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Inhibition of Lipid Peroxidation During Cardiac Surgery

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01366976
Recruitment Status : Completed
First Posted : June 6, 2011
Results First Posted : January 14, 2015
Last Update Posted : January 27, 2015
Information provided by (Responsible Party):
Mias Pretorius, Vanderbilt University

Brief Summary:
Acute kidney injury is a major complication of cardiac surgery requiring cardiopulmonary bypass (CPB). Hemolysis and rhabdomyolysis frequently occur during CPB. Hemolysis leads to an increase in free hemoglobin, whereas rhabdomyolysis leads to an increase in myoglobin. Free plasma hemoglobin and myoglobin have been shown to be independent predictors of the acute kidney injury that results from CPB. When these hemeproteins are released into the plasma, they undergo redox cycling, generating radical species that initiate lipid peroxidation and a cascade of oxidative damage to cellular membranes, notably in the kidney. F2-isoprostanes and isofurans are sensitive and specific markers of oxidative stress in vivo, and are increased after CPB, particularly in those patients with acute kidney injury. Acetaminophen inhibits the lipid peroxidation catalyzed by myoglobin and hemoglobin. Moreover, in an animal model of rhabdomyolysis-induced kidney injury, acetaminophen significantly attenuated the decrease in creatinine clearance compared to control. The current proposal tests the central hypothesis that acetaminophen will attenuate the lipid peroxidation associated with the hemolysis and rhabdomyolysis that occur in patients undergoing CPB. Demonstration that acetaminophen inhibits the lipid peroxidation resulting from CPB would provide a rationale for a prospective randomized trial to test the hypothesis that acetaminophen will reduce the acute kidney injury that results from CPB.

Condition or disease Intervention/treatment Phase
Cardiopulmonary Bypass Induced Lipid Peroxidation Drug: Acetaminophen Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 67 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Inhibition of Lipid Peroxidation During Cardiopulmonary Bypass
Study Start Date : July 2011
Actual Primary Completion Date : June 2013
Actual Study Completion Date : June 2013

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Placebo Comparator: Placebo Drug: Acetaminophen
Acetaminophen 1g every 6 hours for 4 doses over 24 hours
Other Name: Tylenol

Active Comparator: Acetaminophen
Acetaminophen will ge given as 1g every 6 hours for 4 doses over a 24 hours study period
Drug: Acetaminophen
Acetaminophen 1g every 6 hours for 4 doses over 24 hours
Other Name: Tylenol

Primary Outcome Measures :
  1. Plasma Isofuran Concentrations [ Time Frame: 24 hours ]
    Plasma isofuran concentrations as a measure of lipid peroxidation

  2. Plasma F2-isoprostane Concentrations [ Time Frame: 24 hours ]
    Plasma F2-isoprostane concentrations as a measure of lipid peroxidation

Secondary Outcome Measures :
  1. Urinary NGAL (Neutrophil Gelatinase-associated Lipocalin) [ Time Frame: 24 hours ]
    Changes in urinary NGAL (neutrophil gelatinase-associated lipocalin) as marker of acute kidney injury

  2. Serum Creatinine [ Time Frame: 72 hours ]
    Serum creatinine measured over a 72 hour period

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Subjects, 18 to 80 years of age, scheduled for elective cardiac surgery requiring CPB
  2. 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 a negative urine beta-hcg prior to drug treatment

Exclusion Criteria:

  1. Allergic reaction to ApAP (acetaminophen)
  2. Evidence of severe hepatic impairment (history of liver cirrhosis or total bilirubin >2.0mg/dl)
  3. Impaired renal function (serum creatinine >2.0 mg/dl)
  4. Emergency surgery
  5. Pregnancy
  6. Breast-feeding
  7. 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
  8. History of alcohol or drug abuse
  9. Treatment with any investigational drug in the 1 month preceding the study
  10. Mental conditions rendering the subject unable to understand the nature, scope and possible consequences of the study
  11. Inability to comply with the protocol, e.g. uncooperative attitude and unlikelihood of completing the study
  12. History or evidence of active asthma

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01366976

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United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37232
Sponsors and Collaborators
Vanderbilt University
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Principal Investigator: Mias Pretorius, MBChB, MSCI Vanderbilt University

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Mias Pretorius, Associate Professor, Vanderbilt University Identifier: NCT01366976    
Other Study ID Numbers: 110423
First Posted: June 6, 2011    Key Record Dates
Results First Posted: January 14, 2015
Last Update Posted: January 27, 2015
Last Verified: January 2015
Keywords provided by Mias Pretorius, Vanderbilt University:
oxidative stress
cardiopulmonary bypass
Additional relevant MeSH terms:
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Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs