Stop or Ongoing Oral Anticoagulation in Patients Undergoing Pvp (SOAP)

NCT ID: NCT03297281

Last Updated: 2025-06-20

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 389 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-10-30
• Study Completion Date: 2026-05-31

Brief Summary

Benign prostatic hyperplasia (BPH) is a very common pathology of the aging man with an incidence that rises from 40% in men aged 50 to 60 years to 90% in men over 80 years. Studies such as the MTOPS (the Medical Therapy of Prostatic Symptoms) study show that more than half of the patients recruited had an aggravation of their disease over time either by an increase in symptoms or by the appearance of complications such as acute retention of urine.

For benign symptomatic prostate hypertrophy, apart from any complication, first-line treatment is now a medical treatment. For patients who respond poorly to medical treatment or who have complications related to benign prostatic hypertrophy, the treatment becomes surgical. The reference treatment is endoscopic prostate resection (TURP). It is mainly to improve the safety of hemostasis in patients older and older and at significant surgical risk that new "minimally invasive" surgical techniques have emerged. Thus, lasers have been developed and are currently used as an alternative to the TURP. Used in clinical practice since 2000, prostatic photosensitive vaporization (PVP) relies on the absorption of a 532nm (green) wavelength laser beam by the oxyhemoglobin contained in richly vascularized prostate tissue.

Given the aging of the population, more and more patients are being treated with oral anticoagulants (Anti Vitamin K (AVK) or direct oral anticoagulants (DOACs)). Today there are about 1.4 million people on oral anticoagulants, 40% of whom are over 80 years of age. The peri-operative management of the AVK is currently based on the recommendations published by the FHA (French Health Authority) in 2008. Concerning the perioperative management of DOACs, the perioperative haemostasis interest group (GIHP) made proposals updated in September 2015.

Numerous studies published in the literature have concluded the feasibility of prostate removal surgery by PVP with greenlight laser without relay (or interruption) of AVK or DOACs because of the properties of hemostasis. But the levels of evidence for these studies remain low.

No study has focused on rigorously assessing the perioperative hemorrhagic risk associated with OAC therapy in patients eligible for PVP, and this is the originality of this study.

This study is a multicenter prospective randomized study whose objective is to show that the PVP performed in patients with OAC is not associated with an increase in perioperative hemorrhagic risk.

Detailed Description

SOAP is a non-inferiority, multicentric, open-labelled, two parallel arms study.

The expected benefits are to foster and make the perioperative management of OAC safer in patients undergoing BPH surgery with PVP.

Conditions

Benign Prostatic Hyperplasia; Anticoagulant Adverse Reaction

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: NONE

Study Groups

S1: maintenance

Maintenance of OAC in surgery of BPH by PVP.

Group Type: EXPERIMENTAL

Maintenance of OAC in surgery of BPH by PVP.

Intervention Type: OTHER

The maintenance of AVK or DOACs treatment in the perioperative setting (without interruption of oral treatment).

S2 : discontinuation

Discontinuation of OAC in surgery of BPH by PVP.

Group Type: ACTIVE_COMPARATOR

Discontinuation of OAC in surgery of BPH by PVP.

Intervention Type: OTHER

The discontinuation of AVK or DOACs treatment with perioperative heparin relay during postoperative course.

Interventions

Maintenance of OAC in surgery of BPH by PVP.

The maintenance of AVK or DOACs treatment in the perioperative setting (without interruption of oral treatment).

Intervention Type: OTHER

Discontinuation of OAC in surgery of BPH by PVP.

The discontinuation of AVK or DOACs treatment with perioperative heparin relay during postoperative course.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Prostate volume < or = 30 gr
• Micturition disorders resistant to medical treatment related to HBP and/or complications related to BPH (retention, lithiasis...)
• Patient candidate for photovaporization of the prostate
• Patient under treatment AVK (Anti Vitamin K) for more than 3 months with an objective of INR (International Normalized Ratio) between 2 and 3 or patient under DOACs (Direct Oral Anti-coagulants) for more than 3 months
• Unprotected major
• Patient affiliated to a social security scheme or equivalent
• Patient is willing and able to comply with all study requirements and to sign a study-specific informed consent form.

Exclusion Criteria

• History of prostate cancer
• Previous pelvic radiotherapy
• History of stenosis of the urethra
• Patient with one or more bladder polyps
• Patient under antiplatelet agent other than aspirin
• Allergy to heparin or history of heparin-induced thrombocytopenia
• Patients under anticoagulant injectable therapy at baseline (heparin, LMWH (Low Molecular Weight Heparin), fondaparinux)
• Any mechanical prosthetic heart valve
• Stroke (ischemic or hemorrhagic), systemic embolism or transient ischemic attack within past 12 weeks
• Venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) within past 12 weeks
• Major bleeding within past 6 weeks
• Severe renal insufficiency (calculated creatinine clearance < 30 mL / min)
• Thrombocytopenia (platelet count < 100 x 10^9 / L)
• Life expectancy < 1 month
• Condition that impairs compliance with trial protocol (e.g. cognitive impairment, uncontrolled psychiatric condition, geographic inaccessibility)
• Contra-indication to PVP surgery or contra-indication to general anesthesia
• Protected patients : majors under some form of guardianship
• Patient participating in another clinical study

• Minimum Eligible Age: 18 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Boston Scientific Corporation

INDUSTRY

Sponsor Role: collaborator

Iqvia Pty Ltd

INDUSTRY

Sponsor Role: collaborator

Dr Vincent Misrai

OTHER

Sponsor Role: lead

Responsible Party

Dr Vincent Misrai

Investigator coordinator

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Vincent Misrai, Dr

Role: PRINCIPAL_INVESTIGATOR

Clinique Pasteur

Locations

Clinique Pasteur

Toulouse, , France

Site Status: RECRUITING

Countries

France

Central Contacts

Vincent Misraï, Dr

Role: CONTACT

vmisrai@clinique-pasteur.com

05 62 21 33 26

Facility Contacts

Vincent Misraï, Dr

Role: primary

vmisrai@clinique-pasteur.com

05 62 21 33 26

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Related Links

http://sfar.org/wp-content/uploads/2015/09/Reactualisation-GIHP_AOD_actes-programmes_Septembre-20151.pdf

Access the 06/03/2017.

http://www.jle.com/fr/revues/stv/e-docs/les_essais_de_non_inferiorite_292550/article.phtml

Caroline Elie, Emmanuel Touze, Non-inferiority tests, Blood thrombosis vessels 24(2), pp.93-9, 2012.

Other Identifiers

2017-A01236-47

Identifier Type: -

Identifier Source: org_study_id