Change in Platelet Lipid Metabolism and Procoagulant Phenotype Induced by Cardiopulmonary Bypass. Impact on Postoperative Inflammatory Response and Bleeding Complications During Cardiac Surgery. (PLACARD)
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
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.
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Christophe Beauloye, MD, PhD
- Telefoonnummer: 003227642812
- E-mail: christophe.beauloye@uclouvain.be
Studie Contact Back-up
- Naam: Richard Coulie, MD
- E-mail: richard.coulie@uclouvain.be
Studie Locaties
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Brussels, België, 1200
- Cliniques Universitaires Saint-luc
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Contact:
- Christophe Beauloye, MD, PhD
- Telefoonnummer: 003227642812
- E-mail: christophe.beauloye@uclouvain.be
-
Contact:
- Richard Coulie, MD
- E-mail: richard.coulie@uclouvain.be
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Onderonderzoeker:
- Richard Coulie, MD
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Onderonderzoeker:
- Mona Momeni, MD, PhD
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Hoofdonderzoeker:
- Christophe Beauloye, MD, PhD
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Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
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
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Fundamentele wetenschap
- Toewijzing: Niet-gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
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Experimenteel: 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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Experimenteel: 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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Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Procoagulant platelet formation
Tijdsspanne: 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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Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Platelet lipidomics
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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
Tijdsspanne: 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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Medewerkers en onderzoekers
Sponsor
Sponsor
Medewerkers
Medewerkers
Studie record data
Bestudeer belangrijke data
Studie start (Geschat)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
Andere studie-ID-nummers
- PLACARD
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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