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Study of Fibrinogen Concentrate (Human) (FCH) to Control Bleeding During Complex Cardiovascular Surgery (REPLACE)

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
CSL Behring
ClinicalTrials.gov Identifier:
NCT01475669
First received: November 17, 2011
Last updated: September 17, 2014
Last verified: September 2014
November 17, 2011
September 17, 2014
January 2012
July 2014   (Final data collection date for primary outcome measure)
Total units of allogeneic blood products [ Time Frame: Up to 24 hours after investigational medicinal product (IMP) administration ]
Number of units administered of all allogeneic blood products combined (fresh frozen plasma, platelets, and red blood cells)
Total units of allogeneic blood products [ Time Frame: Up to 24 hours after IMP administration ]
Number of units administered of all allogeneic blood products combined (fresh frozen plasma, platelets, and red blood cells)
Complete list of historical versions of study NCT01475669 on ClinicalTrials.gov Archive Site
  • Total avoidance of allogeneic blood transfusions [ Time Frame: 24 hours after IMP administration ]
    Number of subjects who are alive and do not have any administration of platelets, fresh frozen plasma (FFP), and red blood cells (RBCs) during the first 24 hours after administration of IMP
  • Quantity of blood loss (6 hours) [ Time Frame: 6 hours after skin closure ]
    Blood drainage volume from the chest
  • Quantity of blood loss (12 hours) [ Time Frame: 12 hours after skin closure ]
    Blood drainage volume from the chest
  • Quantity of blood loss (24 hours) [ Time Frame: 24 hours after skin closure ]
    Blood drainage volume from the chest
  • Change in bleeding mass [ Time Frame: Immediately before and 5 minutes after completion of IMP administration ]
    The 5-minute bleeding mass is measured as the difference in weight of surgical swabs after 5 minutes of surgical packing of the aortic surgical site.
  • Mortality (Day 10) [ Time Frame: Up to 10 days after surgery ]
    Mortality with adjudicated cause of death up to 10 days after surgery
  • Mortality (Day 30) [ Time Frame: Up to 30 days after surgery ]
    Mortality with adjudicated cause of death up to 30 days after surgery
  • FFP consumption (24 hours) [ Time Frame: 24 hours after IMP administration ]
  • FFP consumption (10 days) [ Time Frame: 10 days after IMP administration ]
  • Platelet consumption (24 hours) [ Time Frame: 24 hours after IMP administration ]
  • Platelet consumption (10 days) [ Time Frame: 10 days after IMP administration ]
  • Red blood cells (RBC) consumption (24 hours) [ Time Frame: 24 hours after IMP administration ]
  • RBC consumption (10 days) [ Time Frame: 10 days after IMP administration ]
  • Total units of all allogeneic blood products (6 hours) [ Time Frame: 6 hours after IMP administration ]
    Number of units of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 6 hours after administration of IMP
  • Total units of all allogeneic blood products (12 hours) [ Time Frame: 12 hours after IMP administration ]
    Number of units of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 12 hours after administration of IMP
  • Volume of all allogeneic blood products (6 hours) [ Time Frame: 6 hours after IMP administration ]
    Volume of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 6 hours after administration of IMP
  • Volume of all allogeneic blood products (12 hours) [ Time Frame: 12 hours after IMP administration ]
    Volume of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 12 hours after administration of IMP
  • Volume of all allogeneic blood products (24 hours) [ Time Frame: 24 hours after IMP administration ]
    Volume of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 24 hours after administration of IMP
  • Time from administration of study drug to completion of skin closure [ Time Frame: Average 2 hours ]
  • Mortality (24 hours) [ Time Frame: WIthin 24 hours after IMP administration ]
    Mortality with adjudicated cause of death during the first 24 hours after administration of IMP
  • Peak plasma concentration of fibrinogen (Cmax) [ Time Frame: At up to 10 time points from baseline and up to Day 11 after surgery. ]
  • Maximum clot firmness [ Time Frame: At baseline; on the day of surgery at: 30 min before CPB, the 1st 5 min bleeding mass, the end of IMP infusion, the 2nd 5-min bleeding mass, and closure; and on Day 2, 3, 4 and at the end of the study (discharge/Day 11 or at discontinuation if earlier). ]
  • Total avoidance of allogeneic blood transfusions [ Time Frame: 24 hours after IMP administration ]
    Number of subjects who are alive and do not have any administration of platelets, fresh frozen plasma (FFP), and RBCs during the first 24 hours after administration of IMP
  • Quantity of blood loss (6 hours) [ Time Frame: 6 hours after skin closure ]
    Blood drainage volume from the chest
  • Quantity of blood loss (12 hours) [ Time Frame: 12 hours after skin closure ]
    Blood drainage volume from the chest
  • Quantity of blood loss (24 hours) [ Time Frame: 24 hours after skin closure ]
    Blood drainage volume from the chest
  • Change in bleeding mass [ Time Frame: Immediately before and 5 minutes after completion of IMP administration ]
    The 5-minute bleeding mass is measured as the difference in weight of surgical swabs after 5 minutes of surgical packing of the aortic surgical site.
  • Mortality (Day 10) [ Time Frame: 10 days after IMP administration ]
    Mortality with adjudicated cause of death during the first 24 hours after administration of IMP, and up to 10 days post surgery
  • Mortality (Day 30) [ Time Frame: 30 days after IMP administration ]
    Mortality with adjudicated cause of death during the first 24 hours after administration of IMP, and up to 30 days post surgery
  • FFP consumption (24 hours) [ Time Frame: 24 hours after IMP administration ]
  • FFP consumption (10 days) [ Time Frame: 10 days after IMP administration ]
  • Platelet consumption (24 hours) [ Time Frame: 24 hours after IMP administration ]
  • Platelet consumption (10 days) [ Time Frame: 10 days after IMP administration ]
  • RBC consumption (24 hours) [ Time Frame: 24 hours after IMP administration ]
  • RBC consumption (10 days) [ Time Frame: 10 days after IMP administration ]
  • Total units of all allogeneic blood products (6 hours) [ Time Frame: 6 hours after IMP administration ]
    Number of units of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 6 hours after administration of IMP
  • Total units of all allogeneic blood products (12 hours) [ Time Frame: 12 hours after IMP administration ]
    Number of units of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 12 hours after administration of IMP
  • Volume of all allogeneic blood products (6 hours) [ Time Frame: 6 hours after IMP administration ]
    Volume of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 6 hours after administration of IMP
  • Volume of all allogeneic blood products (12 hours) [ Time Frame: 12 hours after IMP administration ]
    Volume of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 12 hours after administration of IMP
  • Volume of all allogeneic blood products (24 hours) [ Time Frame: 24 hours after IMP administration ]
    Volume of all allogeneic blood products combined (FFP, platelets, and/or RBCs) administered during the first 24 hours after administration of IMP
  • Time from administration of study drug to completion of skin closure [ Time Frame: Average 2 hours ]
Not Provided
Not Provided
 
Study of Fibrinogen Concentrate (Human) (FCH) to Control Bleeding During Complex Cardiovascular Surgery
REPLACE (Randomized Evaluation of Fibrinogen Versus Placebo in Complex Cardiovascular Surgery): a Prospective, Multinational, Multicenter, Randomized, Double-blind, Placebo-controlled, Phase III Study for the Use of Fibrinogen Concentrate (Human) (FCH) in Complex Cardiovascular Surgery

The purpose of this study is to demonstrate that Fibrinogen Concentrate (Human)(FCH) can reduce the amount of donor blood products needed during complex cardiovascular surgery, and that it is safe and well tolerated. Subjects in this study will get either a FCH or placebo infusion during surgery. This will be in addition to the standard treatment, which is donor blood or blood products. Placebo does not contain any effective medicine.

The study is randomised. This means that the likelihood that subjects will get FCH or placebo is 50%. To make the comparison between FCH and placebo as fair as possible, the study is "double blind". This means that neither the subjects nor the study doctor will know if FCH or placebo is administered. If necessary, the study doctor can find out which treatment the subjects are receiving.

Not Provided
Interventional
Phase 3
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Surgical Blood Loss
  • Postoperative Blood Loss
  • Biological: Fibrinogen Concentrate (Human) (FCH)
    Single dose infused intravenously within 5 minutes of the completion of the measurement of the 5-minute bleeding mass; the dose is determined individually based on the measured maximum clot firmness (MCF) and subject body weight
  • Biological: Placebo
    Single dose of sodium chloride solution infused intravenously within 5 minutes at a volume equivalent to that needed for FCH
  • Experimental: Fibrinogen Concentrate (Human)
    Intervention: Biological: Fibrinogen Concentrate (Human) (FCH)
  • Placebo Comparator: Placebo
    Intervention: Biological: Placebo
Rahe-Meyer N, Levy JH, Mazer CD, Schramko A, Klein AA, Brat R, Okita Y, Ueda Y, Schmidt DS, Ranganath R, Gill R. Randomized evaluation of fibrinogen vs placebo in complex cardiovascular surgery (REPLACE): a double-blind phase III study of haemostatic therapy. Br J Anaesth. 2016 Jul;117(1):41-51. doi: 10.1093/bja/aew169.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
152
September 2014
July 2014   (Final data collection date for primary outcome measure)

Inclusion Criteria:

At Screening:

  • Undergoing elective open surgical procedures on any part of the aorta requiring cardiopulmonary bypass (CPB), with or without other cardiac surgical procedures (e.g. valve replacement or repair, coronary artery bypass grafting, etc.).
  • 18 years of age or older.
  • Written informed consent for study participation obtained before undergoing any study specific procedures.

Intraoperative (at the 1st 5-minute bleeding mass):

  • A 5-minute bleeding mass of 60 to 250 g following discontinuation of CPB, administration of protamine, and establishment of surgical hemostasis.
  • Minimum core body temperature 35°C, measured according to local practice.
  • Activated clotting time ± 25% of baseline levels.
  • Blood pH > 7.3.

Exclusion Criteria:

At Screening and/or baseline:

  • Undergoing emergency aortic repair surgery.
  • Reoperative aortic surgery at the same anatomic site as the original procedure such as replacement of a previously placed aortic graft. Resternotomy and rethoracotomy are permitted.
  • Any operation for infection.
  • Proof or suspicion of a congenital or acquired coagulation disorder (e.g. Von Willebrand's disease, hemophilia or severe liver disease) or a prothrombotic disorder (e.g. protein C or S deficiency).
  • Myocardial infarction (MI), acute coronary syndrome or stroke in the 2 months preceding study surgery.
  • Low molecular weight or unfractionated heparin in the 24 hours preceding study surgery.
  • Clopidogrel administration within 5 days preceding study surgery or prasugrel administration within 7 days preceding study surgery or ticagrelor administration in the 48 hours preceding study surgery.
  • Factor Xa inhibitors within 2 days preceding study surgery.
  • IIb/IIIa antagonist administration in the 24 hours preceding study surgery.
  • Use of direct thrombin inhibitors: within 3 days preceding study surgery for dabigatran and within 24 hours preceding study surgery for all others.
  • An international normalized ratio > 1.3 immediately preceding the start of surgery.

Intraoperative (at the 1st 5-minute bleeding mass):

  • Use of any systemic hemostatic therapy (such as FFP, platelets, prothrombin complex concentrates) from the beginning of surgery until IMP administration.
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
Austria,   Brazil,   Canada,   Czech Republic,   Denmark,   Finland,   Germany,   Italy,   Japan,   Poland,   United Kingdom
 
 
NCT01475669
BI3023_3002
2011-002685-20 ( EudraCT Number )
Yes
Not Provided
Not Provided
CSL Behring
CSL Behring
Not Provided
Principal Investigator: Niels Rahe-Meyer, MD, PhD Hannover Medical School
CSL Behring
September 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP