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The Effect on Blood Loss of Topical and Intravenous Tranexamic Acid in Cardiac Surgery Patients

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01895101
First Posted: July 10, 2013
Last Update Posted: May 20, 2015
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.
Information provided by (Responsible Party):
Thierry V Scohy, Amphia Hospital
  Purpose

It remains still unclear whether topical tranexamic acid has an added value besides the administration of intravenously tranexamic acid. We hypothesize that the addition of topical tranexamic acid, besides intravenous administration of tranexamic acid, results in a 25% reduction of post-operative blood loss after cardiac surgery.

The aim of this study is to determine whether the application of topical tranexamic acid reduces the 12 hours postoperative blood loss by 25% in patient scheduled for cardiac surgery on cardiopulmonary bypass, whereby intravenous tranexamic acid is administrated.

Just before sternal closure, 250 subjects receives pericardial lavage with 2 gr tranexamic acid in 200 ml normothermic saline solution (NaCl 0.9%), 250 subjects receives pericardial lavage with 200 ml normothermic saline solution without TA and 250 subjects (control group) receives no pericardial lavage. The main study parameter is 12 hours post-operative blood loss and is assessed by 12 hours post-operative chest tube production.


Condition Intervention Phase
Blood Loss Tranexamic Acid Cardiac Surgery Drug: 2 gr tranexamic acid Drug: Saline Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Effect on Blood Loss of Topical and Intravenous Tranexamic Acid in Cardiac Surgery Patients: a Randomized Placebo-controlled Trial

Resource links provided by NLM:


Further study details as provided by Thierry V Scohy, Amphia Hospital:

Primary Outcome Measures:
  • Postoperative Blood Loss [ Time Frame: 12 hours postoperative ]
    The primary study parameter is 12 hours postoperative blood loss and is assessed by postoperative chest tube production. Postoperative chest tube production 12 hours after surgical procedure


Secondary Outcome Measures:
  • Number of Participants Requiring Surgical Re-exploration [ Time Frame: participants will be followed for the duration of ICU stay, an expected average of 2 days ]
    the secondary objective of this study is to determine whether pericardial lavage with saline gives an improvement in haemostasis, compared with no pericardial lavage, resulting in a reduction of surgical re-explorations and post-operative 12-hour blood loss. The choice for a surgical re-exploration will be decided according to the ICU protocol.

  • Total Red Blood Cell Transfusions (Cumulative of Pre, Peri and Postoperative Period) [ Time Frame: participants will be followed for the duration of ICU stay, an expected average of 2 days/ And participants will be followed for the duration of hospital stay, an expected average of 3 weeks ]
    The amount of red blood cell transfusions the patient receive pre, peri and postoperatively during their stay in the hospital.


Enrollment: 750
Study Start Date: October 2013
Study Completion Date: March 2015
Primary Completion Date: March 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: pericardial lavage with 200 ml normothermic saline solution

According to the anaesthetic protocol of the Amphia Hospital (Breda, the Netherlands), all patients scheduled for cardiac surgery receive intravenously 2 gr TA before sternal incision and 2 gr TA after cardiopulmonary bypass.

This arm also receives pericardial lavage with 200 ml normothermic saline solution without tranexamic acid.

Drug: Saline
This group receives pericardial lavage with 200 ml normothermic saline solution without tranexamic acid
No Intervention: No pericardial lavage

According to the anaesthetic protocol of the Amphia Hospital (Breda, the Netherlands), all patients scheduled for cardiac surgery receive intravenously 2 gr TA before sternal incision and 2 gr TA after cardiopulmonary bypass.

In this arm the subjects receives as in standard care no pericardial lavage.

Experimental: 2 gr tranexamic acid diluted in 200 ml normothermic saline

According to the anaesthetic protocol of the Amphia Hospital (Breda, the Netherlands), all patients scheduled for cardiac surgery receive intravenously 2 gr TA before sternal incision and 2 gr TA after cardiopulmonary bypass.

This arm receives also pericardial lavage with 2 gr TA diluted in 200 ml normothermic saline solution (NaCl 0.9%).

Drug: 2 gr tranexamic acid
This group receives pericardial lavage with 2 gr tranexamic diluted in 200 ml normothermic saline solution (NaCl 0.9%).

  Eligibility

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Gender; male/ female
  • Age: ≥ 18 year
  • Elective cardiac surgical patients

    • Coronary artery bypass graft (CABG) (conventional, E.CCO)
    • Aortic valve replacement (AVR) (conventional)
    • Mitral valve replacement (MVR)/ Mitral valve repairment (MPL) (conventional)
    • Tricuspid valve replacement (TVR) / Tricuspid valve repairment (TPL)
    • Bentall
    • Combined procedure (e.g. CABG/ AVR, MVR/AVR, AVR/Maze)

Exclusion Criteria:

  • MVR/MPL (minimal invasive, Port Access Surgery)
  • Maze (minimal invasive, via Thoracoscopy)
  • AVR (minimal invasive, via mini Sternotomy)
  • off-pump procedures
  • Emergency operations
  • Patient with increased or decreased blooding tendency (FV leiden, prot C, S deficiency, anti-thrombin deficiency, prothrombin mutation)
  Contacts and Locations
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 ClinicalTrials.gov identifier (NCT number): NCT01895101


Locations
Netherlands
Amphia Hospital
Breda, Netherlands, 4800 RK
Sponsors and Collaborators
Amphia Hospital
Investigators
Principal Investigator: Thierry Scohy Amphia Hospital
  More Information

Publications:
Responsible Party: Thierry V Scohy, MD, phd, Amphia Hospital
ClinicalTrials.gov Identifier: NCT01895101     History of Changes
Other Study ID Numbers: TA-1251
2013-000774-30 ( EudraCT Number )
First Submitted: June 25, 2013
First Posted: July 10, 2013
Results First Submitted: March 30, 2015
Results First Posted: April 10, 2015
Last Update Posted: May 20, 2015
Last Verified: May 2015

Keywords provided by Thierry V Scohy, Amphia Hospital:
blood loss
tranexamix acid
cardiac surgery

Additional relevant MeSH terms:
Hemorrhage
Pathologic Processes
Pharmaceutical Solutions
Tranexamic Acid
Antifibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Hemostatics
Coagulants