A Study Comparing a New Dosing Regimen of Clot-dissolving Drug for Mechanical Heart Valves Which Show Clots

NCT ID: NCT00232622

Last Updated: 2013-10-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-11-30

Study Completion Date

2007-03-31

Brief Summary

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The optimal dosage and duration of administration of clot-dissolving medications for the treatment of patients with mechanical heart valves with clots is not known. We hypothesized that a large dose of the clot-dissolving medicine given initially (akin to the dose given in the treatment of heart attacks), might speed up the dissolution of the clot and rapidly restore the functioning of the mechanical heart valve.

Detailed Description

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The optimal fibrinolytic strategy for left sided prosthetic valve thrombosis (PVT) is not known. A large initial bolus dose of streptokinase (SK) might accelerate fibrinolysis and restore valve function more rapidly.

This is a prospective, randomized trial comparing 2 fibrinolytic protocols in a first episode of PVT. In the rapid fibrinolytic protocol (RFP) 1.5 MU of SK is given over 1 hour, followed if required by a 0.1 MU/h infusion. In the standard protocol (SP) 0.25 MU is given over 30 minutes, followed by an infusion of 0.1 MU/h. Serial echocardiography and fluoroscopy will be done to monitor therapy. The primary end point is the occurrence of a complete clinical response (CCR, complete hemodynamic response without any major complication). 58 patients are required in each arm for detecting a 30% difference with 80% power at α=0.05.

Conditions

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Prosthetic Valve Thrombosis

Keywords

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Prosthetic valve thrombosis Fibrinolysis Streptokinase

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard infusion of streptokinase

Standard infusion of streptokinase

Group Type ACTIVE_COMPARATOR

Streptokinase

Intervention Type DRUG

Standard dose streptokinase

Accelerated infusion of streptokinase

Accelerated infusion of streptokinase

Group Type EXPERIMENTAL

Streptokinase

Intervention Type DRUG

Accelerated infusion of streptokinase

Interventions

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Streptokinase

Accelerated infusion of streptokinase

Intervention Type DRUG

Streptokinase

Standard dose streptokinase

Intervention Type DRUG

Other Intervention Names

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Fibrinolytic therapy Fibrinolytic therapy

Eligibility Criteria

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Inclusion Criteria

* First episode of left sided prosthetic valve thrombosis

Exclusion Criteria

* Contraindication to thrombolysis
* Refusal to give informed consent
* Pregnant women
* age less than 12 years or more than 70 years
* previous treatment for prosthetic valve thrombosis
Minimum Eligible Age

12 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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All India Institute of Medical Sciences

OTHER

Sponsor Role lead

Responsible Party

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Dr Ganesan Karthikeyan

Additional Professor of Cardiology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ganesan Karthikeyan, MD, DM

Role: PRINCIPAL_INVESTIGATOR

Department of Cardiology, All India Institute of Medical Sciences

Countries

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India

References

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Karthikeyan G, Math RS, Mathew N, Shankar B, Kalaivani M, Singh S, Bahl VK, Hirsh J, Eikelboom JW. Accelerated infusion of streptokinase for the treatment of left-sided prosthetic valve thrombosis: a randomized controlled trial. Circulation. 2009 Sep 22;120(12):1108-14. doi: 10.1161/CIRCULATIONAHA.109.876706. Epub 2009 Sep 8.

Reference Type RESULT
PMID: 19738134 (View on PubMed)

Karthikeyan G, Mathew N, Math RS, Devasenapathy N, Kothari SS, Bahl VK. Timing of adverse events during fibrinolytic therapy with streptokinase for left-sided prosthetic valve thrombosis. J Thromb Thrombolysis. 2011 Aug;32(2):146-9. doi: 10.1007/s11239-011-0579-4.

Reference Type RESULT
PMID: 21416132 (View on PubMed)

Barwad P, Raheja A, Venkat R, Kothari SS, Bahl V, Karthikeyan G. High prevalence of silent brain infarction in patients presenting with mechanical heart valve thrombosis. Am J Cardiovasc Drugs. 2012 Oct 1;12(5):345-8. doi: 10.1007/BF03261843.

Reference Type DERIVED
PMID: 22779430 (View on PubMed)

Other Identifiers

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A-29/3.3.2004

Identifier Type: -

Identifier Source: org_study_id