Standard vs High Dose of Unfractionated Heparin in the Incidence of Radial Artery Occlusion (DEFINITION) Trial.

NCT ID: NCT04561648

Last Updated: 2024-02-20

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

1988 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-01

Study Completion Date

2026-03-01

Brief Summary

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Double blind single center clinical trial to compare the incidence of radial artery occlusion (RAO) using standard doses of Unfractionated Heparin (UFH) vs. high doses of UFH.

Detailed Description

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Radial artery occlusion (RAO) is one of the most common complications in transradial artery interventions (up to 30% of cases if specific measures are not taken to prevent it) and is related to the prothrombotic state of the patient, the scarce distal flow to the access site and the trauma caused to the artery during the procedure.

Currently worldwide, the transradial (TRA) access is the most widely used access for coronary angiography (in up to 90% of the procedures) because the transradial approach is associated with lower rates of vascular complications and event mortality (compared to the femoral access).

Although TRA access is safer, it is not free of complications, being one of the most important the RAO.

There are universal efforts to reduce RAO improving every aspects of the technique, from the type of introducer to the hemostasis time to a distal TRA, with evidence suggesting that higher doses of UFH can also decrease RAO to a greater extent. The decrease in the incidence of RAO have been proposed to be up to 2.8 times with high doses of UFH (single-center, retrospective study that compared regular not standard doses of UFH versus higher doses of UFH) although no proper prospective clinical trial have been undertaken to prove this.

The standard dose that has shown a lower rate of RAO is 5000 IU, which will be compared with 100 IU / Kg of UFH, with a randomized, prospective, double-blind design, with short-term (24-hour) follow-up with Doppler ultrasound (DUS) and its correlation with plethysmography to document RAO, and in occluded arteries, there will be a 30-day follow-up to determine the recanalization (or persistent occlusion) rates by DUS (and plethysmography). In order to address safety concerns of higher UFH doses, all the potential hemorrhagic complications will be evaluated during the study follow-up time and higher hemorrhagic risk patients are going to be excluded.

Conditions

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Radial Artery Occlusion

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients that are planned to go to an invasive coronary artery angiography with good radial pulse and using the TRA are going to be randomized to two groups. One will receive the standard UFH dose and the other will receive the prespecified high dose (per Kg of body weight) of UFH.
Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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High Dose of Unfractionated Heparin

100 IU/Kg of Unfractionated Heparin

Group Type EXPERIMENTAL

Unfractionated Heparin

Intervention Type DRUG

Before removing the introducer sheath, the 2nd operator will pass the missing UFH dose to the first operator to reach 100 IU per kg of body weight in a 10 ml syringe mixed with 0.9% saline solution. The blinded first operator will administer this without knowing if it is saline or the supplemental dose of unfractionated heparin.

Standard Dose of Unfractionated Heparin

5000 IU of Unfractionated Heparin.

Group Type ACTIVE_COMPARATOR

Unfractionated Heparin

Intervention Type DRUG

Before removing the introducer sheath, the 2nd operator will pass the missing UFH dose to the first operator to reach 100 IU per kg of body weight in a 10 ml syringe mixed with 0.9% saline solution. The blinded first operator will administer this without knowing if it is saline or the supplemental dose of unfractionated heparin.

Interventions

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Unfractionated Heparin

Before removing the introducer sheath, the 2nd operator will pass the missing UFH dose to the first operator to reach 100 IU per kg of body weight in a 10 ml syringe mixed with 0.9% saline solution. The blinded first operator will administer this without knowing if it is saline or the supplemental dose of unfractionated heparin.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients over 18 years of age, both genders.
* Successful transradial acess for an elective diagnostic coronary angiography.

Exclusion Criteria

* Weight \<50 Kg
* Puncture of the ipsilateral radial artery in the last month.
* Still ongoing effect of pre-procedural recently used oral anticoagulants.
* Use of enoxaparin in the past in the last 12 hours prior to the procedure.
* Use of unfractionated heparin in the last 6 hours prior the procedure
* Alterations in coagulation or platelets prone to bleeding or thrombotic complications.
* Anatomical alterations at the radial access site or radial artery.
* Arteriovenous fistula in the ipsilateral arm.
* History of major bleeding associated with the use of UFH.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto Nacional de Cardiologia Ignacio Chavez

OTHER

Sponsor Role lead

Responsible Party

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Julio Ivan Farjat Pasos

Co-Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Guering Eid Lidt, M.D.

Role: STUDY_DIRECTOR

Instituto Nacional de Cardiología Ignacio Chávez

Julio I Farjat Pasos, M.D.

Role: PRINCIPAL_INVESTIGATOR

Instituto Nacional de Cardiología Ignacio Chávez

Carlos Aguila Bravo, M.D.

Role: PRINCIPAL_INVESTIGATOR

Instituto Nacional de Cardiología Ignacio Chávez

Monserrat Villalobos Pedroza, M.D.

Role: PRINCIPAL_INVESTIGATOR

Instituto Nacional de Cardiología Ignacio Chávez

Locations

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Instituto Nacional de Cardiología Ignacio Chávez

Mexico City, Tlalpan, Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Monserrat Villalobos Pedroza, M.D.

Role: CONTACT

55 5573 2911 ext. 21217

Guering Eid Lidt, M.D.

Role: CONTACT

55 5573 2911 ext. 21217

Facility Contacts

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Monserrat Villalobos, M.D.

Role: primary

55 5573 2911 ext. 21217

Guering Edit Lid, M.D.

Role: backup

55 5573 2911 ext. 21217

Other Identifiers

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INCAR-DG-DI-205-2020

Identifier Type: -

Identifier Source: org_study_id

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