Risk Factor Control Before Orthopedic Surgery

NCT ID: NCT01837069

Last Updated: 2020-07-27

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE4

Total Enrollment

198 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-02-28

Study Completion Date

2018-04-02

Brief Summary

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This trial is designed to determine the best preoperative management strategy for patients undergoing orthopedic surgery.

Detailed Description

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OPTIMIZE - OS (Optimization of Pre-surgical Testing with an Intensive Multifactorial Intervention to MinimiZe Cardiovascular Events - Orthopedic Surgery) trial is to determine the best management strategy for patients undergoing orthopedic surgery. OPTIMIZE will be a prospective randomized trial that will enroll patients during pre-surgical testing before orthopedic surgery. This trial will investigate different strategies aimed at lowering cardiovascular events following orthopedic surgery. The study will compare an intensive multifactorial intervention comprising behavioral modification and polypharmacologic therapy aimed at several modifiable risk factors versus usual care. The trial hypothesis is that a personalized optimization approach is superior to usual care in reducing a composite of death, myocardial infarction, stroke, transient ischemic attack, myocardial necrosis, venous thromboembolism or thrombosis requiring reoperation at 30-days. Secondary endpoints include length of stay, major bleeding, each individual endpoint from the primary endpoint, and quality of life.

Conditions

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Osteoarthritis Cardiovascular Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Treatment

Lifestyle counseling (nutrition, physical activity, medication compliance and smoking cessation) Atorvastatin 80mg PO QD Metoprolol 25mg PO BID if HR is elevated Lisinopril 2.5 mg PO QD if SBP is elevated

Group Type ACTIVE_COMPARATOR

Metoprolol

Intervention Type DRUG

25mg PO BID if the HR is elevated at preadmission testing

Lisinopril

Intervention Type DRUG

2.5mg PO QD if the HR is elevated at preadmission testing

Atorvastatin

Intervention Type DRUG

80mg PO QD at preadmission testing

Lifestyle counseling

Intervention Type BEHAVIORAL

Diet, exercise, medication adherance and smoking counseling

Control

Standard of care

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Metoprolol

25mg PO BID if the HR is elevated at preadmission testing

Intervention Type DRUG

Lisinopril

2.5mg PO QD if the HR is elevated at preadmission testing

Intervention Type DRUG

Atorvastatin

80mg PO QD at preadmission testing

Intervention Type DRUG

Lifestyle counseling

Diet, exercise, medication adherance and smoking counseling

Intervention Type BEHAVIORAL

Other Intervention Names

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Beta blocker ACE inhibitor Statin

Eligibility Criteria

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Inclusion Criteria

* • ≥ 21 years of age

* Subjects undergoing open orthopedic surgery of the hip, knee or spine
* Surgery is scheduled at least 3 days after PAT visit and no more than 14 days.
* High risk subject cohort

* Coronary artery disease, or
* Cerebrovascular disease (prior stroke, TIA or carotid artery disease (\>70% stenosis), or
* Peripheral artery disease, or
* Prior Venous thromboembolism or arterial thromboembolism, or
* Age ≥ 60 years and 2 of the following
* Renal insufficiency (creatinine clearance \< 60ml/min)
* Diabetes
* COPD
* Hypertension
* Active smoker or stopped less than 30 days prior to consent
* Cancer (excluding BCC)
* Heart Failure

Exclusion Criteria

* • Known intolerance to statins

* Subject is already on maximum dose statin (atorvastatin/Lipitor 80mg daily or rosuvastatin/crestor 40mg daily)
* Bilateral renal artery stenosis
* End stage renal disease (receiving dialysis or CrCl \<30ml/min)
* Known allergy or intolerance to ACE-inhibitor (other than cough) or Angiotensin receptor blocker (e.g. angioedema, hyperkalemia)
* Known allergy or intolerance to beta blockers
* Known sick sinus syndrome not treated with permanent pacemaker
* Known greater than first degree AV block not treated with a pacemaker
* Excessive alcohol intake
* Acute Coronary Syndrome requiring hospitalization within 1 month
* Stroke within 1 month
* Known pregnancy
* Severe co-morbid condition with life expectancy \< 6 months
* Inability to give informed consent or adhere to follow-up as per protocol
* Current participation in another investigational drug or device trial
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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NYU Langone Health

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jeffrey Berger, MD

Role: PRINCIPAL_INVESTIGATOR

NYU School of Medicine

Locations

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NYU Hospital for Joint Diseases

New York, New York, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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12-02407

Identifier Type: -

Identifier Source: org_study_id

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