Thoracentesis to Alleviate Cardiac Pleural Effusion

NCT ID: NCT05017753

Last Updated: 2024-12-13

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

135 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-08-31

Study Completion Date

2024-12-11

Brief Summary

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The present study will examine the comparative effectiveness of two treatment strategies currently used in the treatment of patients with systolic heart failure presenting with pleural effusion. Patients will be randomized to standard medical treatment only or medical treatment and referral to thoracentesis.

Study hypothesis: A strategy of referring patients with heart failure-related pleural effusion to thoracentesis increases number of days alive outside of hospital over the following 90 days.

Detailed Description

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Purpose and Rationale: Pleural effusion is a common presentation in patients with heart failure, and the condition is related to a poor prognosis and increased mortality. Therapeutic options consist of intensification of diuretic treatment and invasive drainage of the effusion (thoracentesis). Thoracentesis is a common medical procedure and is often performed on patients with heart failure presenting with a pleural effusion, but there is no randomized evidence to guide the use of thoracentesis in heart failure-related pleural effusion. International guidelines provide no recommendations. Some Danish hospitals use thoracentesis frequently, some rarely. Hence, there is true clinical equipoise and a strong need to assess whether thoracentesis benefits patients or not.

Study Hypothesis: A strategy of referring patients with heart failure-related pleural effusion to thoracentesis increases number of days alive outside of hospital over the following 90 days.

Study Setting:126 adult patients admitted with systolic heart failure and pleural effusion documented by either chest x- ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) will be randomized 1:1 to medical treatment only or medical treatment and referral to thoracentesis. Thoracentesis will be performed according to local practice. Randomization will be stratified according to whether patients are treated with oral anticoagulation.

Crossover/rescue thoracentesis: For patients in the medical treatment arm whose condition deteriorates to the degree that the participant fulfill any of the study exclusion criteria (eg. increased need of oxygen), thoracentesis may be performed immediately. Some patients randomized to medical treatment only may prove to be too diuretic resistant to achieve an adequate effect of medical treatment alone. The recommended waiting period before performing thoracentesis on a patient in the control group is 5 days from randomization.

Patients may be discharged at the discretion of the treating physician. The follow up period is planned to 90 days.

Conditions

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Heart Failure Pleural Effusion

Keywords

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Heart failure Systolic heart failure Pleural effusion Thoracentesis Thoracocentesis Pleurocentesis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The trial is a pragmatic controlled, randomized, multicenter open label trial with including patients admitted with pleural effusion related to systolic heart failure. Patients will be randomized 1:1 to standard-of-care medical treatment only or standard-of-care medical treatment and referral to thoracentesis. Randomization will be stratified according to whether patients are treated with oral anticoagulation.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control group

Standard-of-care medical treatment.

Group Type ACTIVE_COMPARATOR

Standard-of-care medical treatment

Intervention Type DRUG

Standard-of-care medical treatment

Intervention group

Thoracentesis in addition to standard-of-care medical treatment.

Group Type EXPERIMENTAL

Thoracentesis

Intervention Type PROCEDURE

Thoracentesis will be performed according to local practice, either at the ward or at the radiology department, in addition to standard-of-care medical treatment.

Interventions

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Thoracentesis

Thoracentesis will be performed according to local practice, either at the ward or at the radiology department, in addition to standard-of-care medical treatment.

Intervention Type PROCEDURE

Standard-of-care medical treatment

Standard-of-care medical treatment

Intervention Type DRUG

Other Intervention Names

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Thoracocentesis Pleurocentesis

Eligibility Criteria

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Inclusion Criteria

* Left ventricular ejection fraction (LVEF) ≤ 45%
* Non- negligible pleural effusion by x-ray, ultrasound, CT or MRI, suspected to be due to heart failure
* Age ≥ 18 years

Exclusion Criteria

* Clinically indicated diagnostic thoracentesis (e.g. suspected malignant aetiology)
* Suspected pulmonary or pleural infection (pneumonia symptoms with c- reactive protein\>100 mg/L or white blood count\>11)
* Recent (\<3 months) intrathoracic procedure (including heart or lung surgery, transcatheter aortic valve implantation (TAVI) or thoracentesis)
* Contraindications to thoracentesis according to local guidelines (such as spontaneously elevated international normalized ratio (INR) or thrombocytopenia), patients on oral anticoagulation may be randomized.
* Severe aortic stenosis
* Massive pleural effusion (equivalent to \>2/3 of lung on a standing chest x-ray)
* Substantially affected hemodynamics (systolic blood pressure \< 85mmHg, need of inotropes) or high oxygen demand (\>7L/min)
* Estimated glomerular filtration rate (eGFR) \<15ml/min/1.73m2 or dialysis treatment
* Planned or expected admission \> 10 days for other condition than heart failure
* Inability to give informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Independent Research Fund Denmark

INDUSTRY

Sponsor Role collaborator

Hartmann Fonden

OTHER

Sponsor Role collaborator

University Hospital Bispebjerg and Frederiksberg

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role lead

Responsible Party

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Jens Jakob Thune

Clinical Research Associate Professor, Consultant Cardiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University Hospital Aalborg

Aalborg, , Denmark

Site Status

University Hospital Aarhus

Aarhus, , Denmark

Site Status

University Hospital Bispebjerg and Frederiksberg

Copenhagen, , Denmark

Site Status

University Hospital Rigshospitalet

Copenhagen, , Denmark

Site Status

University Hospital Rigshospitalet, Glostrup

Glostrup Municipality, , Denmark

Site Status

University Hospital Herlev/Gentofte

Herlev, , Denmark

Site Status

University Hospital Nordsjaelland

Hillerød, , Denmark

Site Status

University Hospital Hvidovre

Hvidovre, , Denmark

Site Status

University Hospital Odense

Odense, , Denmark

Site Status

University Hospital Zealand, Roskilde

Roskilde, , Denmark

Site Status

Countries

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Denmark

References

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Glargaard S, Thomsen JH, Tuxen C, Lindholm MG, Bang CA, Schou M, Iversen K, Rasmussen RV, Logstrup BB, Vraa S, Stride N, Seven E, Barasa A, Tofterup M, Hofsten DE, Rossing K, Kober L, Gustafsson F, Thune JJ. A Randomized Controlled Trial of Thoracentesis in Acute Heart Failure. Circulation. 2025 Apr 22;151(16):1150-1161. doi: 10.1161/CIRCULATIONAHA.124.073521. Epub 2025 Apr 1.

Reference Type DERIVED
PMID: 40166829 (View on PubMed)

Glargaard S, Thomsen JH, Logstrup BB, Schou M, Iversen KK, Tuxen C, Nielsen OW, Bang CA, Lindholm MG, Seven E, Barasa A, Stride N, Vraa S, Tofterup M, Rasmussen RV, Hofsten DE, Rossing K, Kober L, Gustafsson F, Thune JJ. Thoracentesis to alleviate pleural effusion in acute heart failure: study protocol for the multicentre, open-label, randomised controlled TAP-IT trial. BMJ Open. 2024 Jan 19;14(1):e078155. doi: 10.1136/bmjopen-2023-078155.

Reference Type DERIVED
PMID: 38245015 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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TAP-IT

Identifier Type: -

Identifier Source: org_study_id