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RecruitingNCT03302195Updated Mar 10, 2023

Optimal Cardiopulmonary Bypass and Anticoagulation Management Strategies in Obese Patients Undergoing Cardiac Surgery

An interventional study of Heparin and cardiopulmonary bypass pump flow rate in Cardiopulmonary Bypass and Obesity, sponsored by Laval University. Recruiting at 1 site in Canada. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-03-10.

Sponsored by Laval University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
410
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Standard Heparin management, based on total body weight, is not well established for obese patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

The purpose of this study is to assess the safety and efficacy of using lean body mass (LBM) to determine pump flow rate and/or Heparin dosage in obese patients undergoing CPB.

02

Conditions studied

  • Cardiopulmonary Bypass
  • Obesity

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Keywords

  • Heparin
  • Allogeneic blood product transfusions
  • Bleeding
  • Cardiac surgery
  • Obesity
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Obese patients (BMI ≥ 30kg/m2)
  • Planned cardiac surgery
  • Age ≥ 18 years

Exclusion criteria

Exclusion Criteria:

  • Permanent pacemaker
  • Known intolerance to protamine
  • Known or suspected allergy to the used antifibrinolytic agent
  • Refusal to receive blood products
  • Planned off pump coronary artery bypass
  • Planned peri-operative use of desmopressin
  • Known Heparin-induced thrombocytopenia
  • Known deficiency in protein C, protein S, antithrombin or homozygous factor V Leiden
  • Known congenital bleeding disorders
  • Current endocarditis
  • Planned hypothermic circulatory arrest (\<28C)
  • Two or more cardiac surgery procedures
  • Emergency cardiac surgery procedures (medically required within 24hours of presenting with acute symptoms)
  • Planned CPB priming with red blood cells
  • Any known autoimmune disease
  • Any history of stroke or non-coronary thrombotic disorders including deep venous thrombosis and pulmonary embolism
  • Significant (≥50%) carotid artery stenosis
  • Patient dosed with low molecular weight Heparin less than 24h before surgery
  • Females of childbearing potential who are pregnant, breast-feeding or intend to become pregnant or are not using adequate contraceptive methods
  • Confirmed ST elevation myocardial infarction (STEMI) within 7 days
  • Pre-operative platelet count \<100,000/microliter
  • Anaemia (Hematocrit \<32% for females, \<35%for males)
  • Dosed with clopidogrel or ticagrelor within the last 5 days prior to surgery, or prasugrel within 7 days
  • Dosed with GPIIb/IIIa receptor blockers (Abciximab, Tirofiban, Eptifibatide) ≤ 24 hours prior to surgery
  • International ratio (INR) >1.5 on the day of surgery in patients treated with vitamin K antagonist
  • Liver dysfunction (aspartate aminotransferase (AST) or alanine aminotransferase (ALT) increased ≥ 2-fold above the upper limit of local laboratory normal ranges)
  • Renal failure (creatinine ≥ 175 micromol/L or dialysis)
  • Current thromboembolic disease other than myocardial infarct
  • Patients who have pre-donated autologous blood
  • Patient presenting with a resistance to Heparin
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Participant)
Enrollment
410 participants (estimated)

Study arms

  • Active comparator
    Control group

    Heparin dose and cardiopulmonary bypass pump flow rate are calculated using total body weight. An initial 400 IU/Kg Heparin dose will be administered, with an additional dose of 75 IU/kg if the activated clotting time remains below the 425 seconds target value. The cardiopulmonary bypass pump flow rate of 2.4 L/min/m2 of body surface area will be calculated.

    Drug: Heparin · Procedure: cardiopulmonary bypass pump flow rate

  • Experimental
    Intervention group A

    Heparin dose is adjusted for lean body weight and cardiopulmonary bypass pump flow rate is calculated using total body weight. An initial 400 IU/Kg Heparin dose will be administered, with an additional dose of 75 IU/kg if the activated clotting time remains below the 425 seconds target value. The cardiopulmonary bypass pump flow rate of 2.4 L/min/m2 of body surface area will be calculated.

    Drug: Heparin · Procedure: cardiopulmonary bypass pump flow rate

  • Experimental
    Intervention group B

    Heparin dose is calculated using total body weight and cardiopulmonary bypass pump flow rate is adjusted for lean body weight. An initial 400 IU/Kg Heparin dose will be administered, with an additional dose of 75 IU/kg if the activated clotting time remains below the 425 seconds target value. The cardiopulmonary bypass pump flow rate of 2.4 L/min/m2 of body surface area will be calculated.

    Drug: Heparin · Procedure: cardiopulmonary bypass pump flow rate

  • Experimental
    Intervention group C

    Heparin dose and cardiopulmonary bypass pump flow rate are adjusted for lean body weight. An initial 400 IU/Kg Heparin dose will be administered, with an additional dose of 75 IU/kg if the activated clotting time remains below the 425 seconds target value. The cardiopulmonary bypass pump flow rate of 2.4 L/min/m2 of body surface area will be calculated.

    Drug: Heparin · Procedure: cardiopulmonary bypass pump flow rate

Interventions

  • DrugHeparin

    Based on patient body weight (UI/kg)

  • Procedurecardiopulmonary bypass pump flow rate

    Based on patient body weight (L/min/m2)

05

What researchers measure

Primary outcomes

  1. Allogeneic transfusions of red blood cells

    Percentage of subjects avoiding any allogeneic transfusions of red blood cells

    Time frame: Seven days post-operatively or until discharge, whichever comes first

Secondary outcomes

  1. Allogeneic transfusions of blood products

    Percentage of subjects avoiding any allogeneic transfusions

    Time frame: Seven days post-operatively or until discharge, whichever comes first

  2. Units of blood product transfusions

    Number of units of transfused blood products

    Time frame: Seven days post-operatively or until discharge, whichever comes first

  3. Massive red blood cell transfusions

    Percentage of subjects avoiding massive red blood cell transfusion (more than 5 units)

    Time frame: Seven days post-operatively or until discharge, whichever comes first

  4. Post-operative complications

    Monitoring the safety of strategies by monitoring post-operative complications

    Time frame: Post-operatively from day 0 up to first hospital discharge

  5. Bleeding

    Per- and post-operative bleeding

    Time frame: Peroperative, 4 and 24 hours post-operative

06

Study locations

1 of 1 sites recruiting
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT03302195
Lead sponsor
Laval University
Collaborators
Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec
Responsible party
Pierre Voisine (Cardiac surgeon, Laval University) — Principal investigator
First posted
Oct 5, 2017
Start date
Aug 21, 2015
Primary completion
Dec 31, 2024 (estimated)
Completion
Dec 31, 2027 (estimated)
Last update
Mar 10, 2023

Study contacts

Hugo Tremblay, Bachelor
Contact
hugo.tremblay@criucpq.ulaval.ca
418-656-8711 ext. 3797
Pierre Voisine, MD
principal investigator · University Laval

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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