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- Ensaio Clínico NCT04244981
Eficácia do Concentrado do Complexo de Protrombina na Redução da Perda Sanguínea Perioperatória em Cirurgia Cardíaca
Eficácia do concentrado do complexo de protrombina na redução da perda sanguínea perioperatória em cirurgia cardíaca, em comparação com o plasma fresco congelado: protocolo de estudo para um estudo controlado randomizado de não inferioridade
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 4
Contactos e Locais
Locais de estudo
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Beijing Municipality
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Beijing, Beijing Municipality, China, 100730
- Peking Union Medical College Hospital
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Beijing, Beijing Municipality, China, 100037
- Cardiovascular Institute and Fuwai Hospital, CAMS&PUMC
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Descrição
Critério de inclusão:
- Recebendo cirurgia de revascularização do miocárdio eletiva (CABG), ou substituição de válvula ou valvoplastia com circulação extracorpórea
- Assine o consentimento informado
Critério de exclusão:
- Histórico de cirurgia cardíaca;
- disfunção hepática;
- Insuficiência renal (creatinina sérica superior a 176 µmol/l);
- Coagulopatia grave;
- Suspensão de clopidogrel ou aspirina menos de 7 dias e heparina de baixo peso molecular menos de 24 horas antes da cirurgia;
- Distúrbios hematológicos;
- Transfusão de sangue em massa 24 horas antes da cirurgia;
- Alergia a hemoderivados alogênicos;
- Gravidez;
- Outras doenças graves que podem afetar o tempo de sobrevida do paciente, como tumores.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Quadruplicar
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: PCC group
Four-factor PCC 8 -15 IU/kg; Four types of 4-factor prothrombin complex concentrate will be used.
Rather than requiring strict weight-based dosing, clinicians are instructed to use the drug by administering whole bottles. Consequently, some variation in the per-kilogram dose occurred across patients. |
Cross-Reference to FFP group.
Outros nomes:
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Comparador Ativo: FFP group
FFP 6 -10 mL/kg; FFP is supplied in 100- or 200- packages.
Rather than requiring strict weight-based dosing, clinicians are instructed to use the drug efficiently by administering whole packages.
Consequently, some variation in the per-kilogram dose occur across patients.
|
All patients have valve surgery via median sternotomy with general anaesthesia and CPB. Mild hypothermia (32-34 ℃) is maintained during bypass, with patients thereafter being rewarmed to a nasopharyngeal temperature of 37.0 ℃ and a rectal temperature of 35.5 ℃. Heparin (400 IU/kg) is given before initiation of CPB, and ACT is maintained above 480 seconds. Tranexamic acid is administered as a 20-mg/kg bolus within the first hour, followed by an infusion of 2 mg/kg per hour infusion until the end of surgery. After CPB, heparin is neutralised with protamine sulphate (1 mg per 100 IU heparin), targeting an ACT within ±10% of the baseline value; an additional 20-30 mg is given if ACT remains elevated. FFP or PCC, per randomization, is given once post-CPB coagulation factor deficiency is confirmed.
Outros nomes:
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Cumulative Chest Tube Drainage
Prazo: between 1 hour after trial drug administration and 24 hours after surgery
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cumulative chest tube drainage between 1 hour after trial drug administration and 24 hours after surgery
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between 1 hour after trial drug administration and 24 hours after surgery
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Efficacy of Haemostasis
Prazo: from 1 hour after trial drug administration to 24 hours after surgery
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Effectiveness of haemostasis if no hemostatic interventions occurred from 60 minutes to 24 hours after treatment initiation.
Hemostatic interventions included surgical reoperation for bleeding, transfusion of any allogeneic blood products (excluding red blood cells), or administration of any coagulation factor concentrate.
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from 1 hour after trial drug administration to 24 hours after surgery
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Allogeneic RBCs Units Transfused
Prazo: between 1 hour after trial drug administration and 24 hours after surgery; and between 1 hour after trial drug administration and 7 days postoperatively
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the cumulated allogenic Red blood cells (RBC) units transfused
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between 1 hour after trial drug administration and 24 hours after surgery; and between 1 hour after trial drug administration and 7 days postoperatively
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Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Changes in aPTT, INR, Fibrinogen Levels, Platelet Count, and Hemoglobin
Prazo: between the preoperative period and the first postoperative morning
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Changes in aPTT, INR, fibrinogen levels, platelet count, and hemoglobin between the preoperative period and the first postoperative morning
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between the preoperative period and the first postoperative morning
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ICU Stay and Total Hospital Stay
Prazo: from admission to discharge
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the length(days) of ICU stay and total hospital stay
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from admission to discharge
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Cadeira de estudo: Lijian Pei, M.D., Peking Union Medical College Hospital
- Investigador principal: Jia Shi, M.D., Chinese Academy of Medical Sciences, Fuwai Hospital
Publicações e links úteis
Publicações Gerais
- Goldstein JN, Refaai MA, Milling TJ Jr, Lewis B, Goldberg-Alberts R, Hug BA, Sarode R. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet. 2015 May 23;385(9982):2077-87. doi: 10.1016/S0140-6736(14)61685-8. Epub 2015 Feb 27.
- Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):160S-198S. doi: 10.1378/chest.08-0670.
- Song HK, Tibayan FA, Kahl EA, Sera VA, Slater MS, Deloughery TG, Scanlan MM. Safety and efficacy of prothrombin complex concentrates for the treatment of coagulopathy after cardiac surgery. J Thorac Cardiovasc Surg. 2014 Mar;147(3):1036-40. doi: 10.1016/j.jtcvs.2013.11.020. Epub 2013 Dec 22.
- Ortmann E, Besser MW, Sharples LD, Gerrard C, Berman M, Jenkins DP, Klein AA. An exploratory cohort study comparing prothrombin complex concentrate and fresh frozen plasma for the treatment of coagulopathy after complex cardiac surgery. Anesth Analg. 2015 Jul;121(1):26-33. doi: 10.1213/ANE.0000000000000689.
- Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF. Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol. 2004 Jul;126(1):139-52. doi: 10.1111/j.1365-2141.2004.04973.x.
- Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg. 1996 May;111(5):1037-46. doi: 10.1016/s0022-5223(96)70380-x.
- Society of Thoracic Surgeons Blood Conservation Guideline Task Force; Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, Royston BD, Bridges CR, Higgins RS, Despotis G, Brown JR; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion; Spiess BD, Shore-Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg. 2007 May;83(5 Suppl):S27-86. doi: 10.1016/j.athoracsur.2007.02.099.
- Dacey LJ, Munoz JJ, Baribeau YR, Johnson ER, Lahey SJ, Leavitt BJ, Quinn RD, Nugent WC, Birkmeyer JD, O'Connor GT. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg. 1998 Apr;133(4):442-7. doi: 10.1001/archsurg.133.4.442.
- Zacharias A, Habib RH. Factors predisposing to median sternotomy complications. Deep vs superficial infection. Chest. 1996 Nov;110(5):1173-8. doi: 10.1378/chest.110.5.1173.
- Sun JC, Davidson MJ, Lamy A, Eikelboom JW. Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends. Lancet. 2009 Aug 15;374(9689):565-76. doi: 10.1016/S0140-6736(09)60780-7.
- Parr KG, Patel MA, Dekker R, Levin R, Glynn R, Avorn J, Morse DS. Multivariate predictors of blood product use in cardiac surgery. J Cardiothorac Vasc Anesth. 2003 Apr;17(2):176-81. doi: 10.1053/jcan.2003.44.
- Mariscalco G, Biancari F, Juvonen T, Zanobini M, Cottini M, Banach M, Murphy GJ, Beghi C, Angelini GD. Red blood cell transfusion is a determinant of neurological complications after cardiac surgery. Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):166-71. doi: 10.1093/icvts/ivu360. Epub 2014 Nov 2.
- Alfirevic A, Xu M, Johnston D, Figueroa P, Koch CG. Transfusion increases the risk for vasoplegia after cardiac operations. Ann Thorac Surg. 2011 Sep;92(3):812-9. doi: 10.1016/j.athoracsur.2011.04.020. Epub 2011 Jul 23.
- Sellman M, Intonti MA, Ivert T. Reoperations for bleeding after coronary artery bypass procedures during 25 years. Eur J Cardiothorac Surg. 1997 Mar;11(3):521-7. doi: 10.1016/s1010-7940(96)01111-6.
- Ottino G, De Paulis R, Pansini S, Rocca G, Tallone MV, Comoglio C, Costa P, Orzan F, Morea M. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg. 1987 Aug;44(2):173-9. doi: 10.1016/s0003-4975(10)62035-8.
- Linden MD. The hemostatic defect of cardiopulmonary bypass. J Thromb Thrombolysis. 2003 Dec;16(3):129-47. doi: 10.1023/B:THRO.0000024051.12177.e9.
- Despotis G, Eby C, Lublin DM. A review of transfusion risks and optimal management of perioperative bleeding with cardiac surgery. Transfusion. 2008 Mar;48(1 Suppl):2S-30S. doi: 10.1111/j.1537-2995.2007.01573.x. No abstract available.
- Karkouti K, Callum J, Crowther MA, McCluskey SA, Pendergrast J, Tait G, Yau TM, Beattie WS. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg. 2013 Jul;117(1):14-22. doi: 10.1213/ANE.0b013e318292efa4. Epub 2013 May 17.
- Weber CF, Klages M, Zacharowski K. Perioperative coagulation management during cardiac surgery. Curr Opin Anaesthesiol. 2013 Feb;26(1):60-4. doi: 10.1097/ACO.0b013e32835afd28.
- Khuri SF MA, Valeri CR. The effects of cardiopulmonary bypass on hemostasis. Loscabo J, Schafer AI, eds. Thrombosis & Hemorrhage. Cambridge: Blackwell Science. 1993;1993:1051-1073.
- Kaspereit F, Hoffmann S, Pragst I, Dickneite G. Prothrombin complex concentrate mitigates diffuse bleeding after cardiopulmonary bypass in a porcine model. Br J Anaesth. 2010 Nov;105(5):576-82. doi: 10.1093/bja/aeq216. Epub 2010 Aug 17.
- Eitz T, Schenk S, Fritzsche D, Bairaktaris A, Wagner O, Koertke H, Koerfer R. International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement. Ann Thorac Surg. 2008 Mar;85(3):949-54; discussion 955. doi: 10.1016/j.athoracsur.2007.08.071.
- Safaoui MN, Aazami R, Hotz H, Wilson MT, Margulies DR. A promising new alternative for the rapid reversal of warfarin coagulopathy in traumatic intracranial hemorrhage. Am J Surg. 2009 Jun;197(6):785-90. doi: 10.1016/j.amjsurg.2008.04.003. Epub 2008 Aug 22.
- Fariborz Farsad B, Golpira R, Najafi H, Totonchi Z, Salajegheh S, Bakhshandeh H, Hashemian F. Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015 Summer;14(3):877-85.
- Cromwell C, Aledort LM. FEIBA: a prohemostatic agent. Semin Thromb Hemost. 2012 Apr;38(3):265-7. doi: 10.1055/s-0032-1309286. Epub 2012 Mar 29.
- Franchini M, Lippi G. Prothrombin complex concentrates: an update. Blood Transfus. 2010 Jul;8(3):149-54. doi: 10.2450/2010.0149-09. No abstract available.
- Hellstern P. Production and composition of prothrombin complex concentrates: correlation between composition and therapeutic efficiency. Thromb Res. 1999 Aug 15;95(4 Suppl 1):S7-12. doi: 10.1016/s0049-3848(99)00078-x.
- Cappabianca G, Mariscalco G, Biancari F, Maselli D, Papesso F, Cottini M, Crosta S, Banescu S, Ahmed AB, Beghi C. Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery. Crit Care. 2016 Jan 6;20:5. doi: 10.1186/s13054-015-1172-6.
- Weinberger J, Cipolle M. Optimal Reversal of Novel Anticoagulants in Trauma. Crit Care Clin. 2017 Jan;33(1):135-152. doi: 10.1016/j.ccc.2016.08.005.
- Patanwala AE, Acquisto NM, Erstad BL. Prothrombin complex concentrate for critical bleeding. Ann Pharmacother. 2011 Jul;45(7-8):990-9. doi: 10.1345/aph.1Q096. Epub 2011 Jul 5.
- Hellstern P, Halbmayer WM, Kohler M, Seitz R, Muller-Berghaus G. Prothrombin complex concentrates: indications, contraindications, and risks: a task force summary. Thromb Res. 1999 Aug 15;95(4 Suppl 1):S3-6. doi: 10.1016/s0049-3848(99)00077-8. No abstract available.
- Huttner HB, Schellinger PD, Hartmann M, Kohrmann M, Juettler E, Wikner J, Mueller S, Meyding-Lamade U, Strobl R, Mansmann U, Schwab S, Steiner T. Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates. Stroke. 2006 Jun;37(6):1465-70. doi: 10.1161/01.STR.0000221786.81354.d6. Epub 2006 May 4.
- Erber WN, Perry DJ. Plasma and plasma products in the treatment of massive haemorrhage. Best Pract Res Clin Haematol. 2006;19(1):97-112. doi: 10.1016/j.beha.2005.01.026.
- Vigue B, Ract C, Tremey B, Engrand N, Leblanc PE, Decaux A, Martin L, Benhamou D. Ultra-rapid management of oral anticoagulant therapy-related surgical intracranial hemorrhage. Intensive Care Med. 2007 Apr;33(4):721-5. doi: 10.1007/s00134-007-0528-z. Epub 2007 Jan 27.
- Levy JH, Tanaka KA, Dietrich W. Perioperative hemostatic management of patients treated with vitamin K antagonists. Anesthesiology. 2008 Nov;109(5):918-26. doi: 10.1097/ALN.0b013e3181895bd8.
- Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol. 2008 Feb;83(2):137-43. doi: 10.1002/ajh.21046.
- Bux J. Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion. Vox Sang. 2005 Jul;89(1):1-10. doi: 10.1111/j.1423-0410.2005.00648.x.
- Pabinger I, Brenner B, Kalina U, Knaub S, Nagy A, Ostermann H; Beriplex P/N Anticoagulation Reversal Study Group. Prothrombin complex concentrate (Beriplex P/N) for emergency anticoagulation reversal: a prospective multinational clinical trial. J Thromb Haemost. 2008 Apr;6(4):622-31. doi: 10.1111/j.1538-7836.2008.02904.x. Epub 2008 Jan 15.
- Pabinger-Fasching I. Warfarin-reversal: results of a phase III study with pasteurised, nanofiltrated prothrombin complex concentrate. Thromb Res. 2008;122 Suppl 2:S19-22. doi: 10.1016/S0049-3848(08)70005-7.
- Nienaber U, Innerhofer P, Westermann I, Schochl H, Attal R, Breitkopf R, Maegele M. The impact of fresh frozen plasma vs coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion. Injury. 2011 Jul;42(7):697-701. doi: 10.1016/j.injury.2010.12.015. Epub 2011 Mar 9.
- Green L, Roberts N, Cooper J, Field J, Gill R, Klein A, Agarwal S, Stanworth S, Johnston A, Monk V, O'Brien B. A pragmatic pilot phase II randomised controlled trial of prothrombin complex concentrates (PCC) versus fresh frozen plasma (FFP) in adult patients who are undergoing heart surgery (PROPHESY). Trials. 2019 Dec 9;20(1):684. doi: 10.1186/s13063-019-3759-8.
- Pei L, Sun C, Lv H, Zhang Y, Shi J. Efficacy of prothrombin complex concentrate (PCC) versus fresh frozen plasma (FFP) in reducing perioperative blood loss in cardiac surgery: study protocol for a non-inferiority, randomised controlled trial. BMJ Open. 2022 Feb 10;12(2):e051072. doi: 10.1136/bmjopen-2021-051072.
- Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, Fries D, Gorlinger K, Haas T, Imberger G, Jacob M, Lance M, Llau J, Mallett S, Meier J, Rahe-Meyer N, Samama CM, Smith A, Solomon C, Van der Linden P, Wikkelso AJ, Wouters P, Wyffels P. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013 Jun;30(6):270-382. doi: 10.1097/EJA.0b013e32835f4d5b.
- Hayes K, Fernando MC, Jordan V. Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding. Cochrane Database Syst Rev. 2022 Nov 21;11(11):CD013551. doi: 10.1002/14651858.CD013551.pub2.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Doenças Genéticas, Congênitas
- Doenças Hematológicas
- Distúrbios da Coagulação Sanguínea
- Distúrbios hemorrágicos
- Doenças Genéticas, Ligadas ao X
- Distúrbios da Coagulação Sanguínea, Herdados
- Distúrbios da Proteína de Coagulação
- Doenças e Anormalidades Congênitas, Hereditárias e Neonatais
- Doenças hemic e linfáticas
- Hemofilia B
- Aminoácidos, peptídeos e proteínas
- Proteínas
- Fatores biológicos
- Enzimas e coenzimas
- Proteínas sanguíneas
- Fatores de coagulação do sangue
- Precursores enzimáticos
- Precursores de proteínas
- Fator IX
Outros números de identificação do estudo
- PCC vs FFP Study
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
Prazo de Compartilhamento de IPD
Critérios de acesso de compartilhamento IPD
Tipo de informação de suporte de compartilhamento de IPD
- PROTOCOLO DE ESTUDO
- SEIVA
Informações sobre medicamentos e dispositivos, documentos de estudo
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Estuda um produto de dispositivo regulamentado pela FDA dos EUA
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