- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03915327
Short-term Intravenous Iron Isomaltose Anhydride for IDA
Short-term Use of Intravenous Iron Isomaltose Anhydride for Preoperative Anemic Patients Undergoing Orthopedic Surgery: a Prospective, Randomized, Controlled Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Anemia is a decrease in the concentration of hemoglobin (Hb) or RBC count in the blood ting, causing body not being able to adequately supply oxygen to tissues and cells. Preoperative anemia is common in patients receiving elective surgery, with a prevalence ranging from 5% to 75%. For instance, the prevalence of anemia before total hip or total knee arthroplasty is around 35%. Preoperative anemia is one of the main predictors of perioperative allogeneic RBC transfusion, and is closely associated with postoperative infection, increased morbidity and mortality, prolonged hospital stay, and decreased quality of life.
As the world enters an aging society, the proportion of elderly patients receiving surgery, especially orthopedic surgery, is increasing. There are 3 main causes of anemia in the elderly: nutritional anemia (~34%), which is caused by lack of hematopoietic materials. Iron-deficiency anemia (IDA) is the most common type of nutritional anemia, while megaloblastic anemia caused by lack of folic acid and vitamin B12 is relatively rare. Anemia of chronic disease (~32%), which is characterized by disorders of iron metabolism that occurs in certain chronic diseases, such as persistent infections, inflammation and tumors. Anemia of unknown cause (-34%), which may involve multifactorial pathogenic mechanisms and comorbidities. IDA, the most common cause of perioperative anemia in patients receiving orthopedic surgery, is a condition caused by hematopoietic materials deficiency and has a good clinical response to iron supplementation with a rapid rise of Hb level. Iron supplementation in patients with preoperative IDA, or insufficient iron intake and excessive loss is able to improve the patients' surgical tolerance and reduce the transfusion rate; For anemic patients with acute blood loss during surgery, iron supplementation is able to accelerate anemia correction, thus enhancing postoperative recovery and shortening length of hospital stay.
Iron therapy can be administrated by the oral or intravenous route. Absorption of oral iron therapy is relatively low, and it usually takes over 1 to 2 months to correct the iron deficiency status. Therefore, intravenous iron therapy is recommended for patients diagnosed with IDA after admission to hospital to receive surgery. Intravenous iron therapy was originally the standard iron supplementation in chronic renal failure patients with IDA. Subsequently, it was expanded to the anemia of patients with conventional inflammatory bowel disease for its desirable efficacy. Several studies of elderly IDA patients receiving orthopedic surgery and gynecologic surgery suggest that intravenous iron therapy can rapidly increase hemoglobin levels before surgery, leading to a decrease in blood transfusion rates. The calculation of the total dose of intravenous iron is as follows:
= Weight (kg) ×[Target Hb level(g/L)- actual Hb level(g/L)] ×0.24 + 500mg Treatment duration is over 2 weeks in most clinical studies of intravenous iron therapy. In China, few patients are treated with intravenous iron therapy in community hospitals for 2 to 4 weeks before surgery. Therefore, many IDA patients did not receive proper preoperative intravenous iron therapy. Iron isomaltose anhydride, an intravenous iron preparation that can be administered in a single treatment up to 1000 mg in a relatively short (15 minutes) time without need for test dose, is of low risk of adverse reactions. Therefore, sufficient amount of iron can be administrated during preoperative. Currently, there is no evidence to elucidate whether short-term sufficient intravenous iron supplementation can reduce perioperative blood transfusion requirements among IDA patients. Thus, we hypothesized that short-term intravenous administration of sufficient iron isomaltose anhydride can reduce the need for perioperative allogeneic RBC transfusion without increasing the incidence of adverse reactions.
This prospective, randomized, controlled study aims to evaluate the impact of short-term (1 week) intravenous iron isomaltose anhydride in preoperative IDA patients receiving orthopedic surgery on postoperative allogeneic RBC transfusion rate and amount, hemoglobin level and iron storage, postoperative complications, average length/expense of hospital stay, etc., to determine the safety and efficacy of short-term sufficient intravenous iron therapy, and to develop a simple and effective preoperative iron supplementation program.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age > 14 years;
- Sign and date the "informed consent form"
Exclusion Criteria:
- Pregnant or lactation;
- Drug abuse, including but not limited to opioids, amphetamines, ice, ketamine, etc.;
- History of anaphylaxis to oral or intravenous iron;
- Nervous system diseases such as peripheral neuropathy, mental illness;
- Other conditions that the investigator deems are not suitable for the study, such as deafness, Parkinson's disease, communication disorders, etc.;
- Participated in other clinical trials during the first three months of the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intravenous iron group
Enrolled subjects would receive intravenous iron isomaltose anhydride within 24 hours of the subject's inclusion.
|
Enrolled subjects would receive intravenous iron isomaltose anhydride within 24 hours of the subject's inclusion.
|
No Intervention: Control group
Clinical management, including surgical procedures, anesthesia, and perioperative management, are performed in accordance with standard clinical practice.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of allogeneic RBC transfusion
Time Frame: 30 days after randomization
|
Number of patients who receive allogeneic RBC transfusion/total number of patients.
|
30 days after randomization
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average number of units of RBC transfused in patients who receive allogeneic RBC transfusion
Time Frame: 30 days after randomization
|
Total number of units of RBC transfused/number of patients who receive allogeneic RBC transfusion
|
30 days after randomization
|
Average number of units of RBC transfused in the entire study population
Time Frame: 30 days after randomization
|
Total number of units of RBC transfused/total number of patients
|
30 days after randomization
|
Incidence of postoperative adverse events (AEs)
Time Frame: 30 days after randomization
|
AEs are graded according to the severity: Grade 1 Recovery after temporary treatment, such as postoperative nausea and vomiting (PONV), urinary retention, anxiety, temporary insomnia, etc. Grade 2 Results in prolonged hospitalization, such as lung infections requiring antibiotic treatment, incision infections requiring debridement treatment, etc.; Grade 3 life-threatening, recovery after treatment during hospitalization, such as acute renal failure requiring renal replacement therapy, postoperative hemorrahge requiring surgical intervention, respiratory failure requiring mechanical ventilation, etc.; Grade 4 Injury last 30 days or more after surgery, a significant decrease in the quality of life, such as acute myocardial infarction, stroke, etc.; Grade 5 Death with 30 days after surgery |
30 days after randomization
|
Hemoglobin (Hb) levels
Time Frame: 30 days after randomization
|
Hemoglobin (Hb) levels at different time points;
|
30 days after randomization
|
Length of stay (LOS)
Time Frame: 30 days after randomization
|
Length of stay (LOS), defined as number of days from admission to discharge
|
30 days after randomization
|
Postoperative hospital stay
Time Frame: 30 days after randomization
|
Number of days from the day of surgery to discharge
|
30 days after randomization
|
Re-admission
Time Frame: 30 days after randomization
|
Re-admission within 30 days after surgery
|
30 days after randomization
|
Cost of Hospitalization
Time Frame: 30 days after randomization
|
Total cost of hospitalization from admission to discharge.
|
30 days after randomization
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ren Liao, M.D., Department of Anesthesiology, West China Hospital, Sichuan University
Study record dates
Study Major Dates
Study Start (Anticipated)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- WCH20190308
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
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.
Clinical Trials on Iron Deficiency Anemia
-
Pennington Biomedical Research CenterRecruitingIron-deficiency | Iron Deficiency Anemia | Iron Deficiency Anemia TreatmentUnited States
-
Children's Hospital Los AngelesNot yet recruitingAnemia | Iron Deficiency Anemia | Anemia, Iron Deficiency | IDA - Iron Deficiency AnemiaUnited States
-
King's CollegeCompletedIron-deficiency | Iron Deficiency Anemia | Iron Deficiency (Without Anemia)United States
-
Arrowhead Regional Medical CenterRecruitingIron Deficiency Anemia of PregnancyUnited States
-
Swiss Federal Institute of TechnologyUnited States Agency for International Development (USAID); Quadram Institute... and other collaboratorsCompletedIron-deficiency | Iron Deficiency Anemia | Iron Deficiency (Without Anemia)Peru
-
Luzerner KantonsspitalRecruitingIron Deficiency Anemia | Iron Deficiency Anemia Treatment | Iron DeficienciesSwitzerland
-
Children's Hospital Los AngelesWithdrawnAnemia | Iron-deficiency Anemia | Healthy ControlsUnited States
-
Baylor College of MedicineNational Heart, Lung, and Blood Institute (NHLBI)CompletedIron-deficiency | Iron Deficiency AnemiaUnited States
-
Iowa State UniversityCompletedIron-deficiency | Iron Deficiency Anemia | Iron Deficiency Anemia Treatment | Iron Deficiency Anaemia Due to Dietary CausesUnited States
-
Société des Produits Nestlé (SPN)CompletedIron-deficiency | Anemia | Iron Deficiency AnemiaPhilippines
Clinical Trials on Intravenous iron isomaltose anhydride
-
University of PecsNot yet recruitingAnemia | GastroIntestinal BleedingHungary
-
Oslo University HospitalActive, not recruitingIron-deficiency | Severe Aortic StenosisNorway
-
University of ZurichCompletedNon Anemic Patients With Iron Deficiency (Low Ferritin Value)Switzerland
-
Texas Tech University Health Sciences Center, El...CompletedIron-deficiency | Iron Deficiency Anemia | Iron Deficiency Anemia Treatment | Iron Deficiency Anemia Due to Blood LossUnited States
-
Benha UniversityNew Jeddah Clinic HospitalCompletedDepression | Hemodialysis Complication | Iron Deficiency Anemia
-
University of OxfordColumbia University; ETH Zurich; Jomo Kenyatta University of Agriculture and... and other collaboratorsRecruitingPregnancy | Lactation | Iron Absorption | Iron Requirements | InfancyKenya
-
Leiden University Medical CenterRadboud University Medical Center; University Medical Center Groningen; Maastricht... and other collaboratorsRecruitingInflammatory Bowel Diseases | Iron-deficiency | Iron Deficiency AnemiaNetherlands
-
Imperial College LondonFu Wai Hospital, Beijing, ChinaCompletedPulmonary Arterial Hypertension | Iron DeficiencyUnited Kingdom, China, Germany
-
Federal University of São PauloCompletedAnemia, Iron-Deficiency | Weight LossBrazil
-
Yonsei UniversityUnknownPost Gastrectomy AnemiaKorea, Republic of