Relationship Between Level of Hemoglobin A1c and Platelet Function in Patients Undergoing Cardiac Surgery

NCT ID: NCT02711124

Last Updated: 2016-03-22

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

Total Enrollment

130 participants

Study Classification

OBSERVATIONAL

Study Start Date

2014-02-28

Study Completion Date

2016-08-31

Brief Summary

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The aim of this study is to evaluate whether increased level of hemoglobin A1c (HbA1c) correlates to higher level of platelet reactivity assessed by impedance aggregometry in patients with diabetes mellitus undergoing elective coronary artery bypass grafting (CABG).

Detailed Description

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This study will be conducted at Cardiac Surgery Department, University Hospital Center Zagreb. It will be conducted in prospective observational fashion. Diabetic patients undergoing isolated, primary on-pump CABG will be consecutively recruited. Patients requiring urgent procedure will be excluded. Blood samples, both for conventional lab. findings (including HbA1c) and impedance aggregometry will be drawn prior to surgery and postoperatively on daily basis.

Cohort sample will be divided into two subgroups according to HbA1c level (Group 1 with HbA1c \< 7% and Group 2 with HbA1c ≥ 7%, respectively). Respective subgroups will be compared for basic demographic data, laboratory findings including those obtained using platelet function testing, and for clinical outcomes, respectively.

Multiple-electrode aggregometry:

Whole blood aggregation will be determined using a new-generation impedance aggregometer (Multiplate analyzer; Roche Diagnostics). In brief, when platelets expose receptors on their surface they get activated and stick on the Multiplate sensor wires enhancing the electrical resistance between them. An increase in impedance is expressed in arbitrary area under the curve (AUC) units. Platelet aggregation is determined in response to stimulation with arachidonic acid (ASPI (aspirin-sensitive patients identification) test designed to evaluate the effect to acetylsalicylic acid (ASA)) and adenosine diphosphate (ADP) (ADP test designed to evaluate the effect of thienopyridines, such as clopidogrel).

Conditions

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Diabetes Mellitus Complication of Coronary Artery Bypass Graft Blood Platelet Disorders

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Group with hemoglobin A1c < 7

There will be no intervention administered to the group. The group will be observed for platelet function pre- and postoperatively.

No interventions assigned to this group

Group with hemoglobin A1c ≥ 7%

There will be no intervention administered to the group. The group will be observed for platelet function pre- and postoperatively.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing isolated primary on-pump CABG
* Elective surgery
* Diabetic patients including insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus NIDDM
* Patients on antiplatelet therapy (aspirin and/or clopidogrel) pre- and postoperatively

Exclusion Criteria

* Missing consent
* Patients with cardiac surgical procedures other than isolated CABG
* Patients on antiplatelet therapy other than aspirin or clopidogrel
* Urgent surgery
* Off-pump CABG
* Redo CABG
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Clinical Hospital Centre Zagreb

OTHER

Sponsor Role lead

Responsible Party

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Martina Zrno Mihaljević, MD

Principal Investigator, Surgeon at the Department of cardiac surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Martina Zrno Mihaljević

Role: PRINCIPAL_INVESTIGATOR

Bojan Biočina

Role: STUDY_CHAIR

Mate Petričević

Role: STUDY_DIRECTOR

Locations

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The University Hospital Centre Zagreb, Department of cardiac surgery

Zagreb, , Croatia

Site Status RECRUITING

Countries

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Croatia

Central Contacts

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Martina Zrno Mihaljević

Role: CONTACT

00385 1 2367 529

Mate Petričević

Role: CONTACT

00385 1 2367 529

Facility Contacts

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Martina Zrno Mihaljević

Role: primary

00385 1 2367 529

Mate Petričević

Role: backup

00385 1 2367 529

References

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Thourani VH, Weintraub WS, Stein B, Gebhart SS, Craver JM, Jones EL, Guyton RA. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg. 1999 Apr;67(4):1045-52. doi: 10.1016/s0003-4975(99)00143-5.

Reference Type BACKGROUND
PMID: 10320249 (View on PubMed)

Woods SE, Smith JM, Sohail S, Sarah A, Engle A. The influence of type 2 diabetes mellitus in patients undergoing coronary artery bypass graft surgery: an 8-year prospective cohort study. Chest. 2004 Dec;126(6):1789-95. doi: 10.1378/chest.126.6.1789.

Reference Type BACKGROUND
PMID: 15596675 (View on PubMed)

Lazar HL, Chipkin SR, Fitzgerald CA, Bao Y, Cabral H, Apstein CS. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004 Mar 30;109(12):1497-502. doi: 10.1161/01.CIR.0000121747.71054.79. Epub 2004 Mar 8.

Reference Type BACKGROUND
PMID: 15006999 (View on PubMed)

Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, Floten HS, Starr A. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003 May;125(5):1007-21. doi: 10.1067/mtc.2003.181.

Reference Type BACKGROUND
PMID: 12771873 (View on PubMed)

Halkos ME, Puskas JD, Lattouf OM, Kilgo P, Kerendi F, Song HK, Guyton RA, Thourani VH. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008 Sep;136(3):631-40. doi: 10.1016/j.jtcvs.2008.02.091.

Reference Type BACKGROUND
PMID: 18805264 (View on PubMed)

Kempfert J, Anger K, Rastan A, Krabbes S, Lehmann S, Garbade J, Sauer M, Walther T, Dhein S, Mohr FW. Postoperative development of aspirin resistance following coronary artery bypass. Eur J Clin Invest. 2009 Sep;39(9):769-74. doi: 10.1111/j.1365-2362.2009.02175.x.

Reference Type BACKGROUND
PMID: 19674078 (View on PubMed)

Petricevic M, Biocina B, Konosic S, Burcar I, Siric F, Mihaljevic MZ, Ivancan V, Svetina L, Gasparovic H. Definition of acetylsalicylic acid resistance using whole blood impedance aggregometry in patients undergoing coronary artery surgery. Coll Antropol. 2013 Sep;37(3):833-9.

Reference Type BACKGROUND
PMID: 24308225 (View on PubMed)

Petricevic M, Biocina B, Konosic S, Kopjar T, Kunac N, Gasparovic H. Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy. Heart Vessels. 2013 Jan;28(1):57-65. doi: 10.1007/s00380-011-0216-3. Epub 2011 Dec 28.

Reference Type BACKGROUND
PMID: 22203409 (View on PubMed)

Other Identifiers

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KBC Zagreb

Identifier Type: -

Identifier Source: org_study_id

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