FFP Versus PCC in Intracranial Hemorrhage

NCT ID: NCT02429453

Last Updated: 2016-11-16

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

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-30

Study Completion Date

2016-03-31

Brief Summary

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The goal of this study will be to determine whether PCC confers any benefits over FFP in traumatic and spontaneous intracranial hemorrhage with respect to multiple factors including time to correction, absolute international normalized ratio correction amount, cost, need for surgical intervention, and radiographic bleed expansion through a prospective, randomized control trial.

Detailed Description

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Vitamin K antagonists in general and Coumadin in particular remains the most common form of outpatient anticoagulation in patients today. Despite the therapeutic benefits of these agents, bleeding in general and intracranial bleeding in particular are significant risks associated with these medications. Intracranial bleeding on oral anticoagulation agents are associated with a 20% increase in 30 day mortality versus non-anticoagulated controls, and rapid reversal of vitamin K antagonists in this population has been shown to have survival benefits.

Historically, vitamin K antagonists have been reversed using fresh frozen plasma (FFP) transfusions which, though effective, often incur delays due to the time required to obtain a type \& screen, thaw the product, and administer the product to the patient. In 2013, the FDA approved 4-factor prothrombin complex (PCC), a concentrate of factors II, VII, IX, X, protein C and protein S for use as a method for correcting vitamin K antagonist related coagulopathy. Though large, prospective randomized control trials have demonstrated efficacy and safety in a general population of all-comers bleeding, there is very little literature regarding the benefits of PCC versus FFP in the traumatic and spontaneous intracranial hemorrhage population.

Current standard of care in patients with traumatic and spontaneous intracranial hemorrhage who are on vitamin K antagonists is to reverse the effect of these agents with FFP or PCC. The choice of which agent to use is currently determined by both availability of each agent and surgeon preference. For this study, there will be an equal likelihood of either treatment being given.

The goal of this study will be to determine whether PCC confers any benefits over FFP in traumatic and spontaneous intracranial hemorrhage with respect to multiple factors including time to correction, absolute international normalized ratio correction amount, cost, need for surgical intervention, and radiographic bleed expansion through a prospective, randomized control trial.

Conditions

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Intracranial Hemorrhage, Traumatic Intracranial Hemorrhage, Spontaneous

Keywords

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Warfarin Traumatic intracranial hemorrhage prothrombin complex concentrate fresh frozen plasma Spontaneous intracranial hemorrhage

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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Fresh Frozen Plasma

Administration of a single dose of fresh frozen plasma based on INR per the following regimen: 2U for INR of 2-2.5; 3U for INR of 2.5-3; 4U for INR of 3-3.5; 5U for INR of 3.5-4; 6U for INR of 4+

Group Type ACTIVE_COMPARATOR

Fresh Frozen Plasma

Intervention Type BIOLOGICAL

A pooled collection of plasma from donors

Four Factor Prothrombin Complex Concentrate

Administration of a single dose of four factor prothrombin complex concentrate per the following dosing regimen: 25 U/kg for INR of 2-4; 35 U/kg for INR of 4-6; 50 U/kg for INR of 6+; maximum dosing weight of 100kg, patients may be dispensed +/- 10% of ordered dose

Group Type EXPERIMENTAL

Four Factor Prothrombin Complex Concentrate

Intervention Type DRUG

A purified, non-activated prothrombin complex concentrate containing factors II, VII, IX and X and proteins C \& S

Interventions

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Four Factor Prothrombin Complex Concentrate

A purified, non-activated prothrombin complex concentrate containing factors II, VII, IX and X and proteins C \& S

Intervention Type DRUG

Fresh Frozen Plasma

A pooled collection of plasma from donors

Intervention Type BIOLOGICAL

Other Intervention Names

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Kcentra

Eligibility Criteria

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Inclusion Criteria

* Coumadin use
* INR of 2.0 or higher on arrival at the study center
* Evidence on cranial imaging of spontaneous intracranial hemorrhage, subdural hematoma, epidural hematoma, cerebral contusion, traumatic subarachnoid hemorrhage, or traumatic intraparenchymal hemorrhage

Exclusion Criteria

* Unable to obtain consent
* Estimated survival \<24 hours
* Hypersensitivity to 4 factor prothrombin complex concentrate
* Concomitant use of novel vitamin K antagonists
* Religious/social prohibition to receiving blood products
* Need for emergent, non-neurosurgical operative intervention
* Mechanical heart valves
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Utah

OTHER

Sponsor Role lead

Responsible Party

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Jian Guan

Neurosurgery Resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of Utah Medical Center

Salt Lake City, Utah, United States

Site Status

Countries

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United States

References

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Eilertsen H, Menon CS, Law ZK, Chen C, Bath PM, Steiner T, Desborough MJ, Sandset EC, Sprigg N, Al-Shahi Salman R. Haemostatic therapies for stroke due to acute, spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev. 2023 Oct 23;10(10):CD005951. doi: 10.1002/14651858.CD005951.pub5.

Reference Type DERIVED
PMID: 37870112 (View on PubMed)

Other Identifiers

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IRB_00078143

Identifier Type: -

Identifier Source: org_study_id