Assessment of Blood Loss With a Point Of Care Device (BLOOD)
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ClinicalTrials.gov Identifier: NCT01430273 |
Recruitment Status
: Unknown
Verified April 2015 by Assistance Publique - Hôpitaux de Paris.
Recruitment status was: Recruiting
First Posted
: September 8, 2011
Last Update Posted
: April 3, 2015
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Condition or disease |
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Acute or Programmed Hip Replacement (Gamma Nail, Total Prosthesis or Throuhg DHS) / Knee Surgery |
Type of study : Prospective, non-interventional, multicenter registry Principal Investigator: Collet Jean-Philippe Rational: Discontinuation of antiplatelet therapy in patients with established coronary artery disease (CAD) has become an increasingly important concern given the risk of recurrent arterial event. Exaggerated concern about increased procedure-related bleeding remains the major factor for premature discontinuation of APT. Interruption modalities and their impact on perioperative bleeding has never been prospectively evaluated and it is accepted that the maximum duration of interruption should not exceed 5 days for Clopidogrel/Ticagrelor and 7 days for Prasugrel given the fact that the remaining antiplatelet effect of APT is observed in less than 50% of patients after 3 days of interruption. Resuming APT after the operation has never been studied and remains a complex situation during anticoagulation is often prescribed to prevent deep vein thrombosis further increasing perioperative bleeding.
Hypotheses: (i) the volume of perioperative blood loss is correlated to the degree of platelet inhibition. (ii) Clopidogrel metabolizer status as defined by genetic profile is also correlated to perioperative blood loss. (iii) Resuming antiplatelet therapy during the perioperative period is not associated with a significant recovery of the antiplatelet effect.
Primary endpoint: Perioperative (day 1-day 5) blood loss in mL assessed by NADLER & Mercurial formula* and PRU** (for patients under Clopidogrel/ARU*** as measured using the VerifyNow®P2Y12 and aspirin assays at baseline. Secondary objectives: (i) to evaluate the correlation between clopidogrel genetic metabolizer status**** and perioperative blood loss. To evaluate antiplatelet pharmacodynamic response at discharge according to metabolizer status. Definition*Blood loss in mL of Red Blood Cell (RBC) = Compensated RBC Volume (1 Pack=150mL) + Non Compensated RBC Vol. (Total Blood Loss : Ht D-1-Ht D+5). *PRU=Platelet Reaction Unit. It is a specific measure of on-clopidogrel platelet reactivity. Cut-off value is for defining high-on clopidogrel platelet reactivity is 230. **ARU=Aspirin Reaction Unit. It is a specific measure of on-aspirin platelet reactivity. Cutoff value to identify high on-aspirin platelet reactivity is 550. ***Clopidogrel Metabolizer Phenotype is defined according to the carriage of the loss/gain-of function allele 2C19*2-*8/*17 as follows: SM for slow metabolizer: (*2-*8/*2-*8) ; Ultrafast Metabolizer (FM): (*17/*17) ; Normal/intermediate (M): (wt/wt, wt/*17, *2-*8/*17 or *2-*8/wt)
Number of subjects : 200 patients
Study duration: Two years.
Study duration per subject: length of hospital stay with a maximum duration of 30 days.
Study Type : | Observational |
Estimated Enrollment : | 200 participants |
Observational Model: | Cohort |
Time Perspective: | Prospective |
Official Title: | Assessment of Blood Loss With a Point Of Care Device During Hip/Knee Surgery Performed On Dual/Single Antiplatelet Therapy |
Study Start Date : | June 2013 |
Estimated Primary Completion Date : | June 2015 |
Estimated Study Completion Date : | July 2015 |

Group/Cohort |
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Planned hip or knee arthroplasty
Patients with planned hip or knee arthroplasty
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urgent hip or knee arthroplasty
Patients with hip or knee arthroplasty in emergency.
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- Perioperative blood loss in mL assessed by NADLER & Mercurial formula* and PRU**/ARU*** as measured using the VerifyNow®P2Y12 and aspirin assays at baseline [ Time Frame: day 1- day 5 ]Perioperative (day 1-day 5) blood loss in mL assessed by NADLER & Mercuriali formula* and PRU**/ARU*** as measured using the VerifyNow®P2Y12 and aspirin assays at baseline.
- Evaluate the correlation between clopidogrel genetic metabolizer status**** and perioperative blood loss. [ Time Frame: up to 10 days ]When the patient discharges of surgery department
- To evaluate clopidogrel and aspirin pharmacodynamic response at discharge according to metabolizer status. [ Time Frame: up to 10 days ]When the patient discharges of surgery department
Biospecimen Retention: Samples With DNA

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Ages Eligible for Study: | 18 Years and older (Adult, Senior) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Sampling Method: | Non-Probability Sample |
This study targets CAD patients exposed to antiplatelelt mono/bitherapy who need planned or emergency knee/hip athroplasty. This innovative study will bring new insights on how works antiplatelet therapy during the perioperative period according to drug exposition and metabolizer profile.
Patients ethnicity will be recorded and defined according to the place of birth of the participants and of their parents given the identification of the metabolizer profile with respect to the CYP 2C19*2 carriage. The analysis will bestratified according to ethnicity to avoid biases.
Inclusion Criteria:
- ≥18 years
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Patient in antiplatelet monotherapy (aspirin or clopidogrel) or dual therapy (aspirin + clopidogrel / prasugrel / ticagrelor) in the context of secondary prevention after:
- acute coronary syndrome
- and / or intracoronary stenting
- Planned or urgent hip (gamma nail, total prosthesis or through DHS) or knee arthroplasty
- Informed consent of the participant
- Patient receiving a social security scheme or entitled
Exclusion Criteria:
- Polytrauma
- Anemia <9g/dL
- Indication for oral anticoagulation
- Pelvic fracture justifying complex surgery
- Ongoing or recent major bleeding or recent major surgery (< 3 weeks)
- Liver failure
- Thrombopenia <80 000/µl
- Lack of health insurance
- Mental disability
- Participation to any other research protocol

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 ClinicalTrials.gov identifier (NCT number): NCT01430273
Contact: Jean-Philippe COLLET, MD,PhD | 00331 42 16 30 13 | jean-philippe.collet@psl.aphp.fr |
France | |
Institute of cardiology - Pitié Salpêtrière Hospital | Recruiting |
Paris, France, 75013 | |
pôle Anesthesie -Réanimation- CHU Pitie -Salpetrière | Recruiting |
Paris, France, 75013 | |
Contact: Olivier LANGERON, MD 01 42 16 22 59 olivier.langeron@psl.aphp.fr | |
CHU Toulouse - Hôpital de Rangueil - Anésthésie-Réanimation | Recruiting |
Toulouse, France, 31403 | |
Contact: Vincent MINVILLE, MD 33 1 05 61 32 35 21 minville.v@chu-toulouse.fr | |
Principal Investigator: Vincent MINVILLE, MD |
Principal Investigator: | COLLET Jean-Philippe, MD-PhD | Assistance Publique - Hôpitaux de Paris |
Responsible Party: | Assistance Publique - Hôpitaux de Paris |
ClinicalTrials.gov Identifier: | NCT01430273 History of Changes |
Other Study ID Numbers: |
NI10028 2010-A01454-35 ( Other Identifier: IDRCB ) |
First Posted: | September 8, 2011 Key Record Dates |
Last Update Posted: | April 3, 2015 |
Last Verified: | April 2015 |
Keywords provided by Assistance Publique - Hôpitaux de Paris:
Antiplatelet therapy Surgery Bleeding Platelet aggregation |