Thromboembolic Complications After Pacemaker or Implantable Cardioverter-Defibrillator Procedures
Thromboembolic Complications Associated With Pacemaker or Implantable Cardioverter-Defibrillator Procedures: a Prospective Registry
Aperçu de l'étude
Statut
Description détaillée
More than 235.500 cardiac pacemakers and cardioverter-defibrillators are implanted in the US every year, with an estimated 25,000 new implants in Brazil. Despite its proven clinical effectiveness and efficacy for a number of clinical conditions such as arrhythmias, the number of adverse events in the post-implant period remains substantial. Among these complications, venous obstructions occurs anywhere between 14% and 64% of all patients, causing devastating consequences such as upper extremity deep venous thrombosis and pulmonary embolism, ultimately leading to either significant impairment or death. Although retrospective studies have demonstrated the high incidence of these complications, as a consequence of a paucity of reliable registries we know next to nothing regarding how these venous lesions may influence the clinical outcome and mortality of patients, whether laboratorial markers may contribute to the early diagnosis of venous thrombosis and its complications, and about properties of diagnostic imaging for the identification of thromboembolic complications after permanent transvenous leads implantation.
The objective of this study is therefore to propose a significant improvement in an existing clinical database located within the Heart Institute (INCOR) at the University of Sao Paulo to enable the provision of answers to a clinical, biomarker, and imaging-related research questions. Specifically, our aims are to:
- Aim 1 - Registry infrastructure: In collaboration with professors from Duke University, we will create a series of improvements to the current database to enable it to serve as a platform not only for the current studies but also for future longitudinal, randomized studies. These include the standardization of variables in accordance with international guidelines, increase in patient retention and the ability to have additional data points in-between clinical appointments, improvement in the determination of cause of mortality, data quality monitoring, the creation of an item bank to measure aspects of quality of life that are specific for this population, as well as the integration of images and biomarkers to the clinical database.
- Aim 2 - Diagnostic imaging methods: To identify the incidence of upper extremity deep venous thrombosis after cardiac devices implantations or reoperation procedures, as well, the incidence of symptomatic and asymptomatic pulmonary thromboembolism.
- Aim 3 - Prognostic clinical factors: To study the impact of thromboembolic complications in the clinical prognostic and mortality of patients;
- Aim 4 - Prognostic biomarkers: To determine the association between the biomarkers related with alterations in the hemostasis system and the occurrence of venous thrombosis (biomarkers: Fibrinogen, D Dimer, Antithrombin, Prothrombin fragment 1 +2, thromboxane B, Platelets, Plasminogen)
At the end of this study we will have a registry with one of the largest number of patients with this condition around the world, fully equipped for future randomized controlled trials. We will also have a much better understanding regarding clinical, imaging, and biomarkers for this condition.
Type d'étude
Inscription (Anticipé)
Contacts et emplacements
Lieux d'étude
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São Paulo, Brésil, 05403-900
- Recrutement
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Contact:
- Katia R Silva, RN PhD
- Numéro de téléphone: 5284 55-11-2661
- E-mail: katia.regina@incor.usp.br
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Chercheur principal:
- Roberto Costa, MD PhD
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Chercheur principal:
- Katia R Silva, RN PhD
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Sous-enquêteur:
- Martino Martinelli Filho, MD PhD
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Sous-enquêteur:
- Mario Terra Filho, MD PhD
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Sous-enquêteur:
- Wilson Mathias Jr, MD PhD
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Sous-enquêteur:
- Marta F Lima, MD PhD
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Sous-enquêteur:
- Roberto A Rached, MD PhD
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Sous-enquêteur:
- Claudio L Lucarelli, MD PhD
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Sous-enquêteur:
- Francisco C Carnevale, MD PhD
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Sous-enquêteur:
- Airton M Moreira, MD PhD
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Sous-enquêteur:
- Wagner T Tamaki, MD PhD
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
Méthode d'échantillonnage
Population étudiée
La description
Inclusion Criteria:
- Older than 18 years
- Pacemaker/ implantable-cardioverter defibrillator (ICD) / cardiac resynchronization therapy (CRT) initial implant by transvenous approach or
- Patients submitted to reoperation procedures, as: pulse generator replacement, implant of an additional lead, lead extraction, lead repositioning;
- Subject agreed to participate and signed the consent form
Exclusion Criteria:
- Patients with a history of venous thromboembolism, coagulopathy or malignancy
- Pregnancy
- Life expectancy of less than one year
- Contraindication to administration of iodinated contrast (creatinine > 3.0)
- Unable to attend the follow-up appointments
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
Cohortes et interventions
Groupe / Cohorte |
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Implantation Procedures
Patients submitted to initial pacemaker or ICD implantation
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Reoperation Procedures
Patients submitted to pacemaker or implantable cardioverter-defibrillator generator replacements, upgrade procedures and lead extraction
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Thromboembolic complications
Délai: Participants will be evaluated at 1, 6, 12 months after the surgical procedure
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Upper extremity deep venous thrombosis Pulmonary embolism All cause mortality
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Participants will be evaluated at 1, 6, 12 months after the surgical procedure
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Venous lesions
Délai: Participants will be evaluated at 12 months after the surgical procedure
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Venous stenosis (any degree) detected by subtraction venography
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Participants will be evaluated at 12 months after the surgical procedure
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Katia R Silva, RN PhD, University of Sao Paulo
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Anticipé)
Achèvement de l'étude (Anticipé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- CAPPesq: 0730/11
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