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Hematologic NeoplasmsMATTERNCT03288441

Management and Outcomes of Anti-thrombotic Medication Use in Thrombocytopenia

An observational study of Hematologic Neoplasms and Thrombocytopenia, run by Maastricht University Medical Center at 21 sites in 4 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Background: Antithrombotic therapy in the context of treatment related thrombocytopenia (i.e. low levels of platelets) is not uncommon. Guidelines are based upon a paucity of retrospective data and focus on the scenario of cancer associated venous thrombosis and low molecular weight heparin treatment. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Hold, Prophylactic dose antithrombotic and Change antithrombotic Drug
Type of treatment
Medical device
How many people
300 participants
Where
21 sitesin 4 countries
Study dates
20 Mar 2018to 31 Dec 2021
How long will I take part?
6 Months
Phase
Observational
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Subjects treated at the inpatient or outpatient hematology departments at the participating centers

Who may be able to join

  • Any hematological malignancy with or without active treatment (including autologous or allogeneic stem cell transplantation), irrespective of the treatment line and disease status.
  • Disease-related and/or current/predicted treatment-related thrombocytopenia (<50 X 109/L) of any duration.
  • Current antiplatelet and/or anticoagulant treatment of any duration and for any indication. This treatment may have been started before or after diagnosis of the hematological malignancy and thrombocytopenia.
  • "Current" refers to the time when the current thrombocytopenia, or risk thereof (i.e. "predicted"), was first identified (even if the treatment is subsequently stopped)

Who cannot join

  • Previous thrombocytopenia (<50 X 109/L) while using the current antithrombotic regimen.
  • Current diagnosis of heparin induced thrombocytopenia (HIT) or thrombotic thrombocytopenia purpura (TTP)

Trial locations and contacts

21 sites in 4 countries.

Avi Leader, MD contact

+972-3-9377906

avileader@yahoo.com

Hugo ten Cate, MD, PhD contact

h.tencate@maastrichtuniversity.nl

21 sites in 4 countries

Italy11 sites, 11 recruiting
  • Azienda Ospedaliera Nazionale SS. Antonio e Biagio e C. Arrigo di Alessandria

    Alessandria, 15121

    Dr. Roberto Santi, +39 (0)131 206111, dr.rsanti@gmail.com

    Recruiting
  • A.O. Papa Giovanni XXIII - S.I.M.T.

    Bergamo, 24127

    Anna Falanga, MD, +39-035.267.8597, annafalanga@icthic.com

    Alessandro Rambaldi, MD, arambaldi@asst-pg23.it

    Recruiting
  • ASST degli Spedali Civili di Brescia

    Brescia, 25123

    Dr. Giuseppe Rossi, +39 (0)30 399 8870, giuseppe.rossi@asst-spedalicivili.it

    Recruiting
  • A.O.U. di Modena

    Modena, 41125

    Dr. Marco Marietta, +39 (0)59 422 2111, marco.marietta1@gmail.com

    Not yet recruiting
  • Ospedale San Gerardo di Monza

    Monza

    Andrea Carrer, mail.carrer@gmail.com

    Recruiting
  • University Hospital Policlinico di Palermo

    Palermo

    Sergio Siragusa, MD

    Mariasanta Napolitano, +39-91 655 1111, mariasanta.napolitano@unipa.it

    Recruiting
  • A.O.U Policlinico Umberto I di Roma

    Roma, 00161

    Dr. Antonio Chistolini, +39 06 49971, chistolini@bce.uniroma1.it

    Recruiting
  • Fondazione Policlinico Universitario A. Gemelli

    Roma, 00168

    Prof. Valerio De Stefano, +39 06 30151, valerio.destefano@unicatt.it

    Recruiting
  • Università degli studi di Roma "Tor Vergata"

    Roma

    Maria Ilaria Del Principe, Del.Principe@Med.uniroma2.it

    Recruiting
  • A.O.U. CITTA' della SALUTE e della SCIENZA di TORINO

    Torino

    Eloise Beggiato, MD, +39-11 633 1633, ebeggiato@cittadellasalute.to.it

    Recruiting
  • AZIENDA ULSS N. 8 BERICA di Vicenza

    Vicenza, 36100

    Dr. Marco Ruggeri, +39 (0)444 753111, marco.ruggeri@ulssvicenza.it

    Not yet recruiting

Other trials in Italy

Netherlands5 sites, 4 recruiting
  • Amsterdam University Medical Centers

    Amsterdam

    Harry R Büller, MD, PhD, h.r.buller@amc.uva.nl

    Eva N Hamulyák, MD, +31 20 5667516, e.n.hamulyak@amc.uva.nl

    Recruiting
  • University Medical Center Groningen

    Groningen

    Karina Meijer, MD, PhD, k.meijer@umcg.nl

    Tessa Elling, MD, +31 6 31623491, t.elling@umcg.nl

    Recruiting
  • Maastricht University Medical Center (MUMC+)

    Maastricht, 6229 HX

    Avi Leader, MD, +31-43-3874780, avileader@yahoo.com

    Recruiting
  • Erasmus Medical Center

    Rotterdam

    Mandy Lauw, MD, PhD, m.lauw@erasmusmc.nl

    Recruiting
  • HagaZiekenhuis

    The Hague, 2545 AA

    Withdrawn

Other trials in Netherlands

Israel4 sites, 4 recruiting
  • Rambam Health Care Campus

    Haifa

    Yona Nadir, MD, PhD

    Debbie Steiner, MHA, +972-4-8543592, d_steiner@rambam.health.gov.il

    Recruiting
  • Meir Medical Center

    Kfar Saba, 4428164

    Orly Avnery, MD, +972-9-7471755, avneryho@clalit.org.il

    Recruiting
  • Rabin Medical Center

    Petah Tikva

    Galia Spectre, MD, PhD, +972-3-9377906, galiasp1@clalit.org.il

    Recruiting
  • Tel Aviv Sourasky Medical Center

    Tel Aviv, 64239

    Ron Ram, MD, +972-3-697-3577, ronr@tlvmc.gov.il

    Recruiting

Other trials in Israel

United States1 site
  • Oregon Health & Science University Hospital

    Portland, Oregon, 97239

    Terminated

Other trials in United States

About this study

Official title: Management Patterns of AntiThrombotics and Outcomes in Patients With Hematological Malignancy and ThrombocytopEnia: a Prospective Registry (MATTER Study)

Background: Antithrombotic therapy in the context of treatment related thrombocytopenia (i.e. low levels of platelets) is not uncommon. Guidelines are based upon a paucity of retrospective data and focus on the scenario of cancer associated venous thrombosis and low molecular weight heparin treatment. Even less is known regarding direct oral anticoagulants, antiplatelet therapy, or anticoagulation prescribed for other indications.

Aims: The study aims are to evaluate how physicians manage anticoagulant and antiplatelet medication in patients with hematological malignancy and thrombocytopenia, and to assess the frequency of bleeding and thrombosis. Additional aims are to assess how management changes affect drug activity and blood clotting (coagulation), and to evaluate the use of platelet transfusions.

Read more

Design: The investigators plan a multinational prospective registry of patients admitted to the inpatient hematology department or outpatient clinic at one of the study centers. Patients with hematological malignancies, platelets below 50 X 109/L, and anticoagulant and/or antiplatelet medication will be studied.

Patients will be enrolled when the combination of antiplatelet/anticoagulant medication and thrombocytopenia is first detected. Patients will be followed until 30 days after the baseline study visit (which occurs 30 days after enrollment or when platelets < 50*109/L, whichever come first) or death. Patients will be indexed at the time of baseline visit.

Patients will be excluded from study analysis if one of the following events occurs before study index: Withdrawal of consent, death, clinically-relevant non-major bleeding or the composite primary outcome.

Risk factors for bleeding and thrombosis will be recorded at baseline. Parameters from routine blood tests will be recorded throughout the study. During the study major bleeding events and thrombosis will be recorded. Investigational blood tests assessing coagulation and drug activity will be drawn at baseline (=study index). Throughout the study all management decisions regarding antithrombotic therapy, including platelet and red blood cell transfusion, will be recorded. This is an observational study and management will be solely at the discretion of the physician.

Analysis: The investigators will first look at the frequency of either bleeding or thrombosis according to the type of management strategy and evaluate the platelet threshold at which a given management strategy is employed.

At the next stage, in selected subgroups, the optimal management strategy with respect to bleeding/thrombotic risk, will be determined.

Read the detailed description
  • Thrombocyte-level cohorts Patients will be divided into two groups based on the platelet level at study index .
  1. Thrombocytopenic Cohort: Patients with morning platelet count below 50*109/L at study index. This is the main study cohort for all analyses
  2. Non-thrombocytopenic Cohort: Patients whose morning platelet count is ≥ 50*109/L at study index will be considered as a reference group, and not included in the primary analysis.
  • Analysis of outcomes:

By definition, there will be an intervention at the time of study index (baseline), meaning that even if no change is made, it will be considered an intervention. Each patient may have multiple exposures/interventions over the study.

Therefore, in a time dependent analysis, each outcome will be linked to the exposure/intervention at study index.

Each exposure/intervention will be linked with the platelet level on the day of the intervention.

#Competing Events:

The following events (in addition to death) will be considered competing events and will be considered as such in the statistical analyses of the outcomes:

  1. The composite primary outcome
  2. change in the antithrombotic regimen after study index
  3. diagnosis of HIT or TTP
  4. a change in the hematological malignancy treatment regimen. Study follow-up will continue after these events, and study data will continue to be recorded until censorship for end of study period or death.
  • Detecting selection bias:

Patients fulfilling the inclusion criteria but not included in the study, will be detected by reviewing the medical records of the hematology institute, weekly. The baseline characteristics and reason for not including these patients will be recorded retrospectively in the "not-included cohort". The baseline characteristics of this cohort will be compared with the study cohort to ascertain whether selection bias exists.

Being tested
Hold, Prophylactic dose antithrombotic, Change antithrombotic Drug, Change platelet transfusion threshold, Full dose antithrombotics
Keywords
Hematologic Neoplasms, Thrombocytopenia, Anticoagulants, Platelet Aggregation Inhibitors
Medical subject headings
Hematologic Neoplasms, Thrombocytopenia

What participants receive

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

  • HoldDrug

    Hold antithrombotic therapy

  • Prophylactic dose antithromboticDrug

    Reduction in antithrombotic medication dose to prophylactic dose (without changing type)

  • Change antithrombotic DrugDrug

    Change in type of antithrombotic therapy

  • Change platelet transfusion thresholdBiological

    Increase or reduce platelet transfusion threshold

  • Full dose antithromboticsDrug

    Continue full dose antithrombotic therapy

  • Mechanical measuresDevice

    Mechanical measures to reduce thrombotic risk including: IVC filter insertion, Intermittent Pneumatic Compression (IPC), Removal of Central venous catheter

  • Intermediate dose antithromboticDrug

    Reduction in antithrombotic medication dose to prophylactic dose (without changing type). Intermediate dose in between prophylactic and full dose

Study groups in NCT03288441
Study groupRoleWhat they receive
antiplatelet onlyPatients receiving antiplatelet medication, but not anticoagulation. Antiplatelet drugs include any class, dose or duration of any platelet aggregation inhibitor. This refers to the antithrombotic regimen when the current thrombocytopenia, or risk thereof (i.e. "predicted"), was first identified (even if the treatment is subsequently stopped)
Receives: Drug: Hold; Drug: Change antithrombotic Drug; Biological: Change platelet transfusion threshold; Drug: Full dose antithrombotics
anticoagulant-basedPatients receiving only anticoagulants or both anticoagulant and antiplatelet medication combined. This includes any class, dose or duration of any antiplatelet or anticoagulant drug. This refers to the antithrombotic regimen when the current thrombocytopenia, or risk thereof (i.e. "predicted"), was first identified (even if the treatment is subsequently stopped)
Receives: Drug: Hold; Drug: Prophylactic dose antithrombotic; Drug: Change antithrombotic Drug; Biological: Change platelet transfusion threshold; Drug: Full dose antithrombotics; Device: Mechanical measures; Drug: Intermediate dose antithrombotic

What is being measured

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

  1. Composite of major bleeding or thrombosis

    1. ISTH-defined Major bleeding events defined as: Fatal bleeding; bleeding into a critical organ; clinically overt bleeding associated with a decrease in hemoglobin level of more than 2 g/dL or leading to the transfusion of two or more units of blood OR: 2) Thrombosis defined as: Any symptomatic deep or superficial venous or arterial thromboembolism demonstrated on objective imaging/laboratory tests. Ischemic strokes with no immediate imaging signs will also be considered events, provided this was diagnosed by a neurologist and that the patient had objective neurological signs.

    Measured: 30 days (from study index) or until death (whichever first)

Secondary outcomes (6)
  1. Platelet transfusion related adverse effects

    Number of adverse effects (all types and individually grouped) related to platelet/plasma transfusion, occurring within 24 hours of transfusion

    Measured: 30 days (from study index) or until death (whichever first)

  2. Clinically Relevant non-Major Bleeding

    Defined according to the ISTH criteria published in the journal of thrombosis and Hemostasis by Kaatz et al in 2015

    Measured: 30 days (from study index) or until death (whichever first)

  3. Number of platelet tranfusions

    Number of platelet transfusions

    Measured: 30 days (from study index) or until death (whichever first)

  4. Number of RBC tranfusions

    Number of red blood cell transfusions

    Measured: 30 days (from study index) or until death (whichever first)

  5. Death

    death from any cause

    Measured: 30 days (from study index)

  6. Change in antithrombotic management

    Change in dose/type of antiplatelet or anticoagulant medication OR change in platelet threshold, AFTER the initial intervention which was recorded at study index.

    Measured: 30 days (from study index) or until death (whichever first)

Timeline

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

  1. First posted20 Sep 2017
  2. Study start20 Mar 2018
  3. Primary completion31 Dec 2020 (estimated)
  4. Study completion31 Dec 2021 (estimated)

Resources

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
300 participants (estimated)
Target duration
6 Months
IDs, dates and publications
ClinicalTrials.gov ID
NCT03288441
Sponsor's protocol ID
METC 17-4-061
Acronym
MATTER
Status last verified
Sep 2020
First submitted
7 Sep 2017
Last updated
17 Sep 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

An observational study of Hematologic Neoplasms and Thrombocytopenia, run by Maastricht University Medical Center at 21 sites in 4 countries.

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 4 inclusion and 2 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: status not confirmed, as of the sponsor's last update on 17 Sep 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 21 sites in Italy, Netherlands, Israel, United States. 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?

Results are not available in the source record.

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

Contact Avi Leader, MD (+972-3-9377906, avileader@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Composite of major bleeding or thrombosis (time frame: 30 days (from study index) or until death (whichever first)). 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 17 Sep 2020.

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