Anticoagulation Management in Complex Cardiac Surgery

NCT ID: NCT05944107

Last Updated: 2023-07-14

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

PHASE4

Total Enrollment

65 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-01

Study Completion Date

2023-02-20

Brief Summary

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The goal of this clinical trial is to compare the anticoagulation management with or without heparin concentration level guidance, in patients undergoing valve or complex cardiac surgery during cardiopulmonary bypass using closed, coated circuits. The main questions it aims to answer are:

* initial heparin bolus, subsequent supplementary doses and total heparin variance among groups.
* protamine dose among groups.

Participants are adult patients scheduled for valve or complex cardiac surgery. They are randomised to either Activated Clotting Time guided management alone or combined with heparin level concentration monitoring.

Detailed Description

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Conditions

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Extracorporeal Circulation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Activated Clotting Time (ACT)

In this group, only ACT measurements and fixed doses of heparin and protamine are administered.

ACT is measured using the ACT Plus device (Medtronic, MN, USA). Heparin formulation administered is HEPARIN/LEO INJ.SOL 25000IU/5ML. Protamine formulation administered is PROTAMINE SULPHATE/LEO PHARMA 10mg/ml

Group Type ACTIVE_COMPARATOR

Activated Clotting Time

Intervention Type OTHER

The target ACT for procedures other than Coronary Artery Bypass Grafting (CABG) is 400s when Minimally Invasive Extracorporeal Circulation is used. A bolus of 300 International Units(IU)/kg heparin are administered to reach this target and initiate cardiopulmonary bypass (CPB). Repeated ACT measurements guide further heparin dose to maintain adequate anticoagulation. Then, at the end of the CPB, 0.75 mg of protamine are administered for every 100IU of the initial heparin bolus.

Heparin Concentration (HC)

In this group, the Hepcon HMS Plus (Medtronic, MN, USA) is used to perform heparin concentration calculations and test each patient's individual response to heparin. Specifically tests performed were:

* Heparin Dose Response test
* Heparin Assay test

Group Type ACTIVE_COMPARATOR

Activated Clotting Time measurements combined with heparin concentration monitoring

Intervention Type OTHER

In the HC group, the initial heparin dose is calculated using the HepCon HMS Plus . Except for ACT, heparin concentration is measured to maintain target heparin levels during CPB. The protamine dose for reversal is computed based on actual measured heparin levels using the device. ACT is also performed in all instances.

Interventions

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Activated Clotting Time measurements combined with heparin concentration monitoring

In the HC group, the initial heparin dose is calculated using the HepCon HMS Plus . Except for ACT, heparin concentration is measured to maintain target heparin levels during CPB. The protamine dose for reversal is computed based on actual measured heparin levels using the device. ACT is also performed in all instances.

Intervention Type OTHER

Activated Clotting Time

The target ACT for procedures other than Coronary Artery Bypass Grafting (CABG) is 400s when Minimally Invasive Extracorporeal Circulation is used. A bolus of 300 International Units(IU)/kg heparin are administered to reach this target and initiate cardiopulmonary bypass (CPB). Repeated ACT measurements guide further heparin dose to maintain adequate anticoagulation. Then, at the end of the CPB, 0.75 mg of protamine are administered for every 100IU of the initial heparin bolus.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* elective procedures
* cardiac surgery, except for Coronary Artery Bypass Grafting
* Cardiopulmonary bypass under Minimally Invasive Extracorporeal Circulation

Exclusion Criteria

* known allergy to heparin or protamine
* hematological disease
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aristotle University Of Thessaloniki

OTHER

Sponsor Role lead

Responsible Party

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Anna Gkiouliava

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Helena Argiriadou, Dr

Role: STUDY_DIRECTOR

AHEPA University Hospital, Aristotole University of Thessaloniki

Locations

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AHEPA University Hospital, Aristotle University of Thessaloniki

Thessaloniki, , Greece

Site Status

Countries

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Greece

Other Identifiers

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3432

Identifier Type: -

Identifier Source: org_study_id

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