Fibrin Clot Properties and Blood Loss Following Coronary Artery By-pass Grafting

NCT ID: NCT03622671

Last Updated: 2020-02-12

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

Clinical Phase

NA

Total Enrollment

62 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-26

Study Completion Date

2020-02-10

Brief Summary

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Up to 15% of operations in cardio-pulmonary by-pass are complicated by excessive postoperative blood loss, which negatively affects the outcomes. Recently, it has been demonstrated that fibrin clot susceptibility to lysis is a modulator of postoperative blood loss after cardiac surgery for aortic stenosis. Earlier, a preliminary study showed a negative association of postoperative blood loss after coronary artery by-pass grafting (CABG) with fibrin clot lysis time, reflecting susceptibility to fibrinolysis.

In CABG, postoperative blood loss may depend on the operative technique with respect to left internal mammary artery (LIMA) harvesting. LIMA is taken down in virtually all CABG procedures, but harvesting technical details remain at surgeons discretion (skeletonization without opening the pleural cavity vs. pedicled graft with pleura wide open).

The investigators decided to test the hypothesis that fibrin clot properties modulate the postoperative drainage following CABG strongly enough to attenuate the influence of surgical technique by randomizing the patients undergoing CABG with regard to LIMA harvesting technique.

Detailed Description

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Conditions

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Coronary Artery Disease Internal Mammary-Coronary Artery Anastomosis Coronary Artery Bypass Blood Loss, Postoperative Fibrinolysis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized clinical trial with parallel group design. Equal allocation.
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Participants Outcome Assessors
The patient will be blinded to LIMA harvesting technique. The laboratory technicians will be blinded to LIMA harvesting technique.

Study Groups

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Skeletonized LIMA

In patients in this arm the left internal mammary artery will be skeletonized without opening of the left pleural cavity during CABG.

Group Type ACTIVE_COMPARATOR

Skeletonized LIMA

Intervention Type PROCEDURE

Standard CABG - no different form any other procedure of this type except LIMA will be skeletonized without opening the pleura

Pedicled LIMA

In patients in this arm the left internal mammary artery will be harvested as a pedicled graft with wide opening of left pleural cavity.

Group Type ACTIVE_COMPARATOR

Pedicled LIMA

Intervention Type PROCEDURE

Standard CABG - no different form any other procedure of this type except LIMA will be taken down as a pedicled graft with opening the pleura

Interventions

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Skeletonized LIMA

Standard CABG - no different form any other procedure of this type except LIMA will be skeletonized without opening the pleura

Intervention Type PROCEDURE

Pedicled LIMA

Standard CABG - no different form any other procedure of this type except LIMA will be taken down as a pedicled graft with opening the pleura

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Angiographically confirmed coronary artery disease
* Heart Team qualification for first time elective coronary artery by-pass grafting
* No significant valvular disease or congenital heart disease
* Normal sinus rhythm on ECG
* Continued aspirin in perioperative period

Exclusion Criteria

* Need for any concomitant cardiac procedure
* St. p. percutaneous coronary intervention within preceding 3 months
* Any previous cardiac surgery
* Known bleeding diathesis
* Acute cardiovascular incident within preceding 3 months
* Heart failure with left ventricular ejection fraction \<30%
* Any autoimmune disease
* Any acute infection
* Known neoplasm
* Any thyroid disease
* Treatment with any thienopyridine, oral anticoagulant, heparin or any non-steroid anti-inflammatory agent other than aspirin
* Mental disorder
* Severe comorbidities (liver failure, renal failure on hemodialysis)
* Lacking consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jagiellonian University

OTHER

Sponsor Role lead

Responsible Party

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Piotr Mazur

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Piotr Mazur, MD

Role: PRINCIPAL_INVESTIGATOR

Jagiellonian University

Locations

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The John Paul II Hospital

Krakow, Lesser Poland Voivodeship, Poland

Site Status

Countries

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Poland

Other Identifiers

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K/ZDS/007961

Identifier Type: -

Identifier Source: org_study_id

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