Preoperative Intravenous Iron to Treat Anaemia in Major Surgery

NCT ID: NCT01692418

Last Updated: 2019-06-03

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

487 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-31

Study Completion Date

2019-05-31

Brief Summary

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Anaemia is a common problem in patients undergoing surgery. About half of patients undergoing a major operation have anaemia, often a consequence of the disease requiring surgery. Anaemia causes patients to feel tired and unwell. Anaemia at the time of surgery increases the requirement for blood transfusion (50% if anaemic compared to only 15% without anaemia). Both anaemia and blood transfusions are associated with increased complications from surgery, delayed recovery and prolonged hospital stay. The investigators propose that giving intravenous iron before operation can be used to correct anaemia in these patients. Consequently if patients are not anaemic they are less likely to need blood transfusion. Also patients feel better and their health is improved before their operation they are more likely to tolerate the surgery, recover faster, be less likely to have complications from surgery and return home sooner. This will have benefits to the individual patient and also to the NHS by reducing costs.

Oral Iron tablets are not effective as they take 3-6 months to increase blood levels, the tablets are often not tolerated as cause constipation or stomach pain, overall only 30-50% of people continue taking oral iron. A full treatment dose of intravenous iron can be given in 15 minutes with minimal side effects. The effect is to rapidly increase blood counts in 2-4 weeks. The investigators propose that this treatment can be incorporated to patient preparation pathways for surgery as an outpatient without the need for additional visits to hospital.

Small studies have suggested a benefit of iron therapy in orthopaedic and gynaecological surgery. This study will look at 500 patients undergoing major surgery at 20 hospitals in the UK. The investigators anticipate half of patients treated will have their anaemia corrected before operation. Patients with anaemia will be identified as part of the routine blood tests taken preoperatively and invited to take part in the study. Following informed consent, they will be randomly allocated to receive either intravenous iron or a placebo infusion of saline. Intravenous iron is a dark liquid given continuously into a vein over 15 minutes. To ensure neither doctor nor patient knows which treatment is being given both infusions will be prepared and administered by an unblinded authorised person via a black bag through black tubing. There will be no other changes to the patient's normal treatment.

The main aim of this study is to assess if intravenous iron will reduce the need for blood transfusion in the time period around the operation. Further outcome measures will include; patient-reported quality of life, complications, length of hospital stay, and cost. Outcomes will be assessed both during hospital stay and after the patient has been discharged. The trial will be run through a Clinical Trials Unit with considerable experience in conducting large trials. The team has a large range of experience in anaemia management and assessment of complications, quality of life and the cost of health care.

The main aim of this study is to assess if intravenous iron will reduce the need for blood transfusion in the time period around the operation. Further outcome measures will include; patient-reported quality of life, complications, length of hospital stay, and cost. Outcomes will be assessed both during hospital stay and after the patient has been discharged. The trial will be run through a Clinical Trials Unit with considerable experience in conducting large trials. The team has a large range of experience in anaemia management and assessment of complications, quality of life and the cost of health care.

Detailed Description

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Conditions

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Anaemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Ferric carboxymaltose

1000mg of ferric carboxymaltose will be administered as an i.v. infusion (100ml normal saline) over a minimum of 15 minutes

Group Type EXPERIMENTAL

Ferric carboxymaltose

Intervention Type DRUG

1000mg of ferric carboxymaltose will be administered as an i.v. infusion (100ml normal saline)

Normal saline

Intervention Type DRUG

Normal saline will be administered as an i.v. infusion (100ml normal saline)

Placebo

Normal saline will be administered as an i.v. infusion (100ml normal saline) over a minimum of 15 minutes

Group Type PLACEBO_COMPARATOR

Normal saline

Intervention Type DRUG

Normal saline will be administered as an i.v. infusion (100ml normal saline)

Interventions

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Ferric carboxymaltose

1000mg of ferric carboxymaltose will be administered as an i.v. infusion (100ml normal saline)

Intervention Type DRUG

Normal saline

Normal saline will be administered as an i.v. infusion (100ml normal saline)

Intervention Type DRUG

Other Intervention Names

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Ferinject

Eligibility Criteria

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Inclusion Criteria

1. At least 18 years of age and signed written informed consent.
2. Patients undergoing elective major open abdominal surgery.

* The Indication for operation may be for benign or malignant disease.
* Major Surgery is defined as an operation of anticipated duration more than one hour.
3. Screening haemoglobin (Hb) greater than or equal to 90 g/L (9.0 g/dL) but below or equal to 120 g/L (12.0 g/dL) in women or 130 g/L (13.0 g/dL) in men within four weeks of randomisation.
4. Randomisation and administration of study infusion a minimum of 10 days and maximum 42 days before planned operation.
5. Negative pregnancy test for women of childbearing potential (within last 7 days), and agree to use effective form of contraception until 6 weeks post treatment.
6. Laboratory data used for determination of eligibility at the baseline visit must not be older than four weeks.

Exclusion Criteria

1. Patients undergoing laparoscopic surgery.
2. Body weight under 50kg.
3. Known history of acquired iron overload, or family history of haemochromatosis or thalassemia or TSAT \> 50%.
4. Known reason for anaemia (e.g. untreated B12 or folate deficiency or haemoglobinopathy).
5. Known hypersensitivity to ferric carboxymaltose (Ferinject®) or its excipients.
6. Temperature \> 37.5 degrees celsius or patient on non-prophylactic antibiotics
7. Known chronic liver disease
8. If clinically indicated for the patient to have LFT's as part of pre-assessment for surgery and this screening alanine transaminase (ALT) or aspartate transaminase (AST) is above three times the upper limit of the normal range.
9. Received erythropoietin or i.v. iron therapy in the previous 12 weeks.
10. Immunosuppressive therapy (for organ transplantation) or renal dialysis (current or planned within the next 12 months).
11. Patients with severe asthma or severe allergy (requiring hospitalisation within the last 12 months).
12. Unfit for elective surgery.
13. Pregnancy or lactation.
14. Inability to fully comprehend and/or perform study procedures in the investigator's opinion.
15. Patient involvement in another IMP trial within the previous 4 weeks, prior to randomisation. Involvement in another IMP trial, following randomisation, that may impact on the results of the PREVENTT trial.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University College, London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Toby Richards, MD FRCS

Role: PRINCIPAL_INVESTIGATOR

University College, London

Locations

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Basildon University Hospital

Basildon, , United Kingdom

Site Status

Blackpool Teaching Hospitals

Blackpool, , United Kingdom

Site Status

Southmead Hospital

Bristol, , United Kingdom

Site Status

Broomfield Hospital

Broomfield, , United Kingdom

Site Status

Countess of Chester Hospital

Chester, , United Kingdom

Site Status

Russells Hall Hospital

Dudley, , United Kingdom

Site Status

Royal Infirmary of Edinburgh

Edinburgh, , United Kingdom

Site Status

Queen Elizabeth Hospital

Gateshead, , United Kingdom

Site Status

Hereford County Hospital

Hereford, , United Kingdom

Site Status

Hillingdon Hospital

Hillingdon, , United Kingdom

Site Status

St James's Hospital

Leeds, , United Kingdom

Site Status

Aintree University Hospital

Liverpool, , United Kingdom

Site Status

Liverpool Women's Hospital

Liverpool, , United Kingdom

Site Status

University College London

London, , United Kingdom

Site Status

Guy's and St Thomas' Hospital

London, , United Kingdom

Site Status

Imperial College Hospital

London, , United Kingdom

Site Status

King's College Hospital

London, , United Kingdom

Site Status

Royal Marsden

London, , United Kingdom

Site Status

James Cook University Hospital

Middlesbrough, , United Kingdom

Site Status

Queen's Medical Centre

Nottingham, , United Kingdom

Site Status

Pennine Acute Hospitals

Oldham, , United Kingdom

Site Status

John Radcliffe Hospital

Oxford, , United Kingdom

Site Status

Peterborough and Stamford Hospitals

Peterborough, , United Kingdom

Site Status

Salford Royal

Salford, , United Kingdom

Site Status

Northern General Hospital

Sheffield, , United Kingdom

Site Status

Southampton General Hospital

Southampton, , United Kingdom

Site Status

Morriston Hospital

Swansea, , United Kingdom

Site Status

Royal Cornwall Hospital

Truro, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Richards T, Baikady RR, Clevenger B, Butcher A, Abeysiri S, Chau M, Swinson R, Collier T, Dodd M, Dyck LV, Macdougall I, Murphy G, Browne J, Bradbury A, Klein A. Preoperative intravenous iron for anaemia in elective major open abdominal surgery: the PREVENTT RCT. Health Technol Assess. 2021 Feb;25(11):1-58. doi: 10.3310/hta25110.

Reference Type DERIVED
PMID: 33632377 (View on PubMed)

Richards T, Clevenger B, Keidan J, Collier T, Klein AA, Anker SD, Kelly JD. PREVENTT: preoperative intravenous iron to treat anaemia in major surgery: study protocol for a randomised controlled trial. Trials. 2015 Jun 4;16:254. doi: 10.1186/s13063-015-0774-2.

Reference Type DERIVED
PMID: 26041028 (View on PubMed)

Related Links

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Other Identifiers

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2012-002786-35

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

10/104/06

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

12/EE/0445

Identifier Type: OTHER

Identifier Source: secondary_id

ISRCTN67322816

Identifier Type: REGISTRY

Identifier Source: secondary_id

12/0246

Identifier Type: -

Identifier Source: org_study_id

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