Bradykinin Receptor Antagonism During Cardiopulmonary Bypass - Full Text View

Purpose

Each year over a million patients worldwide undergo cardiac surgery requiring cardiopulmonary bypass (CPB). CPB is associated with significant morbidity including the transfusion of allogenic blood products, inflammation and hemodynamic instability. In fact, approximately 20% of all blood products transfused are associated with coronary artery bypass grafting procedures. Transfusion of allogenic blood products is associated with well-documented morbidity and increased mortality after cardiac surgery. Enhanced fibrinolysis contributes to increased blood product transfusion in the perioperative period. The current proposal tests the central hypothesis that endogenous bradykinin contributes to the hemodynamic, fibrinolytic and inflammatory response to CPB and that bradykinin receptor antagonism will reduce hypotension, inflammation and transfusion requirements. In SPECIFIC AIM 1 we will test the hypothesis that the fibrinolytic and inflammatory response to CPB differ during ACE inhibition and angiotensin II type 1 receptor antagonism. In SPECIFIC AIM 2 we will test the hypothesis that bradykinin B2 receptor antagonism attenuates the hemodynamic, fibrinolytic, and inflammatory response to CPB. In SPECIFIC AIM 3 we will test the hypothesis that bradykinin B2 receptor antagonism reduces the risk of allogenic blood product transfusion in patients undergoing CPB. These studies promise to provide important information regarding the effects of drugs that interrupt the RAS and generate new strategies to reduce morbidity in patients undergoing CPB.

Condition	Intervention	Phase
Cardiopulmonary Bypass Inflammation Fibrinolysis Surgery	Drug: HOE 140 Drug: Aminocaproic Acid Drug: Placebo	Phase 2 Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Prevention
Official Title:	Bradykinin Receptor Antagonism During Cardiopulmonary Bypass

Resource links provided by NLM:

MedlinePlus related topics: Blood Transfusion and Donation

Drug Information available for: Aminocaproic acid Icatibant Icatibant acetate

U.S. FDA Resources

Further study details as provided by Vanderbilt University:

Primary Outcome Measures:

Allogenic Blood Product Transfusion Risk [ Time Frame: Patients were followed for the duration of hospital stay, an average of 6 days ] [ Designated as safety issue: No ]
Blood product transfusion during hospitalization that included packed red blood cells, plasma, platelets and cryoprecipitate.

Secondary Outcome Measures:

Units of Packed Red Blood Cells Transfused During Hospitalization [ Time Frame: Patients were followed for the duration of hospital stay, an average of 6 days ] [ Designated as safety issue: No ]
Units of Packed Red Blood Cells Transfused
Units of Plasma Transfused During Hospitalization [ Time Frame: Patients were followed for the duration of hospital stay, an average of 6 days ] [ Designated as safety issue: No ]
Units of plasma transfused
Inflammatory Response as Measured by Interleukin-6 [ Time Frame: Patients were followed from the start of surgery until postoperative day 2 ] [ Designated as safety issue: No ]
Interleukin-6 was measured at baseline, post-bypass and on postoperative day 1 and 2.
Fibrinolytic Response as Measured by D-dimer [ Time Frame: Patients were followed from the start of surgery until postoperative day 1 ] [ Designated as safety issue: No ]
D-dimer concentrations were measured at baseline, 30min and 60min of bypass, post-bypass and postoperative day 1


Enrollment:	150
Study Start Date:	May 2006
Study Completion Date:	June 2012
Primary Completion Date:	June 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: HOE 140 Bradykinin receptor antagonist	Drug: HOE 140 HOE 140 (a bradykinin B2 receptor antagonist) was started in the operating room after induction of anesthesia and before heparinization, continued throughout the bypass period, and discontinued at the end of surgery. HOE 140 was given as an intravenous bolus of 22 µg/kg over one-half hour followed by an infusion of 18 µg/kg/hr. Other Name: Icatibant
Active Comparator: Aminocaproic Acid Antifibrinolytic	Drug: Aminocaproic Acid Aminocaproic acid (an antifibrinolytic drug) was started in the operating room after induction of anesthesia and before heparinization, continued throughout the bypass period, and discontinued at the end of surgery. Aminocaproic acid was given as an intravenous bolus of 100 mg/kg over one-half hour followed by an infusion of 30 mg/kg/hr. Other Names: Amicar EACA
Placebo Comparator: Placebo Placebo	Drug: Placebo Normal saline (placebo) was started in the operating room after induction of anesthesia and before heparinization, continued throughout the bypass period, and discontinued at the end of surgery. Other Name: Placebo/Normal Saline

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Eligibility


Ages Eligible for Study:	18 Years to 80 Years (Adult, Senior)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Subjects, 18 to 80 years of age, scheduled for elective CABG requiring CPB
For female subjects, the following conditions must be met:

postmenopausal for at least 1 year, or status-post surgical sterilization, or if of childbearing potential, utilizing adequate birth control and willing to undergo urine beta-hcg testing prior to drug treatment and on every study day

Exclusion Criteria:

Evidence of coagulopathy (INR greater than 1.7 without warfarin therapy)
Preoperative hematocrit less than 30%
Preoperative platelet count less than 100X109ml-1
GPIIb/IIIa antagonist within 48 hours of surgery
Emergency surgery
Impaired renal function (serum creatinine >1.6 mg/dl)
Pregnancy
Breast-feeding
Any underlying or acute disease requiring regular medication which could possibly pose a threat to the subject or make implementation of the protocol or interpretation of the study results difficult
History of alcohol or drug abuse
Treatment with any investigational drug in the 1 month preceding the study
Mental conditions rendering the subject unable to understand the nature, scope and possible consequences of the study
Inability to comply with the protocol, e.g. uncooperative attitude and unlikelihood of completing the study

Contacts and Locations

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Please refer to this study by its ClinicalTrials.gov identifier: NCT00223704

Locations


United States, Tennessee
TN Valley Healthcare System
Nashville, Tennessee, United States, 37212
Vanderbilt University
Nashville, Tennessee, United States, 37232

Sponsors and Collaborators

Vanderbilt University

Investigators


Principal Investigator:	Mias Pretorius, MBChB	Vanderbilt University

More Information

Publications:

Balaguer JM, Yu C, Byrne JG, Ball SK, Petracek MR, Brown NJ, Pretorius M. Contribution of endogenous bradykinin to fibrinolysis, inflammation, and blood product transfusion following cardiac surgery: a randomized clinical trial. Clin Pharmacol Ther. 2013 Apr;93(4):326-34. doi: 10.1038/clpt.2012.249. Epub 2012 Dec 24.


Responsible Party:	Mias Pretorius, Associate Professor, Vanderbilt University
ClinicalTrials.gov Identifier:	NCT00223704 History of Changes
Other Study ID Numbers:	IRB #051171 HL085740-02
Study First Received:	September 19, 2005
Results First Received:	July 29, 2013
Last Updated:	October 15, 2013
Health Authority:	United States: Food and Drug Administration

Keywords provided by Vanderbilt University:


Coronary Artery Bypass Blood Transfusion Bradykinin Receptor Antagonism Anti-Inflammatory Agents Antifibrinolytic Agents

Additional relevant MeSH terms:


Inflammation Pathologic Processes Bradykinin Kininogens Aminocaproic Acid Antifibrinolytic Agents Icatibant Vasodilator Agents Cysteine Proteinase Inhibitors Protease Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Fibrin Modulating Agents Hemostatics	Coagulants Anti-Inflammatory Agents, Non-Steroidal Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs Anti-Inflammatory Agents Antirheumatic Agents Bradykinin B2 Receptor Antagonists Bradykinin Receptor Antagonists Complement Inactivating Agents Immunosuppressive Agents Immunologic Factors

ClinicalTrials.gov processed this record on September 26, 2016

Bradykinin Receptor Antagonism During Cardiopulmonary Bypass (BRAC)