A Pilot Study Comparing Enoxaparin to Fondaparinux to Prevent Venous Thromboembolism (VTE) in Bariatric Surgical Patients - Full Text View

Purpose

This pilot study is designed to determine the feasibility of conducting a randomized clinical trial comparing fondaparinux sodium (Arixtra) once daily with enoxaparin (Lovenox®) twice daily with respect to preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after bariatric surgery in obese patients.

Condition	Intervention	Phase
Deep Venous Thrombosis Pulmonary Embolism	Drug: Enoxaparin Drug: Fondaparinux	Early Phase 1


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Factorial Assignment Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Prevention
Official Title:	A Pilot Study to Determine the Feasibility of Conducting a Randomized Clinical Trial Comparing Fondaparinux Sodium (Arixtra) Once Daily With Enoxaparin (Lovenox®) Twice Daily With Respect to Preventing VTE After Bariatric Surgery in Obese Patients

Resource links provided by NLM:

MedlinePlus related topics: Blood Clots Deep Vein Thrombosis Pulmonary Embolism Weight Loss Surgery

Drug Information available for: Fondaparinux Fondaparinux sodium

U.S. FDA Resources

Further study details as provided by Kimberley Steele, Johns Hopkins University:

Primary Outcome Measures:

To estimate the prevalence of asymptomatic deep venous thrombosis and pulmonary emboli in obese patients undergoing bariatric surgery. [ Time Frame: 2 years ]

Secondary Outcome Measures:

To assess the relationship of Anti-factor Xa levels and the occurrence of deep venous thrombosis and pulmonary emboli in bariatric patients receiving standard dose of anticoagulation (enoxaparin/Lovenox or fondaparinux/Arixtra). [ Time Frame: 2 years ]


Enrollment:	198
Study Start Date:	June 2009
Study Completion Date:	September 2013
Primary Completion Date:	September 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Enoxaparin Patients will receive enoxaparin 40mg subcutaneously twice daily during perioperative period of bariatric surgery. Patients will be encouraged to ambulate and compression stockings while in bed.	Drug: Enoxaparin Patients will receive enoxaparin 40mg subcutaneously twice daily during perioperative period of bariatric surgery. Patients will be encouraged to ambulate and compression stockings while in bed.
Active Comparator: Fondaparinux Fondaparinux 5mg subcutaneously 6 hours following surgery, fondaparinux 5mg subcutaneously once daily during hospitalization. Patients will be encouraged to ambulate and compression stockings while in bed.	Drug: Fondaparinux Fondaparinux 5mg subcutaneously 6 hours following surgery, fondaparinux 5mg subcutaneously once daily during hospitalization. Patients will be encouraged to ambulate and compression stockings while in bed.

Detailed Description:

In order to determine the feasibility of such a trial we need to determine the necessary sample size. In order to determine the necessary sample size, we need to obtain estimates of the incidence of DVT and the prevalence of PE using MRV in each treatment group. Descriptive statistics and 95% confidence intervals will be calculated to determine the incidence of DVT and the prevalence of PE using MRV in obese patients who have received treatment to prevent DVT and PE associated with bariatric surgery.

Anti-factor Xa levels will be used to help determine if treatments are reaching appropriate levels.

Eligibility


Ages Eligible for Study:	18 Years to 70 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Men or women 18 years or older.
Body mass index (BMI) of 35kg/m2 or greater.
Undergoing laparoscopic bariatric surgery, i.e., laparoscopic sleeve gastrectomy, laparoscopic Roux-en Y gastric bypass or laparoscopic duodenal switch.

Exclusion Criteria:

History of previous deep vein thrombosis.
History of previous pulmonary emboli.
History of documented clotting/coagulation disorder.
History of cancer.
Weight < 50 kg or > 200 kg or unable to fit in MRI scanner.
Presence of metallic foreign bodies
Recent history of smoking (within the last year).
History of venous stasis disease.
History of obesity hypoventilation syndrome.
Patients who are unable to lay flat for extended periods of time or are claustrophobic.
Patients who have a pacemaker, an implanted defibrillator or certain other implanted or electronic or metallic devices (implanted medical or metallic devices, shrapnel, or metal).
History of hypersensitivity reaction to anticoagulation products.
History of HIT (Heparin Induced Thrombocytopenia.
History of Renal Insufficiency (Creatinine Clearance < 50).
Active clinically significant bleeding.
Acute bacterial endocarditis.
BMI > 60.
Patients with metallic foreign body or implant (unable to have an MRV study).

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00894283

Locations


United States, Maryland
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, United States, 21224

Sponsors and Collaborators

Johns Hopkins University

GlaxoSmithKline

Investigators


Principal Investigator:	Kimberley E Steele, MD	Johns Hopkins University

More Information


Responsible Party:	Kimberley Steele, Assistant Professor of Surgery, Johns Hopkins University
ClinicalTrials.gov Identifier:	NCT00894283 History of Changes
Other Study ID Numbers:	NA_00025492
Study First Received:	May 5, 2009
Last Updated:	August 6, 2014

Keywords provided by Kimberley Steele, Johns Hopkins University:


DVT PE MRV bariatric surgery

Additional relevant MeSH terms:


Thrombosis Embolism Venous Thromboembolism Pulmonary Embolism Venous Thrombosis Embolism and Thrombosis Vascular Diseases Cardiovascular Diseases Thromboembolism	Lung Diseases Respiratory Tract Diseases Fondaparinux PENTA Anticoagulants Fibrinolytic Agents Fibrin Modulating Agents Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on June 23, 2017