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Platelet DysfunctionNCT01382134

Effect of Aspirin, Hemodilution and Desmopressin on Platelet Dysfunction

A study testing Aspirin, desmopressin in people with Platelet Dysfunction and Hemodilution, run by The University of Hong Kong at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Study hypothesis: Desmopressin (DDAVP) can improve platelet function under influence of aspirin, hemodilution and mild hypothermia Mild hypothermia (34-35oC) is known to cause platelet dysfunction. This could lead to increased surgical bleeding and increased transfusion requirement during surgery. Read more about this study

Who is it for?
Ages 18 to 60 yearsHealthy volunteers can take part
What is being tested?
Aspirin, desmopressin
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
1 siteChina
Study dates
Jul 2011to Sep 2013
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 60 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • 60 adult Chinese subjects aged 18-60 without known platelet disorder, thrombocytopenia, history of taking drugs that may affect platelet function including herbal preparations.

Who cannot join

  • Any known platelet or coagulation disorder
  • Expected surgical operation or dental treatment within one week of scheduled drug intake.
  • Known peptic ulcer disease
  • Obesity (BMI >=30)
  • Pregnant or lactating women.
  • Known chronic liver or renal disease.
Show all 11Show fewer
  • Coronary artery, carotid artery or peripheral artery disease
  • Recent history of taking antiplatelet drugs, anticoagulants or herbal preparations.
  • Smoker or alcohol user
  • Mentally incapable of providing informed consent
  • Students or junior staff members who had direct working relationship with the PI

Trial locations and contacts

1 site in 1 country.

China1 site
  • Queen Mary Hospital

    Hong Kong

Other trials in China

About this study

Official title: Effect of Aspirin, in Vitro Hemodilution and Desmopressin on Platelet Dysfunction Associated With Mild Hypothermia in Healthy Volunteers

Study hypothesis: Desmopressin (DDAVP) can improve platelet function under influence of aspirin, hemodilution and mild hypothermia

Mild hypothermia (34-35oC) is known to cause platelet dysfunction. This could lead to increased surgical bleeding and increased transfusion requirement during surgery. Although this hypothermia-induced platelet dysfunction seems to be reversible with warming, this is not always possible or desirable.

Read more

Desmopressin (DDAVP) is a drug which has proven efficacy in improving platelet function in uraemic and cirrhosis patients, and in reducing blood loss in selected surgeries. In a recent study, we have found that subcutaneous injection of 1.5 mcg (1/10th the usual dose) is already sufficient to fully reverse the platelet dysfunction seen at 32oC. We have demonstrated in another study that prolongation of the bleeding time in a 20% hemodiluted sample predicts increased postoperative bleeding after total knee replacement.

We have therefore designed this study as a follow up to our last two studies on DDAVP and hypothermia, to investigate whether hemodilution affects hypothermia induced platelet dysfunction and the response to DDAVP. In addition, another common cause of perioperative platelet dysfunction is the intake of COX inhibitors, particularly aspirin by patients. Therefor the effect of aspirin on hypothermia induced platelet dysfunction and the response to DDAVP, will also be investigated.

Read the detailed description

Mild hypothermia (34-35oC) is known to cause platelet dysfunction. Increased surgical bleeding and increased transfusion requirement at this temperature range has been reported in both cardiac and noncardiac surgeries. This degree of hypothermia is common during any general anaesthesia, particularly during surgeries which invlove major fluid shift and large area exposure of patients, e.g. trauma and burn patients.

Although this hypothermia-induced platelet dysfunction seems to be reversible with warming, warming is not always possible or desirable. During major trauma or burn surgery, surface warming of patient is practically difficult. During surgeries with major blood loss and fluid shift, heat loss usually occurs at a rate that is more rapid than any warming device can catch up with. During neurosurgery, cooling may be beneficial to neurological outcome.

Desmopressin (DDAVP) is a drug which has proven efficacy in improving platelet function in uraemic and cirrhosis patients, and in reducing blood loss in selected surgeries. In a previous in vitro study, we have found that desmopressin significantly improves platelet function at 32oC. The improvement is seen with a very low concentration of desmopressin in vitro, which suggests that probably doses much smaller than the "standard dose" (15 mcg slow iv or subcutaneous) may be useful. In keeping with this in vitro study, in a more recent study, we have found that subcutaneous injection of 1.5 mcg (1/10th the usual dose) is already sufficient to fully reverse the platelet dysfunction seen at 32oC.

One of the limitations of our previous two studies is that the degree of platelet dysfuction observed at 32oC is relatively mild, with only around 20% prolongation of the closure times on the PFA-100® platelet function analyser. The clinical significance of such prolongation remains uncertain. However, we have demonstrated previously in another study that prolongation of the closure time to >188 sec in a 20% hemodiluted sample predicts increased postoperative bleeding after total knee replacement. We have therefore designed this study as a follow up to our last two studies on DDAVP and hypothermia, to investigate whether hemodilution affects hypothermia induced platelet dysfunction and the response to DDAVP.

In addition, another common cause of perioperative platelet dysfunction is the intake of COX inhibitors, particularly aspirin by patients. Therefor the effect of aspirin on hypothermia induced platelet dysfunction and the response to DDAVP, will also be investigated.

Being tested
Aspirin, desmopressin, Placebo, desmopressin
Keywords
Platelet dysfunction, Hemodilution, Mild hypothermia, NSAID, Desmopressin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Aspirin, desmopressinDrug

    Aspirin 100mg daily for 3 days Desmopressin 15 microgram subcutaneously once only

  • Placebo, desmopressinDrug

    Placebo 1 tab daily for 3 days Desmopressin 15 microgram subcutaneously once only

Study groups in NCT01382134
Study groupRoleWhat they receive
Placebo groupPlacebo comparatorSubjects will be given placebo daily for 3 days. On day 4 an early morning urine sample will be collected for detection of aspirin metabolite (11-dehydro thromboxane B2). On day 6 venous blood sample will be collected, 17mls before and 17 mls after injection of DDAVP 15 microgram subcutaneously. The blood samples will then be subjected for platelet function analysis.
Receives: Drug: Placebo, desmopressin
Aspirin groupActive comparatorSubjects will be given aspirin 100mg daily for 3 days. On day 4 an early morning urine sample will be collected for detection of aspirin metabolite (11-dehydro thromboxane B2). On day 6 venous blood sample will be collected, 17mls before and 17 mls after injection of DDAVP 15microgram subcutaneously. The blood samples will then be subjected for platelet function analysis.
Receives: Drug: Aspirin, desmopressin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Platelet function

    Venous blood sample will be taken from subjects before and after injection of DDAVP. Blood sample will be subjected to: (i) complete blood count, (ii) PFA-100 platelet function analyzer, (iii) fibrinogen, and (iv) vWF:Ag concentration for analysis.

    Measured: Day 6 after aspirin intake

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jun 2011 (estimated)
  2. Study startJul 2011
  3. Primary completionJul 2012
  4. Study completionSep 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01382134
Sponsor's protocol ID
UW 11-075
Status last verified
Nov 2013
First submitted
23 Jun 2011
Last updated
15 Nov 2013
Results posted
No
Data monitoring committee
Yes

Publications

  • Wolberg AS, Meng ZH, Monroe DM 3rd, Hoffman M. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma. 2004 Jun;56(6):1221-8. doi: 10.1097/01.ta.0000064328.97941.fc.

    PubMed 15211129
  • Cavallini M, Baruffaldi Preis FW, Casati A. Effects of mild hypothermia on blood coagulation in patients undergoing elective plastic surgery. Plast Reconstr Surg. 2005 Jul;116(1):316-21; discussion 322-3. doi: 10.1097/01.prs.0000170798.45679.7a.

    PubMed 15988284
  • Michelson AD, Barnard MR, Khuri SF, Rohrer MJ, MacGregor H, Valeri CR. The effects of aspirin and hypothermia on platelet function in vivo. Br J Haematol. 1999 Jan;104(1):64-8. doi: 10.1046/j.1365-2141.1999.01146.x.

    PubMed 10027713
  • Hofer CK, Worn M, Tavakoli R, Sander L, Maloigne M, Klaghofer R, Zollinger A. Influence of body core temperature on blood loss and transfusion requirements during off-pump coronary artery bypass grafting: a comparison of 3 warming systems. J Thorac Cardiovasc Surg. 2005 Apr;129(4):838-43. doi: 10.1016/j.jtcvs.2004.07.002.

    PubMed 15821652
  • Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996 Feb 3;347(8997):289-92. doi: 10.1016/s0140-6736(96)90466-3.

    PubMed 8569362
  • Winkler M, Akca O, Birkenberg B, Hetz H, Scheck T, Arkilic CF, Kabon B, Marker E, Grubl A, Czepan R, Greher M, Goll V, Gottsauner-Wolf F, Kurz A, Sessler DI. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg. 2000 Oct;91(4):978-84. doi: 10.1097/00000539-200010000-00039.

    PubMed 11004060
  • Schmied H, Schiferer A, Sessler DI, Meznik C. The effects of red-cell scavenging, hemodilution, and active warming on allogenic blood requirements in patients undergoing hip or knee arthroplasty. Anesth Analg. 1998 Feb;86(2):387-91. doi: 10.1097/00000539-199802000-00032.

    PubMed 9459254
  • Todd MM, Hindman BJ, Clarke WR, Torner JC; Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med. 2005 Jan 13;352(2):135-45. doi: 10.1056/NEJMoa040975.

    PubMed 15647576
  • Ying CL, Tsang SF, Ng KF. The potential use of desmopressin to correct hypothermia-induced impairment of primary haemostasis--an in vitro study using PFA-100. Resuscitation. 2008 Jan;76(1):129-33. doi: 10.1016/j.resuscitation.2007.07.009. Epub 2007 Aug 21.

    PubMed 17714852
  • Ng KF, Lawmin JC, Tsang SF, Tang WM, Chiu KY. Value of a single preoperative PFA-100 measurement in assessing the risk of bleeding in patients taking cyclooxygenase inhibitors and undergoing total knee replacement. Br J Anaesth. 2009 Jun;102(6):779-84. doi: 10.1093/bja/aep091. Epub 2009 May 2.

    PubMed 19411670
  • Gallinaro L, Cattini MG, Sztukowska M, Padrini R, Sartorello F, Pontara E, Bertomoro A, Daidone V, Pagnan A, Casonato A. A shorter von Willebrand factor survival in O blood group subjects explains how ABO determinants influence plasma von Willebrand factor. Blood. 2008 Apr 1;111(7):3540-5. doi: 10.1182/blood-2007-11-122945. Epub 2008 Feb 1.

    PubMed 18245665
  • Mannucci PM, Capoferri C, Canciani MT. Plasma levels of von Willebrand factor regulate ADAMTS-13, its major cleaving protease. Br J Haematol. 2004 Jul;126(2):213-8. doi: 10.1111/j.1365-2141.2004.05009.x.

    PubMed 15238142
  • Tsui PY, Cheung CW, Lee Y, Leung SW, Ng KF. The effectiveness of low-dose desmopressin in improving hypothermia-induced impairment of primary haemostasis under influence of aspirin - a randomized controlled trial. BMC Anesthesiol. 2015 May 28;15:80. doi: 10.1186/s12871-015-0061-5.

    PubMed 26017715

Questions about this trial

What is this clinical trial studying?

A study testing Aspirin, desmopressin in people with Platelet Dysfunction and Hemodilution, run by The University of Hong Kong at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 15 Nov 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Platelet function (time frame: Day 6 after aspirin intake). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01382134, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Nov 2013.

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