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Trial registered on ANZCTR
Registration number
ACTRN12613001324707
Ethics application status
Not yet submitted
Date submitted
26/11/2013
Date registered
2/12/2013
Date last updated
2/12/2013
Type of registration
Prospectively registered
Titles & IDs
Public title
Low-dose heparin in critically ill patients undergoing extracorporeal membrane oxygenation – Feasibility study
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Scientific title
Feasibility of administrating a low dose anti coagulant in critically ill patients undergoing Extracorporeal Membrane Oxygenation: a pilot study
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Secondary ID [1]
283654
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
critically ill patients undergoing extracorporeal membrane oxygenation
290605
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Condition category
Condition code
Blood
290995
290995
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0
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Clotting disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Critically ill patients undergoing extracorporeal membrane oxygenation in this group will receive heparin infusion, based on weight (if body weight <50 kg: 8 000 units/24 hours; if body weight comprised between 50 and 70 kg: heparin 10 000 units /24 hours; if body weight >70 kg: 12 000 units/ 24 hours) in absence of any indication for full systemic anticoagulation, and in absence of bleeding. If the Activated Partial Thromboplastin Time (APTT) is higher than 45, the heparin will be withhold until the APTT is equal or less than 45seconds. The APTT is monitored 6 hourly. The intervention will last until the ECMO is removed
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Intervention code [1]
288356
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Prevention
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Comparator / control treatment
Critically ill patients undergoing extra corporeal membrane oxygenation usually receive full systemic anti coagulation with infusion of heparin over 24 hours, unless the patient is bleeding. The dose of heparin is variable between patients and is based on an APTT comprised between 50 and 70 seconds. This treatment is given over the ECMO course.
This control group is standard practice where the study is going to be conducted.
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Control group
Dose comparison
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Outcomes
Primary outcome [1]
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Primary Endpoints for feasibility:
Difference in the mean daily dose of heparin between both study groups
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Assessment method [1]
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Timepoint [1]
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At the end of extra corporeal membrane oxygenation course
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Primary outcome [2]
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Primary Endpoints for safety:
Incidence of ECMO circuit thrombosis requiring circuit change
Incidence of new major systemic thromboembolic events defined as stroke, limb ischemia related to intravascular
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Assessment method [2]
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Timepoint [2]
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At the end of extra corporeal membrane oxygenation course
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Primary outcome [3]
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Difference in the mean APTT and the mean anti-Xa between both study groups thrombosis or emboli or intra-cardiac thrombus
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Assessment method [3]
290990
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Timepoint [3]
290990
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at the end of the ECMO course
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Secondary outcome [1]
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Number of RBC administered per ECMO day
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Assessment method [1]
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Timepoint [1]
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At ECMO ceased, ICU discharge and hospital discharge
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Secondary outcome [2]
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Number of days on the bleeding management protocol
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Assessment method [2]
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Timepoint [2]
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end of ECMO course
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Secondary outcome [3]
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Bleeding events defined by a bleeding associated with either a drop in haemoglobin concentration by 20 g/L or a transfusion of at least 2 units of packed red blood cells/24 hours
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Assessment method [3]
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Timepoint [3]
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until the end of ECMO course
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Secondary outcome [4]
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ICU and Hospital mortality
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Assessment method [4]
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Timepoint [4]
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ICU and Hospital discharge
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Secondary outcome [5]
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ICU and Hospital length of stay
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Assessment method [5]
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Timepoint [5]
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ICU and hospital discharge
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Secondary outcome [6]
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New pulmonary emboli and deep vein thrombosis
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Assessment method [6]
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Timepoint [6]
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ICU discharge
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Secondary outcome [7]
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Number of blood product transfused (Red Blood cells, fresh frozen plasma, Platelets) during the ICU stay and after randomisation
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Assessment method [7]
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Timepoint [7]
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ICU discharge
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Secondary outcome [8]
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Number of blood stream infection diagnosed post randomisation in ICU
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Assessment method [8]
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Timepoint [8]
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ICU discharge
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Eligibility
Key inclusion criteria
patients hospitalised in intensive care unit who require ECMO or on ECMO for less than 48 hours.
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Minimum age
16
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Age younger than 16 years
Pregnancy
Known objection to the administration of human blood products
Participation in a competing study on anticoagulation
Heparin-induced thrombocytopenia
Any pre-existing indication for prolonged full dose anti-coagulation: long-term warfarin for atrial fibrillation), pulmonary emboli, deep venous thrombosis, intra-cardiac thrombus
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 1 / Phase 2
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
3/03/2014
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Address [1]
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Country [1]
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Primary sponsor type
Hospital
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Name
Alfred Hospital
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Address
Alfred Hospital
89 Commercial Road
3004 Melbourne
Victoria
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
287048
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Country [1]
287048
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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Alfred Hospital Ethic Committee
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Ethics committee address [1]
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Alfred Hospital 89 Commercial Road, Melbourne 3004 VIC
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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18/11/2013
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Approval date [1]
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Ethics approval number [1]
290225
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Summary
Brief summary
Extra corporeal membrane oxygenation (ECMO) in intensive care unit (ICU) is a rescue therapy for reversible cardiac and/or respiratory failures. It can also provide support until cardiac or lung transplantation. Haemorrhagic complications are the most frequent of the complications occurring on ECMO, and they have been shown to independently impact on patients’ prognosis. Although some of the haemorrhagic complications may be related to patient severity or patient disease, improving anticoagulation management may prevent some bleeding events and improve patient outcome. The primary aim of this study is to determine the feasibility of administrating low dose anti coagulation in critically ill patients on ECMO when there is no indication for full systemic anticoagulation We will randomise 20 patients so that 10 will receive low dose heparin and compare their complications and outcomes to the other 10 patients treated with the standard dose of heparin.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Jamie D Cooper
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Address
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The Alfred Hospital
Intensive Care Unit
89 Commercial Road, Melbourne 3004
VIC
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Country
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Australia
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Phone
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+61 3 9903 0343
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Cecile Aubron
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Address
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ANZIC-RC, DEPM, Monash University
The Alfred Centre
99 Commercial Road
3004 Melbourne
VIC
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Country
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Australia
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Phone
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+61399030068
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Cecile Aubron
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Address
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ANZIC-RC, DEPM, Monash University
The Alfred Centre
99 Commercial Road
3004 Melbourne
VIC
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Country
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Australia
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Phone
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+61399030068
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Low-Dose Versus Therapeutic Anticoagulation in Patients on Extracorporeal Membrane Oxygenation: A Pilot Randomized Trial.
2019
https://dx.doi.org/10.1097/CCM.0000000000003780
N.B. These documents automatically identified may not have been verified by the study sponsor.
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