Efficacy and Safety of Bivalirudin Versus Heparin During Coil Embolization in Patients With Ruptured Intracranial Aneurysms

NCT ID: NCT04532333

Last Updated: 2020-08-31

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

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

236 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-31

Study Completion Date

2021-06-30

Brief Summary

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This is a randomized, open label, multi-center, positive-controlled study, in which a total of 236 patients will be enrolled and randomly assigned to receive bivalirudin or heparin in a 1:1 ratio during coil embolization in patients with ruptured intracranial aneurysms.

Procedure-related complication, mRS, Activated Clotting Time, ischemic and hemorrhagic complications, symptomatic and asymptomatic intracranial hemorrhage, death, Heparin Induced Thrombocytopenia will be evaluated during procedure, at 24hs, 7days and 30 days after.

Detailed Description

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Endovascular embolization has become an effective modality for the treatment of intracranial aneurysms. Despite advances in technology and techniques, thromboembolic and bleeding events are still encountered as inherent perioperative complications. Hypercoagulability as a systemic response to acute subarachnoid hemorrhage (SAH) may be associated with an increased incidence of thromboembolic events.

The administration of anticoagulant may reduce thromboembolic events during the endovascular embolization, meanwhile, involves the risk of bleeding. Although heparin is commonly used during the procedure, the safety in patients with ruptured intracranial aneurysms has not been established. In contrast to heparin, bivalirudin is a short-lived direct thrombin inhibitor with an intrinsic antiplatelet activity and more stable pharmacokinetic and pharmacodynamic properties which has been associated with reduced bleeding and an overall favorable profile. Bivalirudin administration in patients with high bleeding risk during coronary intervention is recommended by current guidelines.

This is an open label, multicenter, randomized pilot study, which is aimed to investigate the safety and efficacy of bivalirudin coil embolization in patients with ruptured intracranial aneurysms.

Conditions

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Subarachnoid Hemorrhage, Aneurysmal

Keywords

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Anticoagulant Agents Aneurysm, Intracranial Berry Therapeutic Embolization Anticoagulation Agents Heparin Sodium Bivalirudin

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Bivalirudin

Bivalirudin at full dose Bivalirudin 0.75 mg/kg intravenous bolus loading dose, and immediately followed by intravenous infusion of 1.75 mg/kg/h until end of the procedure

Group Type EXPERIMENTAL

Bivalirudin 250 MG Injection

Intervention Type DRUG

Bivalirudin 0.75 mg/kg intravenous bolus loading dose, and immediately followed by intravenous infusion of 1.75 mg/kg/h until end of the procedure

Heparin

Heparin first dose at 0.6mg/kg(75U/kg) Heparin should be administered each hour, 0.6mg/kg(75U/kg) as bolus dose, 0.3mg/kg 1h later, 10mg(1250U) every hour after.

Group Type ACTIVE_COMPARATOR

Heparin

Intervention Type DRUG

Heparin should be administered each hour, 0.6mg/kg(75U/kg) as bolus dose, 0.3mg/kg 1h later, 10mg(1250U) every hour after.

Interventions

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Bivalirudin 250 MG Injection

Bivalirudin 0.75 mg/kg intravenous bolus loading dose, and immediately followed by intravenous infusion of 1.75 mg/kg/h until end of the procedure

Intervention Type DRUG

Heparin

Heparin should be administered each hour, 0.6mg/kg(75U/kg) as bolus dose, 0.3mg/kg 1h later, 10mg(1250U) every hour after.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Aged 18 to 80 years, any gender
* intracranial aneurysms ruptured in 14 days
* Diagnosed as subarachnoid hemorrhage (SAH) by CT, confirmed aneurysmal SAH by DSA
* Hunt-Hess I-III
* Patient is suitable for coil embolization
* Informed consent and availability of the subject for the entire study period and willingness of the subject to adhere to protocol requirements

Exclusion Criteria

* Nonsaccular Aneurysms (include infective, fusiform, dissecting aneurysms)
* Prior intracranial aneurysms
* Poor baseline of mRS 4-5
* Aneurysms that cannot be successfully treated by interventional treatment judged by clinician.
* Patients cannot receive antiplatelet aggregation or anticoagulant therapy
* Patients with indications for emergency craniotomy: intracranial hematoma, high intracranial pressure or hydrocephalus etc..
* Patients with AVM, intracranial artery stenosis or moyamoya disease
* Pregnancy or lactation
* Patients with severe abnormal function of main organs, liver or kidney
* Other serious diseases not suitable for this study
* Patients are currently participating in another drug-related clinical study
* Patients are allergic to heparin or bivalirudin and its excipients or hirudin
* Patients with a clear history of allergy to coil embolic material
* Patients had or may have had severe reactions to contrast media that could not complete the preoperative medication
* Patients are not suitable to participate in this clinical study judged by clinician
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The First Affiliated Hospital of Zhengzhou University

OTHER

Sponsor Role collaborator

Zhejiang University

OTHER

Sponsor Role collaborator

Wuhan University

OTHER

Sponsor Role collaborator

Qilu Hospital of Shandong University

OTHER

Sponsor Role collaborator

The First People's Hospital of Changzhou

OTHER

Sponsor Role collaborator

Changhai Hospital

OTHER

Sponsor Role lead

Responsible Party

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Jian-min Liu

Dean of Neurosurgical Department,Changhai Hospital,Shanghai,China

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jianmin Liu, M.D.

Role: PRINCIPAL_INVESTIGATOR

Neurosurgical Department of Changhai Hospital

Sheng Guan, M.D.

Role: PRINCIPAL_INVESTIGATOR

Neurointerventional Department, The First Affiliated Hospital of Zhengzhou University

Central Contacts

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Rui Zhao, Doctor

Role: CONTACT

Phone: +86-13916728169

Email: [email protected]

Qiao Zuo, Doctor

Role: CONTACT

Phone: +86-13621817430

Email: [email protected]

Other Identifiers

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CHEC2020-042

Identifier Type: -

Identifier Source: org_study_id