Working…
Help guide our efforts to modernize ClinicalTrials.gov.
Send us your comments by March 14, 2020.
ClinicalTrials.gov
ClinicalTrials.gov Menu
Trial record 28 of 56 for:    "Lung Disease" | "Dalteparin"

Extended Out-of-hospital Low-molecular-weight Heparin Prophylaxis Against DVT and PE in Patients Undergoing Major Lung Resection

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.
 
ClinicalTrials.gov Identifier: NCT02258958
Recruitment Status : Completed
First Posted : October 8, 2014
Last Update Posted : December 18, 2014
Sponsor:
Collaborators:
Toronto General Hospital
Heart and Stroke Foundation of Canada
Information provided by (Responsible Party):
Yaron Shargall, McMaster University

Brief Summary:

Postoperative venous thromboembolism (VTE) is a significant health-care problem, resulting in significant morbidity, mortality and resource utilization. The true incidence is unknown, and may range from 1% to 15%. At the current time, the clinical practice of VTE prophylaxis in thoracic surgery includes administration of unfractionated or low molecular weight heparin starting at the perioperative period and finishing at the time of patients' discharge. In orthopaedic surgery, prolonged thromboprophylaxis beyond 10 days and up to 35 days has become the standard of care. There is a clear need to systematically evaluate the incidence of VTE after resection of lung malignancies and to evaluate the role of extended VTE prophylaxis in preventing Deep Vein Thrombosis (DVT) and pulmonary embolus (PE) after those major lung resections. This study will involve patients undergoing lung resection for malignancy at St. Joseph's Healthcare Hamilton and the University Health Network's Toronto General Hospital. The study will include 150 consecutively recruited patients. Study interventions will include Computed Tomography with pulmonary embolus (PE) protocol and bilateral extended leg Doppler Ultrasound for the detection of Deep Vein Thrombosis 30 days post-surgery.

In summary, this study is aimed at evaluating, for the first time in a prospective manner, the actual incidence of DVT and PE in patients undergoing major lung resections for malignancies. The knowledge gained in this study will be used to inform a future investigation involving a Randomized Controlled Trial (RCT) to compare current post-operative thromboprophylaxis with an extended 30-day prophylaxis protocol with the hope of providing an evidence-based practice change in VTE prophylaxis care for this high risk population.


Condition or disease
Venous Thrombosis Pulmonary Embolism Lung Neoplasms

Detailed Description:

Postoperative venous thromboembolism (VTE) is a significant health-care problem, resulting in significant morbidity, mortality and resource utilization. The true incidence is unknown, and may range from 1% to 15%. The latest American College of Chest Physicians (ACCP) guidelines on VTE prevention clearly outlines the perioperative thromboprophylaxis regiments for specific surgical populations. Specifically for patients undergoing orthopaedic procedures, such as total hip replacement, there is strong Grade 1A evidence for the use of extended thromboprophylaxis. For other surgical subgroups such as vascular and thoracic surgery, the evidence is less clear.

Therefore at the current time, the clinical practice of VTE prophylaxis in thoracic surgery includes administration of unfractionated or low molecular weight heparin starting at the perioperative period and finishing at the time of patients' discharge. Prolonged thromboprophylaxis in orthopaedic surgery beyond 10 days and up to 35 days has become the standard of care and has Grade 1A recommendations from ACCP. This approach has never been tested or validated in thoracic surgery, where major lung resection exposes the patient to an increased VTE risk not only due to the surgical stress and existence of malignancy, but also due to direct in-situ vascular injury secondary to resection of pulmonary arterial branches during the lung resection. Hence, there is a clear need to systematically evaluate the incidence of VTE after resection of lung malignancies and to evaluate the role of extended VTE prophylaxis in preventing DVT and pulmonary embolus (PE) after those major lung resections.

The study will involve patients undergoing sub-lobar resection, lobectomy, bilobectomy or pneumonectomy for lung cancer or metastatic lung disease at St. Joseph's Healthcare Hamilton, a regional tertiary thoracic surgery program with more than 350 major lung resections performed within the institution annually, as well as the University Health Network's Toronto General Hospital. The study will evaluate the incidence of post-operative venous thromboembolism (VTE) and will include 150 consecutively recruited patients. Study interventions will include Computed Tomography with pulmonary embolus (PE) protocol and bilateral extended leg Doppler Ultrasound for the detection of Deep Vein Thrombosis 30 days post-surgery.

In summary, this study is aimed at evaluating, for the first time in a prospective manner, the actual incidence of DVT and PE in patients undergoing major lung resections for malignancies. The knowledge gained in this study will be used to inform a future investigation involving an RCT to compare current post-operative thromboprophylaxis with an extended 30-day prophylaxis protocol with the hope of providing an evidence-based practice change in VTE prophylaxis care for this high risk population.

Layout table for study information
Study Type : Observational
Actual Enrollment : 150 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Extended Out-of-hospital Low-molecular-weight Heparin Prophylaxis Against Deep Venous Thrombosis and Pulmonary Embolus in Patients Undergoing Major Lung Resection: A Pilot Study to Evaluate the Incidence of DVT and PE After Major Lung Resection
Study Start Date : January 2014
Actual Primary Completion Date : December 2014
Actual Study Completion Date : December 2014

Resource links provided by the National Library of Medicine

Drug Information available for: Heparin




Primary Outcome Measures :
  1. To determine the incidence of PE/DVT after lung resection for malignancies [ Time Frame: 30 days post hospital discharge ]

Secondary Outcome Measures :
  1. Incidence of post-operative PE and DVT comparing thoracotomy vs. VATS [ Time Frame: 30 days post hospital discharge ]
  2. Complications and mortality of DVT and PE post lung resection [ Time Frame: 30 days post hospital discharge ]
  3. Risk factors for the development of VTE post lung resection [ Time Frame: 30 days post hospital discharge ]
  4. Correlation between DVT and PE in patients developing PE [ Time Frame: 30 days post hospital discharge ]
    In this specific population, many PE events might not be initiated by VTE, but rather by the result of in-situ arterial injury such as division, tying and/or clamping of the pulmonary artery branches during the lung resection. As a result, we postulate that we might identify patients with PE without a preceding DVT.



Information from the National Library of Medicine

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, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
All adults of at least 18 years of age who are to undergo sub-lobar resection, lobectomy, bilobectomy or pneumonectomy for lung cancer or metastatic lung disease will be offered the opportunity to participate in the study. The inclusion criteria are intentionally broad to increase the generalizability of the study. Eligibility criteria will be considered for enrollment in the study and are listed in the methodology section. The study population for both phases one and two of the study will have the same inclusion and exclusion criteria but will not include the same participants.
Criteria

Patient Inclusion Criteria

  • At least 18 years of age
  • Either gender
  • Diagnosed with resectable lung cancer or metastatic lung disease eligible to complete metastasectomy
  • Undergoing one of the following surgeries: Segmentectomy, wedge resection, lobectomy, bilobectomy or pneumonectomy
  • Competent to understand and sign consent documents

Patient Exclusion Criteria

  • Known allergic or anaphylactic reaction to contrast dye, heparin or low molecular weight heparin (LMWH)
  • Under current anticoagulation for venous thromboembolism or other medical conditions
  • Known renal impairment, defined as creatinine clearance value of less than 55ml/min/m2 as calculated by the Cockroft-Gault method
  • History of, or ongoing liver disease, manifested as ascites or previous peritoneal tapping for ascites
  • Pregnant or planning to become pregnant
  • Diagnosed or treated for VTE in the past 3 months prior to surgery
  • Present or previous increase risk of haemorrhage
  • History of previous HIT (heparin induced thrombocytopenia)
  • Platelet count must be below 75,000
  • Previously inserted Inferior Vena Cava Filter (IVC) filter.

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): NCT02258958


Locations
Layout table for location information
Canada, Ontario
St. Joseph's Healthcare Hamilton
Hamilton, Ontario, Canada, L8N 4A6
Toronto General Hospital (UHN)
Toronto, Ontario, Canada, M5G 2C4
Sponsors and Collaborators
McMaster University
Toronto General Hospital
Heart and Stroke Foundation of Canada
Investigators
Layout table for investigator information
Principal Investigator: Yaron Shargall, MD BSc St. Joseph's Healthcare Hamilton

Publications:

Layout table for additonal information
Responsible Party: Yaron Shargall, Head of Services Thoracic Surgery, McMaster University
ClinicalTrials.gov Identifier: NCT02258958    
Other Study ID Numbers: SJHH_VTEincidence
13-368 ( Other Identifier: Hamilton Integrated Research Ethics Board )
First Posted: October 8, 2014    Key Record Dates
Last Update Posted: December 18, 2014
Last Verified: December 2014
Keywords provided by Yaron Shargall, McMaster University:
venous thromboembolism prophylaxis
deep venous thrombosis
pulmonary embolus
thoracic surgery
lung resection
incidence
Additional relevant MeSH terms:
Layout table for MeSH terms
Lung Diseases
Dalteparin
Lung Neoplasms
Pulmonary Embolism
Thrombosis
Embolism
Venous Thrombosis
Embolism and Thrombosis
Vascular Diseases
Cardiovascular Diseases
Respiratory Tract Diseases
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms
Heparin
Heparin, Low-Molecular-Weight
Anticoagulants
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action