Tranexamic Acid to Reduce Blood Loss After Varus Derotation Osteotomy (TABLO)
Postoperative Continuous Intravenous Tranexamic Acid Infusion to Reduce Blood Loss in Non-Ambulatory Children With Cerebral Palsy Following Bilateral Bony Hip Reconstructive Surgery: A Phase III Parallel-Group Randomised Placebo-Controlled Trial
TABLO (Tranexamic Acid to reduce Blood Loss after varus derotation Osteotomy) is a clinical trial of postoperative tranexamic acid vs placebo in non-ambulatory children with cerebral palsy (CP) undergoing reconstructive hip surgery.
Improving surgical outcomes is a high priority in this patient population given the high risk of bleeding and the diminished capacity for these children to withstand substantial blood loss. Preliminary data from the study institution indicates that approximately one third of these patients receive transfusion of blood products in the postoperative period. There is growing evidence that hidden blood loss occurring in the postoperative period is substantial and can potentially be attenuated with the administration of Tranexamic Acid (TXA). However, trials on postoperative TXA have been carried out exclusively in adult surgical populations.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 3
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Erich Rutz, MD, PhD
- Telefonnummer: +61 9345 7645
- E-Mail: erich.rutz@rch.org.au
Studieren Sie die Kontaktsicherung
- Name: Daniel Gould, MD, PhD
- Telefonnummer: +61 9345 7645
- E-Mail: daniel.gould@unimelb.edu.au
Studienorte
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Victoria
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Melbourne, Victoria, Australien, 3052
- The Royal Children's Hospital
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Kind
Akzeptiert gesunde Freiwillige
Beschreibung
Inclusion Criteria:
- Children (aged 4 to 16 years)
- Diagnosis of cerebral palsy (CP). CP is an umbrella term under which many specific diagnoses are captured, and the clinical team at the study institution operates a comprehensive referral network to ensure patients with any relevant diagnoses are included.
- Gross Motor Function Classification System (GMFCS) levels IV and V, with substantial hip displacement (>40% migration percentage per Australian Hip Surveillance Guidelines (Wynter M, Gibson N, Kentish M, Love S, Thomason P, Willoughby K, et al. Australian hip surveillance guidelines for children with cerebral palsy 2014. Australian Academy of Cerebral Palsy and Developmental Medicine. 2014.)), who are on the waitlist for bilateral proximal femoral varus derotational osteotomy (VDRO) +/- unilateral or bilateral pelvic osteotomy.
Exclusion Criteria:
- Haematological disorder (defined as an active genetic or acquired bleeding disorder)
- Known hypersensitivity to tranexamic acid (TXA)
- Children with promyelocytic leukaemia being treated with oral tretinoin will be excluded from the trial because combination with TXA has resulted in fatal thrombotic complications
- Known coagulation defect
- Known renal disorder (moderate to severe as per study institution guidelines)
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Unterstützende Pflege
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Vervierfachen
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
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Experimental: Tranexamic acid postoperative continuous infusion arm
Once the patient has been transferred to recovery after surgery, the postoperative infusion will commence comprising 10mg/kg/hr intravenous tranexamic acid for 24 hours.
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Once the patient has been transferred to recovery after surgery, the postoperative infusion will commence comprising 10mg/kg/hr intravenous tranexamic acid for 24 hours.
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Placebo-Komparator: Normal saline postoperative continuous infusion arm
The control group will receive placebo in the form of normal saline, which is physically identical to tranexamic acid and has been used in previous randomised placebo-controlled trials of tranexamic acid.
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The control group will receive placebo in the form of normal saline.
The volume administered will be identical to that of TXA intervention arm, and the infusion rate will be the same.
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Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Mean change between treatment arms in postoperative haemoglobin mass loss, measured on postoperative day 5 or day of discharge (whichever is earlier) and estimated using the HAEmoglobin Mass loss DuRing the periOperative Period (HAEMDROP) formula
Zeitfenster: Day of surgery (within 15 minutes of the end of surgery), Day 5 or day of discharge (whichever is earlier)
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HAEMDROP formula: mHb_loss = BV*(Hb_initial - Hb_final) + (TV * 200), where:
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Day of surgery (within 15 minutes of the end of surgery), Day 5 or day of discharge (whichever is earlier)
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Number of clinically significant seizures
Zeitfenster: Day of surgery until Day 5 post-operatively
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Seizures experienced between Day of surgery until Day 5 post-operatively which:
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Day of surgery until Day 5 post-operatively
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Duration of hospital stay
Zeitfenster: Date of surgery, date of discharge from hospital which will be an anticipated average of 8.28 days
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Total duration of hospital stay, in calendar days, from date of admission (= day zero) to date of discharge.
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Date of surgery, date of discharge from hospital which will be an anticipated average of 8.28 days
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Duration of paediatric intensive care unit admission
Zeitfenster: Date of PICU admission through to date of discharge from PICU which will be an anticipated average of 26.5 hours
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The occurrence and duration of both planned and unplanned admission to the paediatric intensive care (PICU) unit during the participant's post-operative inpatient period.
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Date of PICU admission through to date of discharge from PICU which will be an anticipated average of 26.5 hours
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Volume of packed red blood cells transfused
Zeitfenster: From end of operation to postoperative day 5 or day of discharge (whichever comes first)
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Volume of packed red blood cells transfused during the period over which the primary outcome is measured (from end of operation to postoperative day 5 inclusive).
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From end of operation to postoperative day 5 or day of discharge (whichever comes first)
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Incidence of surgical wound infections - superficial incisional surgical site infection
Zeitfenster: Day of surgery through to 30 days following surgery
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Surgical site infection event defined in accordance with the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN) criteria
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Day of surgery through to 30 days following surgery
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Incidence of surgical wound infections - deep incisional surgical site infection
Zeitfenster: Day of surgery through to 90 days following surgery
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Surgical site infection event defined in accordance with the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN) criteria
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Day of surgery through to 90 days following surgery
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Incidence of venous thromboembolism events requiring treatment
Zeitfenster: Day of surgery through to Day 5 post-surgery
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Incidence of venous thromboembolism requiring anticoagulant treatment in accordance with study institution guidelines will be captured.
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Day of surgery through to Day 5 post-surgery
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Changes in in quality of life, measured in quality-adjusted life years (QALYs)
Zeitfenster: Preoperatively, 3 months postoperatively, 6 months postoperatively
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The EuroQol 5 dimensions (EQ-5D) by proxy will be completed by participants' parent/guardian.
The EQ-5D is numbered from 0 to 100, where 100 means the best health you can imagine and 0 means the worst health you can imagine.
From this, QALYs will be calculated and compared between intervention and control groups.
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Preoperatively, 3 months postoperatively, 6 months postoperatively
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Changes in quality of life
Zeitfenster: Preoperatively, 3 months postoperatively, 6 months postoperatively
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Changes in quality of life will be captured by the CP-CHILD (caregiver) questionnaire, which measures: Social wellbeing & acceptance, Feelings about functioning, Participation & physical health, Emotional wellbeing & self-esteem, Access to services, Pain & impact of disability, Family health |
Preoperatively, 3 months postoperatively, 6 months postoperatively
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Hauptermittler: Erich Rutz, MD, PhD, The University of Melbourne Department of Paediatrics (Orthopaedics), The Royal Children's Hospital Melbourne
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Erkrankungen des Gehirns
- Erkrankungen des zentralen Nervensystems
- Erkrankungen des Nervensystems
- Pathologische Prozesse
- Hirnschaden, chronisch
- Intraoperative Komplikationen
- Pathologische Zustände, Anzeichen und Symptome
- Zerebralparese
- Blutung
- Blutverlust, chirurgisch
- Organische Chemikalien
- Carboxylsäuren
- Säuren, carbocyclisch
- Cyclohexanecarboxylsäuren
- Tranexamsäure
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- tablotrialvdrocprchmcri2025123
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
Beschreibung des IPD-Plans
The anonymised data set collected for the analysis of this trial will be made available 12 months following analysis and publication of the primary outcome.
This includes data collected for the primary outcome and each secondary outcome.
IPD-Sharing-Zeitrahmen
The anonymised data set collected for the analysis of this trial will be made available 12 months following analysis and publication of the primary outcome.
The source data for patients is collected routinely in the EMR. As this is routinely collected in clinical care, this won't be destroyed after the minimum retention periods. Data files created for the study, i.e. quality of life questionnaires, may be destroyed after 15 years post-trial completion or until child aged 25 years (whichever is the later).
IPD-Sharing-Zugriffskriterien
The trial recognises the value of open data sharing and adherence to data sharing principles that align with applicable laws, regulations, and ethical guidelines. Therefore, anonymised data from this clinical trial will be made available via a controlled access data sharing mechanism. Interested researchers may request access to the data by submitting a formal data sharing request to the Sponsor. The request will be reviewed by the Sponsor and the Sponsor-Investigator, and any relevant Murdoch Children's Research Institute (MCRI) data sharing committee, considering factors such as scientific merit, data security, and adherence to the approved research objectives.
The data may be obtained from the Murdoch Children's Research Institute by emailing MCTC@mcri.edu.au.
Art der unterstützenden IPD-Freigabeinformationen
- STUDIENPROTOKOLL
- SAFT
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
Produkt, das in den USA hergestellt und aus den USA exportiert wird
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