PREVENTion of Clot in Orthopaedic Trauma

NCT ID: NCT02984384

Last Updated: 2024-05-14

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

12424 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-04-24

Study Completion Date

2022-02-18

Brief Summary

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The purpose of this study is to compare aspirin versus low-molecular weight heparin (LMWH) (Enoxaparin) as a thromboprophylaxis in patients who sustain a fracture.

Detailed Description

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Patients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients. However, emerging literature in total joint arthroplasty patients suggests the potential clinical benefits of VTE prophylaxis with aspirin. This trial aims to determine if aspirin is non-inferior to LMWH for thromboprophylaxis in fracture patients.

Conditions

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Blood Clot Trauma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Low Molecular Weight Heparin (LMWH)-Enoxaparin

Injection of 30 mg enoxaparin, twice a day via injection

Group Type ACTIVE_COMPARATOR

Low Molecular Weight Heparin (LMWH)

Intervention Type DRUG

The LMWH intervention will be 30 mg enoxaparin subcutaneous (under the skin) twice a day with variations in dosing allowed, per the standard of care at sites, as needed for patients who are very obese or exhibit renal dysfunction.

Acetylsalicylic acid (ASA)-Aspirin

Enteral ingestion or administration of 81 mg ASA, twice a day

Group Type ACTIVE_COMPARATOR

Acetylsalicylic acid

Intervention Type DRUG

The Aspirin intervention will be 81 mg enteral (by mouth, feeding tube or rectal) twice a day with no variation in dosing allowed.

Interventions

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Acetylsalicylic acid

The Aspirin intervention will be 81 mg enteral (by mouth, feeding tube or rectal) twice a day with no variation in dosing allowed.

Intervention Type DRUG

Low Molecular Weight Heparin (LMWH)

The LMWH intervention will be 30 mg enoxaparin subcutaneous (under the skin) twice a day with variations in dosing allowed, per the standard of care at sites, as needed for patients who are very obese or exhibit renal dysfunction.

Intervention Type DRUG

Other Intervention Names

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Aspirin Enoxaparin

Eligibility Criteria

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Inclusion Criteria

* Patients who have a planned operative or non-operative pelvis or acetabular fracture, or any operative extremity fracture proximal to the metatarsals or carpals.
* Patients at increased risk of blood clot(s) from their orthopaedic injury(ies) and will receive prophylactic blood thinner regimen per standard of care.
* Patients 18 years or older.

Exclusion Criteria

* Patients who present to the hospital more than 48 hours post injury
* Patients who received more than 2 doses of LMWH or aspirin for initial VTE prophylaxis
* Patients on long term blood thinners (other than low-dose aspirin or platelet inhibitors such as Plavix or Aggrenox)
* Patients who have had a VTE within the last 6 months
* Patients on therapeutic (as opposed to prophylactic) blood thinners for an acute issue at the time of admission
* Patients who have a newly diagnosed indication for therapeutic blood thinners (for example vascular injury) that will require therapeutic anticoagulation for more than one week
* Patients who cannot receive either of the study medications due to an allergy (history of heparin induced thrombocytopenia, allergy to aspirin, or NSAIDs) or other medical contraindication to blood thinners
* Patients who are on higher dose aspirin (\>81 mg once a day or higher) for medical reasons or who will be treated with higher dose aspirin
* Patients with underlying chronic clotting disorders (i.e. Factor V Leiden, hyperhomocysteinemia, Protein C and S deficiency) that require full dose anticoagulation or are a contraindication to venous thromboembolism chemoprophylaxis
* Patients with end stage renal disease or impaired creatinine clearance \<30 ml/min at time of randomization(note: creatinine clearance does not need to be documented if prescribing physician would order medication without test as SOC)
* Pregnant or lactating patients
* Prisoners
* Patients who do not speak either English or Spanish
* Patients who are likely to have severe problems maintaining follow-up
* Patients, based upon the clinical judgment of the treating clinician, NOT equally suited for treatment with either aspirin or low-molecular-weight heparin
* Patients may be excluded for other reasons at the discretion of the treating physician; the reason for exclusion must be documented on the screening form
* Patients who have a known COVID-19 diagnosis prior to fracture treatment or within 3 months of the index fracture
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

Major Extremity Trauma Research Consortium

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Robert O'Toole, MD

Role: PRINCIPAL_INVESTIGATOR

University of Maryland

Renan Castillo, PhD

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins Bloomberg School of Public Health

Tara Taylor, MPH

Role: STUDY_DIRECTOR

Johns Hopkins Bloomberg School of Public Health

Katherine Frey, PhD, MPH, RN

Role: STUDY_DIRECTOR

Johns Hopkins Bloomberg School of Public Health

Locations

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University of Arizona

Tucson, Arizona, United States

Site Status

University of Miami Ryder Trauma Center

Miami, Florida, United States

Site Status

Methodist Hospital

Indianapolis, Indiana, United States

Site Status

University of Maryland R Adams Cowley Shock Trauma Center

Baltimore, Maryland, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

University of Mississippi Medical Center

Jackson, Mississippi, United States

Site Status

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire, United States

Site Status

Carolinas Medical Center

Charlotte, North Carolina, United States

Site Status

Wake Forest University Baptist Medical Center

Winston-Salem, North Carolina, United States

Site Status

MetroHealth Medical Center

Cleveland, Ohio, United States

Site Status

Allegheny General Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Rhode Island Hospital, Brown University

Providence, Rhode Island, United States

Site Status

University of Tennessee, RegionOne Medical Center

Memphis, Tennessee, United States

Site Status

Vanderbilt Medical Center

Nashville, Tennessee, United States

Site Status

University of Texas Health Science Center at Houston

Houston, Texas, United States

Site Status

San Antonio Military Medical Center

San Antonio, Texas, United States

Site Status

Inova Fairfax Hospital

Falls Church, Virginia, United States

Site Status

Harborview Medical Center

Seattle, Washington, United States

Site Status

University of Wisconsin

Madison, Wisconsin, United States

Site Status

University of Calgary, Foothills Medical Centre

Calgary, Alberta, Canada

Site Status

McMaster University, Hamilton General Hospital

Hamilton, Ontario, Canada

Site Status

Countries

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United States Canada

References

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O'Toole RV, Stein DM, Frey KP, O'Hara NN, Scharfstein DO, Slobogean GP, Taylor TJ, Haac BE, Carlini AR, Manson TT, Sudini K, Mullins CD, Wegener ST, Firoozabadi R, Haut ER, Bosse MJ, Seymour RB, Holden MB, Gitajn IL, Goldhaber SZ, Eastman AL, Jurkovich GJ, Vallier HA, Gary JL, Kleweno CP, Cuschieri J, Marvel D, Castillo RC; METRC. PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients. BMJ Open. 2021 Mar 24;11(3):e041845. doi: 10.1136/bmjopen-2020-041845.

Reference Type BACKGROUND
PMID: 33762229 (View on PubMed)

Major Extremity Trauma Research Consortium (METRC); O'Toole RV, Stein DM, O'Hara NN, Frey KP, Taylor TJ, Scharfstein DO, Carlini AR, Sudini K, Degani Y, Slobogean GP, Haut ER, Obremskey W, Firoozabadi R, Bosse MJ, Goldhaber SZ, Marvel D, Castillo RC. Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture. N Engl J Med. 2023 Jan 19;388(3):203-213. doi: 10.1056/NEJMoa2205973.

Reference Type DERIVED
PMID: 36652352 (View on PubMed)

O'Hara NN, Degani Y, Marvel D, Wells D, Mullins CD, Wegener S, Frey K, Joseph T, Hurst J, Castillo R, O'Toole RV; PREVENT CLOT Stakeholder Committee. Which orthopaedic trauma patients are likely to refuse to participate in a clinical trial? A latent class analysis. BMJ Open. 2019 Oct 11;9(10):e032631. doi: 10.1136/bmjopen-2019-032631.

Reference Type DERIVED
PMID: 31604788 (View on PubMed)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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PCS-1511-32745

Identifier Type: -

Identifier Source: org_study_id

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