Strategy of Continued Versus Interrupted Dabigatran at Time of Device Surgery in Patients With Moderate to High Risk of Arterial Thromboembolic Events (BRUISECONTROL2)
The purpose of this study is to determine the best strategy to manage Dabigatran at the time of pacemaker or defibrillator surgery. The Investigators hypothesize that performing device surgery without interruption of Dabigatran will result in a reduced rate of clinically significant hematoma.
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||A Randomized Controlled Trial to Investigate Whether a Strategy of Continued Versus Interrupted Dabigatran at the Time of Device Surgery, in Patients With Moderate to High Risk of Arterial Thrombo-embolic Events, Leads to a Reduction in the Incidence of Clinically Significant Hematoma|
- Clinically significant hematoma [ Time Frame: 2 weeks post-op or until resolution of hematoma ] [ Designated as safety issue: Yes ]
Hematoma requiring re-operation
- Defined as a hematoma that continues to expand despite all appropriate non-operative measures, or is producing impending or actual wound breakdown or skin necrosis. Minor hematomas that are evacuated at the time of other re-operation (eg. for lead repositioning) are not considered as a primary outcome.
Hematoma resulting in prolongation of hospitalization
- Defined as extended hospitalization or rehospitalization for > 24 hours, post index surgery, primarily due to hematoma.
- Hematoma requiring interruption of anti-coagulation. - Defined as reversal or intentional withholding of all anticoagulation, in response to wound hematoma.
- Composite of major peri-operative bleeding events and thrombo-embolic events [ Time Frame: 2 weeks post-op ] [ Designated as safety issue: Yes ]
- Each of the components of the primary outcome
Composite of all other major peri-operative bleeding events defined as:
- cardiac tamponade
- significant pericardial effusion
Thrombo-embolic events defined as:
- transient ischemic attack
- deep venous thrombosis
- pulmonary embolism
- peripheral embolus to limb
- peripheral embolus to other major organ
- All cause mortality
- Cost utilization
- Patient quality of life and peri-operative pain, and satisfaction
|Study Start Date:||January 2013|
|Estimated Study Completion Date:||June 2015|
|Estimated Primary Completion Date:||October 2014 (Final data collection date for primary outcome measure)|
Experimental: Continued Dabigatran
- Patients continue on Dabigatran 110 mg BID throughout
Active Comparator: Interrupted Dabigatran
This is a prospective, open-label, randomized trial, with 1:1 randomization to either continued Dabigatran or interrupted Dabigatran in patients at moderate to high risk of arterial thrombo-embolic events who require device surgery.
All patients in the study will be treated with Dabigatran for at least 5 days prior to surgery. Regardless of the chronic dose, all patients will receive Dabigatran 110 mg BID for 5 days prior to device surgery and for the 5 days following surgery. The peri-operative management of Dabigatran 110 mg BID is randomized to the following:
- based on renal function, patients will discontinue Dabigatran 1 day before surgery if GFR > 50 mL/min, and 2 days before surgery if GFR is 30-50 mL/min.
- Dabigatran will be resumed at the next regular dose time, at least 24 hours after the end of surgery.
- patients will continue on Dabigatran 110 mg BID throughout
- patients will have an aPTT measured at trough (within 2 hours prior to next dose)once within 5 days prior to the surgery. If the aPTT is > 2.5 times the upper limit of normal, the dose of Dabigatran will be held on the morning of surgery.
All patients will have clinical lab testing of serum creatinine, CBC, INR, aPTT, thrombin clotting time (TCT) and Hemoclot test on the day of surgery.
Patients will be seen post-op on the day of their surgery for assessment of the surgical site and each day throughout their hospital stay by a blinded member of the research team. A telephone follow-up will be done on day 3-4 post surgery by an unblinded team member. All patients are seen 1-2 weeks post-op at their first routine post-op device clinic visit, for surgical site assessment by the blinded assessor and to complete Quality of Life questionnaires. Patients will be seen for assessment in the case of any bleeding or development of pocket swelling or hematoma. Patients developing a hematoma will be followed until resolution of the hematoma.
|Contact: Karen MacDonald, RN BPE||613-798-5555 ext firstname.lastname@example.org|
|Hamilton Health Sciences General Campus||Not yet recruiting|
|Hamilton, Ontario, Canada, L8L 2X2|
|Principal Investigator: Jeff Healey, MD|
|Southlake Regional Health Centre||Not yet recruiting|
|Newmarket, Ontario, Canada, L3Y 2P9|
|Principal Investigator: Atul Verma, MD|
|University of Ottawa Heart Institute||Recruiting|
|Ottawa, Ontario, Canada, K1Y 4W7|
|Contact: Karen MacDonald, RN 613-798-5555 ext 17077 email@example.com|
|Principal Investigator: Pablo Nery, MD|
|McGill University Health Centre/Montreal General Hospital||Not yet recruiting|
|Montreal, Quebec, Canada, H3G 1A4|
|Principal Investigator: Vidal Essebag, MD|
|Principal Investigator:||David Birnie, MD||University of Ottawa Heart Institute|
|Principal Investigator:||Vidal Essebag, MD||McGill University|
|Study Chair:||Jeff Healey, MD||McMaster University|