- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03680456
Postoperative Replacement of Intraoperative Iron Losses (POREIIL)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In the last few years, state of the art Patient Blood Management (PBM programs have been gaining worldwide attention. This may be attributed to the significant improvements in patient outcomes that follow adequate preoperative preparation and intraoperative optimization of the circulating red cell mass.
The first pillar of PBM (pre-, intra-, and postoperative optimization of red cell mass by means other than red cell transfusions including intravenous iron and erythropoietin stimulating agents) can meet significant barriers and might be difficult to implement. In daily clinical practice, timely identification and treatment of preoperative anemia is difficult to organize due to structural and behavioral constraints. Therefore, today, there are still a striking number of patients who are admitted for surgery without adequate preoperative treatment of anemia regardless of its causes. Notably, even for this patient population, it has been demonstrated by experimental and larger observational data that postoperative application of intravenous iron could help to reduce perioperative transfusions by restoring red cell mass. The complete potential of perioperative intravenous iron therapy has yet to identified, including improvements such as early mobility and other improved outcomes. Furthermore, a substantial number of patients are not included in preoperative red cell mass optimization, since the preoperative hemoglobin concentration is either high enough in terms of the thresholds of the World Health Organization (♂ 13 g/dl and ♀ 12 g/dl), or borderline (mild) anemia is diagnosed and no treatment is offered. These patients may be prone to substantial intraoperative blood losses, and as a consequence might suffer from postoperative iron restricted anemia. In fact, there are a remarkable number of patients that have adequate hemoglobin concentrations preoperatively, but ultimately develop anemia with iron deficiency postoperatively due to significant intraoperative bleeding. Data from ICU patients' with postoperative iron deficiency has significant impact on outcome including postoperative fatigue, and consequently a prolonged healing process.
Although this problem is common, current PBM strategies are in need of validation of one of the PBM guidelines: postoperative replacement of blood loss with resultant iron losses in patients without preoperative anemia thus avoiding exposure to allogeneic transfusions in this population. The untested hypothesis is that this approach could improve postoperative outcomes including mobilization. Based on a recent publication one might surmise that it is not (only) postoperative anemia, but rather untreated iron deficiency, that is responsible for a delay in postoperative mobilization and recovery. It is therefore the aim of the proposal presented to describe an additional approach, in which perioperative, surgical blood loss iron losses are replaced immediately following the surgical procedure in patients that did not receive iron preoperatively due to normal or minor reduction in hemoglobin concentrations (red cell mass). This replacement may take place in either the postoperative anesthesia care unit or in the ICU, Although preoperative treatment of iron deficiency anemia is widely considered the most important domain of perioperative iron therapy, the additional post-operative replacement is as useful as preoperative preparation and seems to be more convenient to implement.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Roxane Brooks, Dr.
- Phone Number: 78148 00435768083
- Email: roxane.brooks@kepleruniklinikum.at
Study Contact Backup
- Name: Jens Meier, Prof
- Phone Number: 2158 00435768083
- Email: jens.meier@kepleruniklinikum.at
Study Locations
-
-
-
Linz, Austria
- Recruiting
- Universitätsklinik für Anästhesie und Intensivmedizin
-
Contact:
- Jens Meier, MD
- Email: jens.meier@kepleruniklinikum.at
-
Sub-Investigator:
- Bernhard Eichler, MD
-
Sub-Investigator:
- Roxanne Brooks, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
patients undergoing non-emergency
- cardiac surgery - obstetric surgery - intra-abdominal surgery
preoperative Hb (during the premedication visit):
- ♂: Hb>12.5g/dl
- ♀: Hb>11.5g/dl
postoperative Hb (immediately after surgical procedure in the recovery room):
- 2 g/dl below preoperative Hb concentration
- age ≥ 18 years
- Admission to intensive care unit or post-anesthesia care unit
- Able to sign consent for the trial
Exclusion Criteria:
- age < 18 years
- emergency surgery
- perioperative application of iron and/or erythropoietin
- intraoperative transfusion of allogeneic erythrocytes
- known hemochromatosis
- known allergic reaction linked to iron medication
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intervention
due to postoperative Hemoglobin Level intravenous iron Ferriccarboxymaltose is Infuses, dosage is based on the Ganzoni-Algorithm
|
maximum of 750mg in U.S. is given, maximum of 1000mg in EU
Other Names:
|
Placebo Comparator: Placebo
Natriumchlorid is the placebo
|
an equivalent volume dose of Natriumchlorid is administered
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemoglobin Level
Time Frame: 30days
|
Hemoglobin in g/dl
|
30days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of RBCs
Time Frame: 30days
|
Number of Units of Red Blood Cell transfusions
|
30days
|
10 Feet Walking test
Time Frame: day 7 and 30 post randomization
|
ability to walk 10 feet or across the room
|
day 7 and 30 post randomization
|
6min Walking Test
Time Frame: preoperative day, day 7 and 30
|
The distance ist measured which the Patient is able to walk in 6 min
|
preoperative day, day 7 and 30
|
Infection
Time Frame: 30 Days
|
Number of severe Sepsis or wound infection due to SSC Guidelines and Sofa-Score
|
30 Days
|
MI
Time Frame: 30days
|
myocardial infarction is diagnosed du to ECG, Troponin T and clinical signs and symptoms for myocardial infarction e.g.
chest pain
|
30days
|
AKI
Time Frame: 30 days
|
acute kidney injury due to KDIGO criteria
|
30 days
|
Stroke
Time Frame: 30days
|
numbers of stroke (e.b. subarachnoid hemorrhage and others)
|
30days
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Jens Meier, Prof, Kepler University Hospital, JKU Linz
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- TPL107
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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