Swedish Multicenter Trial of Outpatient Prevention of Leg Clots

NCT ID: NCT03259204

Last Updated: 2024-03-07

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-01

Study Completion Date

2025-12-31

Brief Summary

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Lower limb immobilization is associated with high risk of complications, i.e. venous thromboembolism (VTE) and failed healing. Pharmacoprophylaxis of VTE is in leg-immobilized patients, however, low- or non-effective and associated with adverse events. Thus, there is a need for novel treatments.

This study aims to demonstrate in leg immobilized patients who have suffered an ankle fracture (1000 patients) or an Achilles tendon rupture (400 patients) that adjuvant intermittent pneumatic compression (IPC) therapy, which targets impaired vascular flow, compared to treatment-as-usual with plaster cast, reduces VTE incidence and improves healing.

Detailed Description

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The proposed intervention, intermittent pneumatic compression (IPC) is an evidence-based prevention for VTE in hospitalized patients and used in daily practice. IPC is, however, not currently used on outpatients and it is currently unknown if it reduces the risk of VTE during long term leg-immobilization. Plaster cast and orthosis treatments are currently used in daily practice on Achilles tendon ruptures and ankle fractures. At present there is no consensus about using VTE prophylaxis in leg-immobilized patients. Since pharmacoprophylaxis has shown low- or no VTE preventive effects in leg-immobilization, is not recommended by some guidelines.

Furthermore, since all patients will undergo clinical examinations and have DVT-screening performed with compression Doppler ultrasound (CDU) removal of leg immobilization this will comprise an extra security for the included patients to detect a VTE. If a VTE is detected clinical guidelines will be followed by initiating chemical VTE-treatment.

Conditions

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Achilles Tendon Rupture Ankle Fractures Venous Thromboembolism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Caregivers Outcome Assessors

Study Groups

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Leg Immobilization

Routine care include that the lower limb will be immobilized in an orthosis or a below-knee plaster cast according to local routines.

Group Type NO_INTERVENTION

No interventions assigned to this group

Adjuvant IPC

Leg Immobilization with the addition of IPC. Patients will during lower limb immobilization receive bilateral calf IPC.

Group Type EXPERIMENTAL

Adjuvant IPC

Intervention Type DEVICE

This IPC-system delivers sequential circumferential compression. The IPC device is mobile and should therefore not restrict patient mobilization, but can be taken off if the patient wants to mobilize independently.

Interventions

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Adjuvant IPC

This IPC-system delivers sequential circumferential compression. The IPC device is mobile and should therefore not restrict patient mobilization, but can be taken off if the patient wants to mobilize independently.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Acute unilateral Achilles tendon rupture or isolated Ankle Fracture
* Treatment starts within 10 days in a hospital setting

Exclusion Criteria

* Inability or refusal to give informed consent for participation in the study
* Inability to comply with the study instructions
* Known kidney disorder
* Heart failure with pitting oedema
* Presence of known malignancy
* Current bleeding disorder
* Pregnancy
* Planned follow-up at another hospital
* Pilon fracture
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sahlgrenska University Hospital

OTHER

Sponsor Role collaborator

Danderyd Hospital

OTHER

Sponsor Role collaborator

Stockholm South General Hospital

OTHER

Sponsor Role collaborator

Uppsala University Hospital

OTHER

Sponsor Role collaborator

Gävle Hospital

OTHER

Sponsor Role collaborator

Höglandssjukhuset Eksjö

UNKNOWN

Sponsor Role collaborator

Norrtälje Hospital

UNKNOWN

Sponsor Role collaborator

Östersund Hospital

UNKNOWN

Sponsor Role collaborator

Helsingborgs Hospital

OTHER

Sponsor Role collaborator

Uddevalla Hospital

UNKNOWN

Sponsor Role collaborator

Norra Älvsborgs Länssjukhus

UNKNOWN

Sponsor Role collaborator

Istituto Ortopedico Rizzoli

OTHER

Sponsor Role collaborator

Lugano Regional Hospital

UNKNOWN

Sponsor Role collaborator

Alingsås Lasarett

UNKNOWN

Sponsor Role collaborator

University Hospital, Akershus

OTHER

Sponsor Role collaborator

Karolinska University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Paul Ackermann

Professor, MD, PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Paul W Ackermann, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Karolinska University Hospital, 171 76 Stockholm, SWEDEN

Locations

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Karolinska University Hospital

Stockholm, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Luigi Belcastro, RN

Role: CONTACT

+46724641144

Simon Svedman, MD

Role: CONTACT

Facility Contacts

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Simon Svedman, MD

Role: primary

Luigi Belcastro, RN

Role: backup

+46724641144

References

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Arverud ED, Anundsson P, Hardell E, Barreng G, Edman G, Latifi A, Labruto F, Ackermann PW. Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture. Bone Joint J. 2016 Dec;98-B(12):1635-1641. doi: 10.1302/0301-620X.98B12.BJJ-2016-0008.R1.

Reference Type BACKGROUND
PMID: 27909125 (View on PubMed)

Domeij-Arverud E, Ackermann PW. Deep Venous Thrombosis and Tendon Healing. Adv Exp Med Biol. 2016;920:221-8. doi: 10.1007/978-3-319-33943-6_21.

Reference Type BACKGROUND
PMID: 27535264 (View on PubMed)

Domeij-Arverud E, Labruto F, Latifi A, Nilsson G, Edman G, Ackermann PW. Intermittent pneumatic compression reduces the risk of deep vein thrombosis during post-operative lower limb immobilisation: a prospective randomised trial of acute ruptures of the Achilles tendon. Bone Joint J. 2015 May;97-B(5):675-80. doi: 10.1302/0301-620X.97B5.34581.

Reference Type BACKGROUND
PMID: 25922463 (View on PubMed)

Abdul Alim M, Domeij-Arverud E, Nilsson G, Edman G, Ackermann PW. Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis. Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2021-2029. doi: 10.1007/s00167-017-4621-8. Epub 2017 Jul 1.

Reference Type BACKGROUND
PMID: 28668970 (View on PubMed)

Svedman S, Alkner B, Berg HE, Domeij-Arverud E, Jonsson K, Nilsson Helander K, Ackermann PW. STOP leg clots-Swedish multicentre trial of outpatient prevention of leg clots: study protocol for a randomised controlled trial on the efficacy of intermittent pneumatic compression on venous thromboembolism in lower leg immobilised patients. BMJ Open. 2021 May 20;11(5):e044103. doi: 10.1136/bmjopen-2020-044103.

Reference Type DERIVED
PMID: 34016662 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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Other Identifiers

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2017-00202

Identifier Type: -

Identifier Source: org_study_id

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