Thrombin Generation and Platelet Activation in CRS/HIPEC

NCT ID: NCT03034850

Last Updated: 2017-01-27

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

Total Enrollment

27 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-04-30

Study Completion Date

2016-07-31

Brief Summary

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Cytoreductive surgery (CRS) with hyperthermic intraperitoneal peroperative chemotherapy (HIPEC), indicated for patients with peritoneal metastases from digestive or gynecological malignancies alike, demonstrates a considerable impact on hemostatic metabolism, both on platelet and on coagulation level. The potential hemostatic interference in CRS and HIPEC is phase dependent. This study demonstrates the combined use of ROTEM (rotational thromboelastometry), PACT (platelet activation test) and CAT (thrombin generation test) assays during CRS and HIPEC with a follow-up of 7 days postoperative.

Detailed Description

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The purpose of this study was to quantitatively assess the impact of CRS and HIPEC, on various components of hemostasis. Routine laboratory assays such as activated clotting time, activated partial thromboplastin time, prothrombin time, or platelet count might, as demonstrated previously, insufficiently provide specificity and/or sensitivity to assess coagulation and platelet disorders. Therefore, additionally thrombin generation (TG) was analyzed by the calibrated automated thrombogram assay (CAT). Also, platelet function was quantitatively assessed by the PAC-t-UB assay and rotational thromboelastometry (ROTEM) was used to elucidate the contribution of platelets, intrinsic and extrinsic coagulation pathways in peri-operative bleeding. The hypothesis of this study was that the procedure exposed an increased thrombotic risk, resulting in a faster and increased TG and hyper platelet function?

Conditions

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Mesothelioma; Peritoneum Pseudomyxoma Peritonei Peritoneal Carcinomatosis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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CRS/HIPEC

Patients with a confirmed histological diagnosis of peritoneal disease treated by cytoreductive surgery (CRS) with hyperthermic intraperitoneal peroperative chemotherapy (HIPEC).

CRS/HIPEC

Intervention Type PROCEDURE

The generic surgical approach involved peritonectomy procedures and visceral resections called CRS as described by Sugarbaker (1995). Peritoneal disease burden was assessed using the perito- neal cancer index (PCI), which scores 13 intra-abdominal sites on a scale of 0 (no disease) to 3 (lesion size \> 5 cm), thus giving a range of possible scores from 0 to 39. The same team performed the surgical procedure of all included patients. Before connection to the patient, the circuit was filled with dextrose 5% (2 L/m2 body surface area) and warmed to 37°C.

Interventions

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CRS/HIPEC

The generic surgical approach involved peritonectomy procedures and visceral resections called CRS as described by Sugarbaker (1995). Peritoneal disease burden was assessed using the perito- neal cancer index (PCI), which scores 13 intra-abdominal sites on a scale of 0 (no disease) to 3 (lesion size \> 5 cm), thus giving a range of possible scores from 0 to 39. The same team performed the surgical procedure of all included patients. Before connection to the patient, the circuit was filled with dextrose 5% (2 L/m2 body surface area) and warmed to 37°C.

Intervention Type PROCEDURE

Other Intervention Names

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oxaliplatinum 5-fluorouracil folinic acid cisplatinum doxorubicin ifosfamide

Eligibility Criteria

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Inclusion Criteria

* a confirmed histological diagnosis of peritoneal disease (e.g., mesothelioma; pseudomyxoma peritonei; colorectal, ovarian, or gastric peritoneal carcinomatosis of colorectal, ovarian, or gastric cancer origin; or abdominal sarcomatosis); and
* age \<80 years; and
* a cardiac, renal, hepatic, and bone marrow function compatible with surgery; and
* informed written consent to participate in the study

Exclusion Criteria

* inherited coagulation abnormalities,
* active systemic infections,
* interstitial lung disease,
* serious cardiac dysrhythmia or condition, New York Heart Association classification of III or IV, congestive cardiac failure, uncontrolled hypertension (diastolic blood pressure constantly \>100 mm Hg, systolic blood pressure constantly \> 180 mm Hg).
* inadequate bone marrow function at the beginning of the trial, defined as platelet count less than \<150 GPT/L or neutrophil granulocyte count less than \<1.5 GPT/L.
* inadequate renal function at the beginning of the trial, defined as GFR less than \<60 ml/min,
* inadequate liver function at the beginning of the trial, defined as bilirubin \>1.5 times ULN (upper limit of normal), active hepatitis B or C infection,
* female patients who are pregnant or breast feeding
* participation in another therapeutic clinical trial.
Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ziekenhuis Oost-Limburg

OTHER

Sponsor Role lead

Responsible Party

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Sven Van Poucke

Medical Doctor, Anesthesiologist, Emergency Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sven Van Poucke, MD

Role: PRINCIPAL_INVESTIGATOR

Ziekenhuis Oost-Limburg

References

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Study Documents

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Document Type: Study Protocol

View Document

Document Type: Advice Ethical Committee

View Document

Related Links

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http://www.cancercenter.com/treatments/hipec/

Hyperthermic intraperitoneal chemotherapy

Other Identifiers

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B37120154199

Identifier Type: -

Identifier Source: org_study_id

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