Botulinum Toxin A for Treatment of Catocholamine Induced Finger Necrosis

NCT ID: NCT01500668

Last Updated: 2012-01-05

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-01-31

Study Completion Date

2013-12-31

Brief Summary

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Patients in the intensive care unit (ICU) often require blood pressure support of vasoactive drugs such as amines. Finger necrosis (so called "blue toe syndrome") is a well documented phenomena with incidence reaching as high as 60% in patients receiving vasopressin. Botulinum toxin is a known muscle relaxant used for a variety of medical application. Recently, several reports have demonstrated its effect in vasospastic disorders. It has also been in mice that when administered locally it has a local vasodilatory effect. The goal of this experiment is to compare the effect of Botulinum Toxin administered locally on amine induced finger necrosis.

Detailed Description

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Conditions

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Catocholamine Induced Finger Necrosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Treatment

Injection of 200 units of Botulinum Toxin A (BOTOX) to a treated limb. Each limb will be divided to two levels - arterial arch and digital arteries (near MCP/MTP) levels. In each level 100 units of Botox will be injected in 6 injection points in the proximity of the arteries.

Group Type ACTIVE_COMPARATOR

Botox

Intervention Type DRUG

Injection of 200 units of Botulinum Toxin A (BOTOX) to a treated limb. Each limb will be divided to two levels - arterial arch and digital arteries (near MCP/MTP) levels. In each level 100 units of Botox will be injected in 6 injection points in the proximity of the arteries.

Control

Injection of 0.5cc of normal saline (0.9% NaCl) to each injection site as in the Active drug arm.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Injection of 0.5cc of normal saline (0.9% NaCl) to each injection site as in the Active drug arm.

Interventions

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Botox

Injection of 200 units of Botulinum Toxin A (BOTOX) to a treated limb. Each limb will be divided to two levels - arterial arch and digital arteries (near MCP/MTP) levels. In each level 100 units of Botox will be injected in 6 injection points in the proximity of the arteries.

Intervention Type DRUG

Placebo

Injection of 0.5cc of normal saline (0.9% NaCl) to each injection site as in the Active drug arm.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients treated with vasoactive drugs (amines) and have finger/toe necrosis

Exclusion Criteria

* Sensitivity to drug (Botox) ingredients.
* Active local limb infection
* ICU admission due to botulism
* Chronic muscular weakness disease, e.g., Myasthenia gravis, ALS
* Age lower than 18
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sheba Medical Center

OTHER_GOV

Sponsor Role lead

Responsible Party

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Dr. Amir Herman

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Amir Herman, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Sheba Medical Center

Locations

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Sheba Medical Center

Tel Litwinsky, , Israel

Site Status RECRUITING

Countries

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Israel

Central Contacts

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Amir Herman, MD, PhD

Role: CONTACT

972-52-2655026

Facility Contacts

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Amir Herman, MD, PhD

Role: primary

972-52-2655026

References

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Dunser MW, Mayr AJ, Tur A, Pajk W, Barbara F, Knotzer H, Ulmer H, Hasibeder WR. Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med. 2003 May;31(5):1394-8. doi: 10.1097/01.CCM.0000059722.94182.79.

Reference Type BACKGROUND
PMID: 12771608 (View on PubMed)

Fregene A, Ditmars D, Siddiqui A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud's phenomenon. J Hand Surg Am. 2009 Mar;34(3):446-52. doi: 10.1016/j.jhsa.2008.11.026.

Reference Type BACKGROUND
PMID: 19258141 (View on PubMed)

Golbranson FL, Lurie L, Vance RM, Vandell RF. Multiple extremity amputations in hypotensive patients treated with dopamine. JAMA. 1980 Mar 21;243(11):1145-6.

Reference Type BACKGROUND
PMID: 7359665 (View on PubMed)

Van Beek AL, Lim PK, Gear AJL, Pritzker MR. Management of vasospastic disorders with botulinum toxin A. Plast Reconstr Surg. 2007 Jan;119(1):217-226. doi: 10.1097/01.prs.0000244860.00674.57.

Reference Type BACKGROUND
PMID: 17255677 (View on PubMed)

Janz BA, Thomas PR, Fanua SP, Dunn RE, Wilgis EF, Means KR Jr. Prevention of anastomotic thrombosis by botulinum toxin B after acute injury in a rat model. J Hand Surg Am. 2011 Oct;36(10):1585-91. doi: 10.1016/j.jhsa.2011.07.008. Epub 2011 Aug 19.

Reference Type BACKGROUND
PMID: 21855233 (View on PubMed)

Clemens MW, Higgins JP, Wilgis EFS. Prevention of anastomotic thrombosis by botulinum toxin a in an animal model. Plast Reconstr Surg. 2009 Jan;123(1):64-70. doi: 10.1097/PRS.0b013e3181904c31.

Reference Type BACKGROUND
PMID: 19116537 (View on PubMed)

Other Identifiers

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9023-11-SMC

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

SHEBA-11-9023-AH-CTIL

Identifier Type: -

Identifier Source: org_study_id

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