Change in Platelet Lipid Metabolism and Procoagulant Phenotype Induced by Cardiopulmonary Bypass. Impact on Postoperative Inflammatory Response and Bleeding Complications During Cardiac Surgery. (PLACARD)
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Descripción detallada
Cardiac surgery remains associated with high morbidity and mortality despite improvements in peri and post-operative care. Cardiopulmonary bypass (CPB) triggers a sterile inflammatory response, characterized by vascular hyperpermeability, excessive vasodilation, and cardiac arrythmias, i.e. atrial fibrillation. In parallel, major peri-operative bleeding frequently necessitates transfusion of allogeneic blood products. The pathophysiology underlying these complications is multifactorial. Direct contact of blood with the CPB tubing system, combined with ischemia-reperfusion injury, profoundly alters both the inflammatory and haemostatic systems. Among blood components, platelets are particularly vulnerable to CPB-induced alterations. Platelet dysfunction is widely recognized as the main haemostatic defect associated with CPB and a major contributor to post-operative bleeding. Recent findings have demonstrated that platelet lipid metabolism plays a key role in regulating thrombo-inflammatory responses in sepsis. These observations raise the hypothesis that CPB-induced alterations in platelet lipid metabolism may critically modulate the balance between inflammation and haemostasis in cardiac surgery.
The PLACARD project therefore aims to investigate how CPB-induced platelet modifications influence post-operative inflammatory responses and bleeding complications.
Specific objectives:
- Characterize the impact of CPB on the formation of procoagulant platelets.
- Assess changes in platelet lipid composition and bioenergetics before, during and after cardiac surgery.
- Correlate ex-vivo platelet alterations with post-operative clinical outcomes and biological markers during the stay in the cardiovascular intensive care unit.
This project addresses a critical unmet need in cardiac surgery: understanding the mechanistic link between CPB-induced platelet dysfunction and thrombo-inflammatory complications. By focusing on platelet lipid metabolism, a pathway largely unexplored in this context, the project moves beyond traditional platelet function assays. The results are expected to provide fundamental mechanistic insights into procoagulant platelet formation during CPB and may identify novel biomarkers or therapeutic targets to reduce bleeding and inflammatory complications in high-risk surgical patients.
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Christophe Beauloye, MD, PhD
- Número de teléfono: 003227642812
- Correo electrónico: christophe.beauloye@uclouvain.be
Copia de seguridad de contactos de estudio
- Nombre: Richard Coulie, MD
- Correo electrónico: richard.coulie@uclouvain.be
Ubicaciones de estudio
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Brussels, Bélgica, 1200
- Cliniques Universitaires Saint-luc
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Contacto:
- Christophe Beauloye, MD, PhD
- Número de teléfono: 003227642812
- Correo electrónico: christophe.beauloye@uclouvain.be
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Contacto:
- Richard Coulie, MD
- Correo electrónico: richard.coulie@uclouvain.be
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Sub-Investigador:
- Richard Coulie, MD
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Sub-Investigador:
- Mona Momeni, MD, PhD
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Investigador principal:
- Christophe Beauloye, MD, PhD
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Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Adult patients (≥ 18 years old) suffering from coronary disease and/or severe valvular dysfunction (mitral or aortic) undergoing elective coronary angiography or cardiac surgery with cardiopulmonary bypass.
Exclusion Criteria:
- Uninterrupted preoperative dual antiplatelet therapy
- Active chronic inflammatory disease
- Recent chemotherapy or immunotherapy (< 3 months)
- Active solid malignancy
- History of hematologic malignancy
- Hemophilia or other coagulopathy
- History of thrombocytopenia (< 100,000 platelets/mm³)
- Recent administration of thrombopoietin receptor agonist or immunoglobulins
- History of thrombopathy, thrombocytosis, or myeloproliferative syndrome
- History of heparin-induced thrombocytopenia (HIT)
- Cirrhosis or hepatic fibrosis (with or without hypersplenism)
- History of splenectomy, regardless of initial indication
- History of systemic autoimmune disease (e.g., systemic lupus erythematosus, scleroderma, antiphospholipid syndrome, systemic vasculitis)
- Recent major surgery (< 3 months)
- Severe renal insufficiency (eGFR ≤ 30 mL/min/m²) with or without dialysis
- Recent or chronic corticosteroid therapy
- Recent acute coronary syndrome, STEMI type (< 3 months)
- Urgent surgery or procedure
- Preoperative hemodynamic instability
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Ciencia básica
- Asignación: No aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
|---|---|
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Experimental: Cathlab patients
This group includes patients with coronary disease and/or valvular disease scheduled for elective coronary angiography.
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An arterial blood sample will be obtained at the beginning of the coronary angiography by using the arterial sheat in place, before administration of Heparin.
An arterial blood sample will be obtained via the arterial line before anesthetic induction, 60 minutes after the beginning of cardiopulmonary bypass and 4 hours after the arrival in the intensive care unit
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Experimental: Cardiac surgery patients
This arm includes patients with coronary disease and/or valvular disease scheduled for elective cardiac surgery with cardiopulmonary bypass.
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An arterial blood sample will be obtained at the beginning of the coronary angiography by using the arterial sheat in place, before administration of Heparin.
An arterial blood sample will be obtained via the arterial line before anesthetic induction, 60 minutes after the beginning of cardiopulmonary bypass and 4 hours after the arrival in the intensive care unit
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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Procoagulant platelet formation
Periodo de tiempo: Throughout the entire study, approximately during 32 months
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Ex-vivo flow cytometric assessment of the pourcentage of procoagulant platelet population under basal and stimulated conditions.
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Throughout the entire study, approximately during 32 months
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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Platelet lipidomics
Periodo de tiempo: Throughout the entire study, approximately during 32 months
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Assessment of the impact of cardiac surgery and cardiopulmonary bypass on platelet lipid metabolism.
Pourcentage of patients with platelet Acety-CoA Carboxylase phosphorylation.
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Throughout the entire study, approximately during 32 months
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Postoperative bleeding
Periodo de tiempo: Throughout the entire study, approximately during 32 months
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Correlation between the ex-vivo primary outcomes and clinical postoperative parameters (chest drain output (mL) and need for blood transfusion (units of packed red cells, fresh frozen plasma, platelets and fibrinogen)).
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Throughout the entire study, approximately during 32 months
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Postoperative inflammation
Periodo de tiempo: Throughout the entire study, approximately during 32 months
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Correlation between the ex-vivo primary outcomes and biological postoperative parameters (C-reactive protein).
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Throughout the entire study, approximately during 32 months
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Postoperative platelet function
Periodo de tiempo: Throughout the entire study, approximately during 32 months
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Correlation between the ex-vivo primary outcomes and biological postoperative parameters (platelet aggregometry results).
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Throughout the entire study, approximately during 32 months
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Postoperative coagulation
Periodo de tiempo: Throughout the entire study, approximately during 32 months
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Correlation between the ex-vivo primary outcomes and biological postoperative parameters (thromboelastography and standard coagulation results (INR, aPTT, Fibrinogen)).
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Throughout the entire study, approximately during 32 months
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Colaboradores
Colaboradores
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
Otros números de identificación del estudio
- PLACARD
Plan de datos de participantes individuales (IPD)
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Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
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