07.002. Epub 2013 Sep 26.
- Sarai M, Tejani AM. Loop diuretics for patients receiving blood transfusions. Cochrane Database Syst Rev. 2015 Feb 16;2015(2):CD010138. doi: 10.1002/14651858.CD010138.pub2.
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 16-5032
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device 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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