Coronary Artery DiseaseNCT01574105
Heparin Dose and Post Operative Bleeding in Cardiopulmonary Bypass Patients
An observational study of Coronary Artery Disease, run by University of Saskatchewan at 2 sites in Canada.
Trial summary
Blood is anticoagulated using a drug named heparin during open-heart surgery to allow it to safely pass through the heart-lung machine which pumps the blood throughout the body during the surgery. Each patient is given the heparin they need for their surgery. Read more about this study
- Who is it for?
- Ages 40 to 85 yearsHealthy volunteers can take part
- Conditions the study is for
- Coronary Artery Disease
- How many people
- 66 participants
- Where
- 2 sitesCanada
- Study dates
- May 2012to Jan 2013
- Phase
- Observational
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
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 40 to 85 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: On the date of surgery, the patient would be brought to the operating room. The first blood sample would be drawn prior to heparinization. This would include analysis for Activated Clotting Time, Heparin Concentration/Heparin Dose Response, antithrombin and Thrombelastograph. During this first sampling interval, the patient's Heparin Sensitivity or Resistance is determined by Heparin Dose Response (slope). The following values would determine which one of the two study groups the patient would be assigned: * Sensitive to heparin: at or above 90 seconds/unit/millilitre * Resistant to heparin: below 89 seconds/unit/millilitre
Who may be able to join
- Patients scheduled for elective or urgent CABG of two to six vessels.
Who cannot join
- Preoperative:
- Hemoglobin of less than 110grams/Litre
- Under 18 years of age
- Mass less than 75 kilograms
- Presence of an intra-aortic balloon pump
- Emergency surgery, requiring operative intervention within 24 hours of consultation to the cardiac surgery team
Show all 18Show fewer
- Need for cardiac surgical intervention in addition to planned CABG (with the exception of patent foramen ovale closure)
- Ejection fraction of less than 50%, as determined by echocardiogram or angiography
- Pulmonary hypertension with pulmonary artery pressures greater than 60mmHg
- Presence of infectious endocarditis
- Hepatic failure with impaired liver function, including INR greater than 1.5 Known diagnosed bleeding disorder
- History of heparin induced thrombocytopenia and thrombosis
- Renal failure with pre-operative creatinine greater than 200ml/min or oliguria with urine output less than 10millilitres/hour
- Allergy to tranexamic acid
- Pregnancy
- Intraoperative:
- Discovery of infectious endocarditis
- Need for cardiac surgical intervention in addition to planned coronary CABG
Trial locations and contacts
2 sites in 1 country.
Canada2 sites
Royal University Hospital
Saskatoon, Saskatchewan, S7N 0W8
Royal University Hospital
Saskatoon, Saskatchewan, S7S 1E1
About this study
Blood is anticoagulated using a drug named heparin during open-heart surgery to allow it to safely pass through the heart-lung machine which pumps the blood throughout the body during the surgery. Each patient is given the heparin they need for their surgery. This means some patients receive more or less heparin than other patients. In this study, the investigators will be evaluating the current anticoagulation protocol for open heart surgery in use at the Royal University Hospital. The goal of this project is to compare patients who require and receive more heparin for proper anticoagulation to those patients who require and receive less heparin.
Open-heart surgery will proceed according to the standard hospital protocol. All research participants will be treated according to standard post-open heart surgery protocol in the ICU. This will include measurement of blood loss by keeping track of chest tube outputs and administration of blood transfusions.
This study focuses on Saskatoon Health Region patients having open heart surgery in terms of the protocol for anticoagulation and blood transfusions.
Read the detailed description
This study examines heparin doses of patients having cardiopulmonary bypass supported surgery in terms of their sensitivity and resistance to heparin which is the standard anticoagulant used. The investigators use the Heparin Management System, an analyser that performs a heparin dose response test. In this test, a patient's whole blood is mixed with increasing amounts of heparin to determine the required dose to achieve a set level of anticoagulation. Patients who are found to resistant to heparin and needing a higher dose are thought by some to bleed more post operatively. It is my view that when the patient is given the correct amount of heparin which is then reversed by the correct amount of protamine (the reversal agent) the bleeding is not determined by heparin dose.
Hypothesis statement: Higher doses of heparin do not cause increased postoperative bleeding and transfusion events in the postoperative CPB patient.
Purposes of the Study
- Compare heparin sensitive and resistant patients in terms of postoperative bleeding and transfusion events.
- Determine the incidence of heparin sensitivity or resistance in patients.
- Identify preoperative factors that lead to heparin resistance or sensitivity in patients.
- Using the Heparin Dose Response test in determining heparin resistant and sensitive patients.
- Examination of anticoagulation protocol for open-heart surgery.
- Effect of preoperative antiplatelet and anticoagulant therapy on perioperative care.
- Use routine laboratory tests and values as well as common clinically available values in the conduct of the study so that results would be clinically relevant.
This is a prospective observational study. Patients will be divided into two groups dependant upon the results of their heparin dose response test; sensitive or resistant. Two groups of thirty will be selected to achieve 90% power at the 0.025 level of significance using a one-sided two-sample t-test.
The primary investigator will collect all data and submit the means to the statistician. Based on anecdotal experience the investigators expect there will be no difference between the two groups in terms of chest tube losses and transfusion events post-operatively.
This work is quite relevant to the investigators daily practice. Every open heart patient is anticoagulated with heparin and bleeds post operatively. The investigators goal is a reproducibly safe anticoagulation level and an acceptable level of chest tube losses. This translates to getting patients out of the operating room in a timely fashion and minimizing transfusion events.
- Conditions
- Coronary Artery Disease
- Keywords
- Heparin Dose, Heparin Resistance, Chest Tube Losses, Transfusion Events
- Medical subject headings
- Coronary Artery Disease
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Heparin Resistant | Patient whose slope calculated by a heparin dose response test is 89 sec/iu/ml or less. | |
| Heparin Sensitive | Patient whose slope calculated by a heparin dose response test is 90 sec/iu/ml or more. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Chest Tube Losses
Chest tube losses will be measured in millilitres upon arrival in the Intensive Care unit (ICU) after six hours in the ICU and total chest tube losses during the ICU stay. Chest tube losses are the amount of blood collected in a graduated chest tube collection reservoir from chest tubes placed in the patient's chest wound at the end of surgery.
Measured: Chest tube losses are recorded from departure from operating room to chest tube removal in the ICU (normally less than 24 hrs)
Secondary outcomes (1)
Transfusion Events
Transfusion events to recorded will be the number of patients receiving units of red blood cells, units of platelets, units of plasma and units of cryoprecipitate.
Measured: Data collection begins with patient arrival in the operating room and ends with discharge from the ICU (normally less than 24hrs)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Apr 2012 (estimated)
- Study startMay 2012
- Primary completionJan 2013
- Study completionJan 2013
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Coronary Artery DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 66 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Saskatchewan
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mark Rosin, University of Saskatchewan
- Investigators
- Mark W Rosin, MPS, Principal investigator, Saskatoon Health Region
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01574105
- Sponsor's protocol ID
- 12-37
- Status last verified
- Jul 2014
- First submitted
- 6 Mar 2012
- Last updated
- 8 Jul 2014
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 8 Jul 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Heparin Dose and Post Operative Bleeding in Cardiopulmonary Bypass Patients
- ClinicalTrials.gov ID
- NCT01574105
- Acronym / sponsor ID
- 12-37
- Conditions
- Coronary Artery Disease
- Keywords
- Heparin Dose, Heparin Resistance, Chest Tube Losses, Transfusion Events
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 66 participants (actual)
- Lead sponsor
- University of SaskatchewanUniversity, hospital or other
- Study start
- May 2012
- Primary completion
- Jan 2013 (actual)
- Study completion
- Jan 2013 (actual)
- First posted
- 10 Apr 2012 (estimated)
- Results
- Posted 8 Jul 2014
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Blood is anticoagulated using a drug named heparin during open-heart surgery to allow it to safely pass through the heart-lung machine which pumps the blood throughout the body during the surgery. Each patient is given the heparin they need for their surgery. This means some patients receive more or less heparin than other patients. In this study, the investigators will be evaluating the current anticoagulation protocol for open heart surgery in use at the Royal University Hospital. The goal of this project is to compare patients who require and receive more heparin for proper anticoagulation to those patients who require and receive less heparin.
Open-heart surgery will proceed according to the standard hospital protocol. All research participants will be treated according to standard post-open heart surgery protocol in the ICU. This will include measurement of blood loss by keeping track of chest tube outputs and administration of blood transfusions.
This study focuses on Saskatoon Health Region patients having open heart surgery in terms of the protocol for anticoagulation and blood transfusions.
Detailed description
This study examines heparin doses of patients having cardiopulmonary bypass supported surgery in terms of their sensitivity and resistance to heparin which is the standard anticoagulant used. The investigators use the Heparin Management System, an analyser that performs a heparin dose response test. In this test, a patient's whole blood is mixed with increasing amounts of heparin to determine the required dose to achieve a set level of anticoagulation. Patients who are found to resistant to heparin and needing a higher dose are thought by some to bleed more post operatively. It is my view that when the patient is given the correct amount of heparin which is then reversed by the correct amount of protamine (the reversal agent) the bleeding is not determined by heparin dose.
Hypothesis statement: Higher doses of heparin do not cause increased postoperative bleeding and transfusion events in the postoperative CPB patient.
Purposes of the Study
- Compare heparin sensitive and resistant patients in terms of postoperative bleeding and transfusion events.
- Determine the incidence of heparin sensitivity or resistance in patients.
- Identify preoperative factors that lead to heparin resistance or sensitivity in patients.
- Using the Heparin Dose Response test in determining heparin resistant and sensitive patients.
- Examination of anticoagulation protocol for open-heart surgery.
- Effect of preoperative antiplatelet and anticoagulant therapy on perioperative care.
- Use routine laboratory tests and values as well as common clinically available values in the conduct of the study so that results would be clinically relevant.
This is a prospective observational study. Patients will be divided into two groups dependant upon the results of their heparin dose response test; sensitive or resistant. Two groups of thirty will be selected to achieve 90% power at the 0.025 level of significance using a one-sided two-sample t-test.
The primary investigator will collect all data and submit the means to the statistician. Based on anecdotal experience the investigators expect there will be no difference between the two groups in terms of chest tube losses and transfusion events post-operatively.
This work is quite relevant to the investigators daily practice. Every open heart patient is anticoagulated with heparin and bleeds post operatively. The investigators goal is a reproducibly safe anticoagulation level and an acceptable level of chest tube losses. This translates to getting patients out of the operating room in a timely fashion and minimizing transfusion events.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Heparin Resistant | – | –Patient whose slope calculated by a heparin dose response test is 89 sec/iu/ml or less. |
| Heparin Sensitive | – | –Patient whose slope calculated by a heparin dose response test is 90 sec/iu/ml or more. |
Who may qualify
- Ages
- 40 to 85 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- On the date of surgery, the patient would be brought to the operating room. The first blood sample would be drawn prior to heparinization. This would include analysis for Activated Clotting Time, Heparin Concentration/Heparin Dose Response, antithrombin and Thrombelastograph. During this first sampling interval, the patient's Heparin Sensitivity or Resistance is determined by Heparin Dose Response (slope). The following values would determine which one of the two study groups the patient would be assigned: * Sensitive to heparin: at or above 90 seconds/unit/millilitre * Resistant to heparin: below 89 seconds/unit/millilitre
Key inclusion criteria (1 listed)
- Patients scheduled for elective or urgent CABG of two to six vessels.
Key exclusion criteria (18 listed)
- Preoperative:
- Hemoglobin of less than 110grams/Litre
- Under 18 years of age
- Mass less than 75 kilograms
- Presence of an intra-aortic balloon pump
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Chest Tube Losses
Time frame: Chest tube losses are recorded from departure from operating room to chest tube removal in the ICU (normally less than 24 hrs)
Chest tube losses will be measured in millilitres upon arrival in the Intensive Care unit (ICU) after six hours in the ICU and total chest tube losses during the ICU stay. Chest tube losses are the amount of blood collected in a graduated chest tube collection reservoir from chest tubes placed in the patient's chest wound at the end of surgery.
1 secondary outcome
Transfusion Events
Time frame: Data collection begins with patient arrival in the operating room and ends with discharge from the ICU (normally less than 24hrs)
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jul 2014.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mark W Rosin, MPS principal investigator
Saskatoon Health Region
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Coronary Artery Disease, run by University of Saskatchewan at 2 sites in Canada.
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 18 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 8 Jul 2014. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Canada. 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. 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?
Yes. Results are posted in the registry (first posted 8 Jul 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
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?
Chest Tube Losses (time frame: Chest tube losses are recorded from departure from operating room to chest tube removal in the ICU (normally less than 24 hrs)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 8 Jul 2014.