- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04272606
TXA in Spinal Fusion
Prospective, Randomized, Double Blind Study on the Effects of Tranexamic Acid on Intraoperative Blood Loss During Lumbar Spinal Fusion And Instrumentation
Study Overview
Status
Conditions
Detailed Description
This study is to assess whether tranexamic acid (a drug that is used to coagulate the blood and reduce bleeding) use in lumbar spinal fusion can reduce blood loss and postoperative delirium compared to placebo. Thusly reducing need for transfusion, shorting the hospital stay and improving outcomes. For this the study will randomize patients who are receiving elective lumbar interbody fusion (PLIF or TLIF) of 2 or more levels for degenerative disc disease (DDD) into 2 groups. Group 1 would receive tranexamic acid during the surgery while group 2 will receive placebo. Blood loss during the surgery and postoperatively (while the patient has a drain) will be monitored along with the amount of transfusions needed, postoperative cognitive status (including delirium), postoperative markers of systemic inflammation, and and the duration of hospital stay. Delirium incidence and severity will be assessed daily for the first 5 days after surgery and at discharge. Cognitive status (neuropsychological tests) will be assessed at post-discharge follow up visits and compared to preoperative status.
The drug or placebo are only given during the surgery. The patient population includes elective cases of patient undergoing lumbar spinal fusion of 2 or more levels. Spinal fusions are known to be associated with blood loss, especially when the surgeries are long and more levels need to be fused.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Sarah Lee
- Phone Number: (951)425-7651
- Email: sarah-j-lee@uiowa.edu
Study Contact Backup
- Name: Catherine Olinger, M.D.
- Phone Number: (319) 384-5892
- Email: catherine-olinger@uiowa.edu
Study Locations
-
-
Iowa
-
Iowa City, Iowa, United States, 52242
- University of Iowa Hospitals and Clinics
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18-90 years
- American Spinal Injury Association (ASA) Impairment Scale anesthesia risk of I to IV
- Patients undergoing 2 or more levels of posterior lumbar interbody fusion for DDD. This includes PLIF or TLIF.
- Patients have failed conservative management, which include physical therapy (PT) or occupational therapy (OT) and/or injections.
Exclusion Criteria:
- ASA class V
- Patient unable to consent
- Patient with chronic kidney disease stage III or above: baseline plasma creatinine>1.5mg/dL
- Patient with known liver failure
- Patients on anticoagulation or dual antiplatelets (presence of vascular stents).
- Patients with artificial valves.
- Patients with allergy to TXA
- Patients with platelet count < 150 000,
- Patients with PT>15s
- Patients with Activated Partial Thromboplastin Time (APPT) >38s
- History of stroke or (an) unprovoked thromboembolic event(s).
- History of intracranial bleeding,
- Pregnancy
- known defective color vision
- history of venous or arterial thromboembolism or active thromboembolic disease
- Patients with severe pulmonary or cardiac disease.
- Patients who refuse transfusion of blood products
- Patients with chronic anemia with Hg<8
- Patients undergoing lumbar fusion for disease other than DDD (neoplasm)
- Patients undergoing lumbar fusion by anterior or lateral approach.
- Minimally invasive TLIF are excluded.
- Emergent cases.
- Women on hormonal contraception
- Retinal vein or artery occlusion
- Hypercoagulability
- Seizure disorder
- Current use of tretinoin
- Current use of chlorpromazine
- Breast feeding
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Treatment
1:1 randomization, given tranexamic acid during surgery, visual acuity exam
|
Antifibrinolytic Agent
Other Names:
Supplemented into standard of care daily neurological exam on day of surgery and day after
Other Names:
3D-CAM is a brief verbal assessment tool that can be used to test patients and study patients for delirium.
|
Placebo Comparator: Placebo
1:1 randomization, given standard of care treatment during surgery, visual acuity exam
|
Supplemented into standard of care daily neurological exam on day of surgery and day after
Other Names:
Placebo
3D-CAM is a brief verbal assessment tool that can be used to test patients and study patients for delirium.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Transfusion
Time Frame: Up to 7 days or until discharge
|
Amount of red blood cells (RBC) transfused intraoperatively and up to 7 days post-operatively
|
Up to 7 days or until discharge
|
Blood Loss
Time Frame: Up to 7 days or until discharge
|
Amount of blood loss intraoperatively and up to 7 days post-operatively
|
Up to 7 days or until discharge
|
Delirium
Time Frame: up to 7 days or until discharge
|
Delirium incidence (yes/no) and severity (score 0-20) using daily 3D-CAM delirium assessment instrument.
|
up to 7 days or until discharge
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Catherine Olinger, M.D., University of Iowa
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- 201912099
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.
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