- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03887819
Pulmonary Embolism: an Autopsy Study
The Dating of Thrombus Organization in Cases of Pulmonary Embolism: an Autopsy Study
BACKGROUND: Pulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study will be to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time.
METHODS: Pulmonary vessels sections will be collected from January 2010 to December 2017. Sections of thrombus sampling will be stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers will be scored using a semi-quantitative three-point scale of range values.
Hypothesis: After a macroscopic observation and a good sampling traditional histology, it will be important to identify the time of thrombus formation. We will identify histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Introduction Venous thromboembolism (VTE) is pathological condition caused by deep vein thrombosis (DVT) with a consequent detaching of thrombus from original sites , that by embolic phenomena and traveling to the lung might result in pulmonary embolism (PE). As first, the diagnosis of PE might result frequently inaccurate, with many cases incorrectly diagnosed or missed. Secondly, it might be caused by several conditions such as surgery and trauma, with a consequent relevant clinical impact and worse prognosis. However, clinical presentation of PE range from those completely asymptomatic or with an insidious disease, to sudden unexpected death (SUD. SUD may be defined as a natural and fatal event that occurs within 1 h of the beginning of symptoms in an apparently healthy subject or in those with a disease not particularly severe to cause an abrupt outcome. Since the diagnosis is challenging, epidemiological data regarding PE mortality remain limited.To date, it is estimated that PE is responsible for 100,000 annual deaths only in the United States and approximately 25-30% of patients had SUD as consequence of PE.
However, in our opinion it might be essential to collect morphological macroscopic evaluation elements to distinguish a thrombus from an embolus or agonic coagulum.To date, the autopsy may be useful for the determination of the identification of death cause, and to establish the dating of transformation of thrombus and evaluate any professional error. Therefore, in this study, authors will critically review the histological section of thrombus from 30 fatal cases of PE pulmonary embolus by autopsies, and its correlation and origin prior or subsequent to a traumatic event, as confirmed by post-mortem examination and final diagnosis. Moreover, the aim of this study will be to evaluate the chronological transformation of the thrombus and to establish the time of death for each subject.
Materials and methods Patients and samples Pulmonary vessels sections will be collected from 30 fatal cases of PE (25 cases of hospitalized patients and 5 cases of SUD) defined according to commonly accepted criteria were routinely collected from January 2010 to December 2017 at the University of Naples Federico II.
Histological evaluation According to the guidelines for autopsy from the Association for European Cardiovascular Pathology, and in all cases authors will examine the pulmonary arterial trunk by posterior approach. Sections (4 μm thick) will be stained with hematoxylin and eosin stain (H&E) for diagnosis. The original tissues samples will be fixed in 10% neutral buffered formalin and embedded in paraffin. The immunohistochemistry for anti-LCA, anti-CD68, and anti-CD3 will be performed to identify the inflammatory infiltrate. In addition, authors will be performed an immunofluorescence method to identifying the deposition of factor VIII and fibrinogen. A Picro Sirius Red/Fast Green will be used for differential staining of collagen during matrix production phase. All stained samples will be examined under infiltrate, absent or rare lympho-monocytic inflammatory elements. The vessels of small and medium will be involved, mainly from the main branches of the pulmonary vessels.In2 patients we observed a score 3 for cellular infiltrate and 1 for fibrosis. In 10 cases (5 heart patients, 2 cardiac patients undergoing surgery and 3 surgeries), authors will observe an increase (score 2) in the digital and light microscope.
Study Type
Enrollment (Actual)
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- diagnosis of acute pulmonary embolism;
- patients died after the pulmonary embolic event.
Exclusion Criteria:
- diagnosis of non acute pulmonary embolism;
- patients survived after the pulmonary embolic event.
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To evaluate pulmonary thrombus burden
Time Frame: 24 months
|
Authors will evaluate if a pulmonary embolus was originated prior or subsequent to a traumatic event.
However, they will evaluate the dimension of the thrombus, and the quantity of fibrinogen present in the thrombus, from pulmonary vessels sections.
The tissues samples will be fixed in 10% neutral buffered formalin and embedded in paraffin blocks, and stained with hematoxylin and eosin stain for diagnosis.
For inflammatory cellular infiltration and fibrosis, authors will attribute a score 0 for no increase, score 1, 2, or 3 for little, moderate, or high increase of cell content compared to adjacent tissue, respectively.
For the extracellular matrix production, authors will attribute a score 0 for absence of collagen production, score 1 and 2 for 10-40% and 40-80% collagen fibers content compared to adjacent normal tissue, respectively, and finally score 3 for wound matrix indistinguishable from adjacent normal tissue.
|
24 months
|
Collaborators and Investigators
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 (Actual)
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
- SecondUNI 21.03.2019
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
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.
Clinical Trials on Pulmonary Embolism
-
Boston Scientific CorporationEKOS CorporationCompletedPulmonary Embolism | Acute Pulmonary Embolism | Pulmonary Thromboembolism | Massive Pulmonary Embolism | Sub-massive Pulmonary EmbolismUnited States
-
Inari MedicalCompletedPulmonary Embolism | Submassive Pulmonary Embolism | Acute Pulmonary Embolism | Massive Pulmonary EmbolismUnited States
-
Hospital San Carlos, MadridAsociación de Cardiología Intervencionista de la Sociedad Española de CardiologíaRecruitingPulmonary Embolism | Pulmonary Embolism and Thrombosis | Pulmonary Thromboembolisms | Pulmonary Embolism Acute | Pulmonary Embolism Acute MassiveSpain
-
University of California, Los AngelesEnrolling by invitationPulmonary Disease | Pulmonary Embolism | Pulmonary Embolus/Emboli | Pulmonary Embolism and Thrombosis | Pulmonary Embolism Subacute Massive | Pulmonary Embolism Acute MassiveUnited States
-
Inari MedicalActive, not recruitingPE - Pulmonary Embolism | PE - Pulmonary ThromboembolismUnited States, Spain, Belgium, Germany, France, Switzerland, Netherlands, United Kingdom, Austria
-
Bristol-Myers SquibbCompletedPulmonary Embolism (PE) | Pulmonary ThromboembolismUnited Kingdom
-
GlaxoSmithKlineCompleted
-
Sociedad Española de Neumología y Cirugía TorácicaCompletedPulmonary Hypertension | Pulmonary ThromboembolismsSpain
-
Victor Tapson, MDBristol-Myers SquibbTerminatedPulmonary Embolism | Right Ventricular Dysfunction | Right Ventricular Failure | Pulmonary Embolism With Acute Cor Pulmonale | Pulmonary Embolism With Pulmonary Infarction | Pulmonary Embolism Subacute MassiveUnited States
-
Imperative Care, Inc.RecruitingCardiovascular Diseases | Vascular Diseases | Embolism | Thrombosis | Thromboembolism | Acute Pulmonary Embolism | Thrombus; Embolism | Emboli, PulmonaryUnited States
Clinical Trials on Hystological evaluation
-
University of Campania "Luigi Vanvitelli"CompletedRight Ventricle Abnormality
-
IRCCS Eugenio MedeaCompletedIntellectual Disability | Autism Spectrum Disorder | Attention Deficit Hyperactivity DisorderItaly
-
University Hospital, BordeauxRoche Pharma AGRecruitingMultiple Sclerosis, Primary ProgressiveFrance
-
University Hospital, BordeauxRecruitingMultiple SclerosisFrance
-
University Hospital, CaenRecruitingDementia | Alzheimer Disease | Mild Cognitive Impairment | Motoric Cognitive Risk SyndromeFrance
-
University of CatanzaroAzienda Sanitaria Provinciale Di Catanzaro; Azienda Ospedaliera Universitaria...Unknown
-
Ankara Yildirim Beyazıt UniversityCompletedType 2 Diabetes Mellitus | BalanceTurkey
-
Kırıkkale UniversityCompleted
-
Institut National de la Santé Et de la Recherche...Terminated