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Trial registered on ANZCTR
Registration number
ACTRN12622000995774p
Ethics application status
Submitted, not yet approved
Date submitted
5/07/2022
Date registered
15/07/2022
Date last updated
15/07/2022
Date data sharing statement initially provided
15/07/2022
Type of registration
Prospectively registered
Titles & IDs
Public title
Tranexamic Acid and Cancer Recurrence after Gastrointestinal Cancer Surgery; A nested substudy of the Tranexamic Acid to Reduce Infection After Gastrointestinal Cancer Surgery (TRIGS) trial
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Scientific title
Tranexamic Acid and Cancer Recurrence after Gastrointestinal cancer Surgery
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Secondary ID [1]
307497
0
NIL
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Universal Trial Number (UTN)
U1111-1280-0254
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Trial acronym
TRIGS Cancer recurrence
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Linked study record
This is a nested substudy of the Tranexamic Acid to Reduce Infection After Gastrointestinal Cancer Surgery (TRIGS) trial NCT04192435'
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Health condition
Health condition(s) or problem(s) studied:
Cancer recurrence
326907
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Gastric cancer
326908
0
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Oesophageal cancer
326971
0
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Hepatobiliary cancer
326972
0
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Pancreatic cancer
326973
0
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Colorectal cancer
326974
0
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Condition category
Condition code
Cancer
324107
324107
0
0
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Biliary tree (gall bladder and bile duct)
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Cancer
324155
324155
0
0
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Bowel - Anal
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Cancer
324156
324156
0
0
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Bowel - Back passage (rectum) or large bowel (colon)
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Cancer
324157
324157
0
0
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Bowel - Small bowel (duodenum and ileum)
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Cancer
324158
324158
0
0
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Liver
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Cancer
324159
324159
0
0
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Oesophageal (gullet)
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Cancer
324161
324161
0
0
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Pancreatic
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Cancer
324162
324162
0
0
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Stomach
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Intervention/exposure
Study type
Observational
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Patient registry
True
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Target follow-up duration
5
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Target follow-up type
Years
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Description of intervention(s) / exposure
This substudy nested within the multicentre, pragmatic, double-blind, randomised TRIGS trial NCT04192435. Assessment will be completed once at 5 years post operatively via cancer registry and the National Death Index (NDI will compare cancer-free survival in patients receiving tranexamic acid, or matched p)lacebo, for gastrointestinal cancer surgery. All adult patients scheduled for elective or semi-elective open or lap-assisted gastrointestinal cancer surgery (oesophageal, gastric, hepatobiliary, pancreatic, colorectal) with one or more risk factors for complications, will be included.
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Intervention code [1]
323955
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Diagnosis / Prognosis
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Comparator / control treatment
Patient recruited to the Trigs trial (NCT04192435) undergoing cancer surgery matched placebo) - A bolus of study drug, 0.15 ml/kg of placebo)) undergoing cancer surgery before surgical incision, and then infusion at 0.05 ml/kg/h until the end of surgery
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Control group
Placebo
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Outcomes
Primary outcome [1]
331911
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Cancer-free survival form state cancer registries
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Assessment method [1]
331911
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Timepoint [1]
331911
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5 years from Gastrointestinal surgery
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Secondary outcome [1]
411583
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All-cause 5-year mortality
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Assessment method [1]
411583
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Timepoint [1]
411583
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5 years from Gastrointestinal surgery, will be collected from the National death Index (NDI)
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Eligibility
Key inclusion criteria
Patients undergoing cancer surgery (oesophageal, gastric, hepatobiliary, pancreatic, colorectal) and enrolled in the TRIGS Trial (NCT04192435.)
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Minimum age
18
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
NONE
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
Analyses will be modified intention-to-treat, whereby all patients randomly assigned to treatment group and undergo a surgical incision will be analysed according to the group to which they were assigned. Survival outcomes will be analysed using Cox proportional hazards model, adjusting for the stratifying variable of diabetes status, and adjusting for cancer staging at the time of surgery (spread yes/no), with results expressed as hazard ratios and 95% CI. Baseline characteristics of the two randomised groups will be tabulated and compared using appropriate summary statistics. Time to recurrence and, separately, time to death from any cause will be compared graphically between groups by Kaplan-Meier survival curves, summarized by median times to event with interquartile ranges, and assessed using the Cox proportional hazards model, adjusting for the stratifying variable of diabetes status. Cox proportional hazards model will be used to adjust for imbalances of potentially important covariates, with assessment of the requisite proportionality assumptions.
The effect of treatment on primary and secondary outcomes in pre-specified subgroups based on patient sex, age, diabetes, ASA physical status, surgery type, and cancer staging at the time of surgery (spread yes/no), will be assessed through the inclusion of treatment-by-subgroup interaction terms in regression models. All reported P values will be 2-sided and not adjusted for multiple comparisons. Multiple imputation will be applied to assess the sensitivity of results to missing outcome data if the proportion of missingness is >5%.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/08/2022
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Actual
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Date of last participant enrolment
Anticipated
31/12/2025
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Actual
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Date of last data collection
Anticipated
31/12/2030
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Actual
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Sample size
Target
1400
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,QLD,SA,TAS,WA,VIC
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Recruitment hospital [1]
22714
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The Alfred - Melbourne
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Recruitment hospital [2]
22715
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Frankston Hospital - Frankston
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Recruitment hospital [3]
22716
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Austin Health - Austin Hospital - Heidelberg
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Recruitment hospital [4]
22717
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Ballarat Health Services (Base Hospital) - Ballarat Central
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Recruitment hospital [5]
22718
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Epworth Eastern Hospital - Box Hill
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Recruitment hospital [6]
22719
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Epworth Richmond - Richmond
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Recruitment hospital [7]
22720
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Barwon Health - Geelong Hospital campus - Geelong
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Recruitment hospital [8]
22721
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Monash Medical Centre - Clayton campus - Clayton
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Recruitment hospital [9]
22722
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Royal Melbourne Hospital - City campus - Parkville
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Recruitment hospital [10]
22723
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St Vincent's Hospital (Melbourne) Ltd - Fitzroy
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Recruitment hospital [11]
22724
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Footscray Hospital - Footscray
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Recruitment hospital [12]
22725
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The Avenue Private Hospital - Windsor
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Recruitment hospital [13]
22727
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Cabrini Hospital - Malvern - Malvern
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Recruitment hospital [14]
22728
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Werribee Mercy Hospital - Werribee
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Recruitment hospital [15]
22729
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Peter MacCallum Cancer Centre - Melbourne
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Recruitment hospital [16]
22730
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Goulburn Valley Health - Shepparton campus - Shepparton
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Recruitment hospital [17]
22731
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La Trobe Private Hospital - Bundoora
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Recruitment hospital [18]
22732
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Northeast Health Wangaratta - Wangaratta
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Recruitment hospital [19]
22733
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Prince of Wales Private Hospital - Randwick
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Recruitment hospital [20]
22734
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Gosford Hospital - Gosford
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Recruitment hospital [21]
22735
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Westmead Hospital - Westmead
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Recruitment hospital [22]
22736
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John Hunter Hospital - New Lambton
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Recruitment hospital [23]
22737
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Blacktown Hospital - Blacktown
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Recruitment hospital [24]
22738
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The Tweed Hospital - Tweed Heads
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Recruitment hospital [25]
22739
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St Vincent's Hospital (Darlinghurst) - Darlinghurst
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Recruitment hospital [26]
22740
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Royal Prince Alfred Hospital - Camperdown
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Recruitment hospital [27]
22741
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Wollongong Hospital - Wollongong
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Recruitment hospital [28]
22742
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The Royal Adelaide Hospital - Adelaide
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Recruitment hospital [29]
22743
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Royal Hobart Hospital - Hobart
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Recruitment hospital [30]
22744
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Gold Coast Hospital - Southport
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Recruitment hospital [31]
22745
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The Prince Charles Hospital - Chermside
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Recruitment hospital [32]
22746
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Princess Alexandra Hospital - Woolloongabba
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Recruitment hospital [33]
22747
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Royal Brisbane & Womens Hospital - Herston
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Recruitment hospital [34]
22748
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Redcliffe Hospital - Redcliffe
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Recruitment hospital [35]
22749
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Caboolture Hospital - Caboolture
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Recruitment hospital [36]
22750
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Mackay Base Hospital - Mackay
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Recruitment hospital [37]
22751
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Queen Elizabeth II Jubilee Hospital - Coopers Plains
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Recruitment hospital [38]
22752
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Logan Hospital - Meadowbrook
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Recruitment hospital [39]
22753
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St John of God Hospital, Subiaco - Subiaco
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Recruitment hospital [40]
22754
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Royal Perth Hospital - Perth
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Recruitment hospital [41]
22755
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Sir Charles Gairdner Hospital - Nedlands
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Recruitment postcode(s) [1]
37993
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3004 - Melbourne
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Recruitment postcode(s) [2]
37994
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3199 - Frankston
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Recruitment postcode(s) [3]
37995
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3084 - Heidelberg
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Recruitment postcode(s) [4]
37996
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3350 - Ballarat Central
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Recruitment postcode(s) [5]
37997
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3128 - Box Hill
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Recruitment postcode(s) [6]
37998
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3121 - Richmond
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Recruitment postcode(s) [7]
37999
0
3220 - Geelong
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Recruitment postcode(s) [8]
38000
0
3168 - Clayton
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Recruitment postcode(s) [9]
38001
0
3050 - Parkville
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Recruitment postcode(s) [10]
38002
0
3065 - Fitzroy
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Recruitment postcode(s) [11]
38003
0
3011 - Footscray
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Recruitment postcode(s) [12]
38004
0
3181 - Windsor
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Recruitment postcode(s) [13]
38006
0
3144 - Malvern
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Recruitment postcode(s) [14]
38007
0
3030 - Werribee
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Recruitment postcode(s) [15]
38008
0
3630 - Shepparton
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Recruitment postcode(s) [16]
38009
0
3083 - Bundoora
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Recruitment postcode(s) [17]
38010
0
3677 - Wangaratta
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Recruitment postcode(s) [18]
38011
0
2031 - Randwick
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Recruitment postcode(s) [19]
38012
0
2250 - Gosford
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Recruitment postcode(s) [20]
38013
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2145 - Westmead
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Recruitment postcode(s) [21]
38014
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2305 - New Lambton
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Recruitment postcode(s) [22]
38015
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2148 - Blacktown
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Recruitment postcode(s) [23]
38016
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2485 - Tweed Heads
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Recruitment postcode(s) [24]
38017
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2010 - Darlinghurst
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Recruitment postcode(s) [25]
38018
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2050 - Camperdown
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Recruitment postcode(s) [26]
38019
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2500 - Wollongong
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Recruitment postcode(s) [27]
38020
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5000 - Adelaide
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Recruitment postcode(s) [28]
38021
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7000 - Hobart
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Recruitment postcode(s) [29]
38022
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4215 - Southport
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Recruitment postcode(s) [30]
38023
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4032 - Chermside
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Recruitment postcode(s) [31]
38024
0
4102 - Woolloongabba
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Recruitment postcode(s) [32]
38025
0
4029 - Herston
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Recruitment postcode(s) [33]
38026
0
4020 - Redcliffe
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Recruitment postcode(s) [34]
38027
0
4510 - Caboolture
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Recruitment postcode(s) [35]
38028
0
4740 - Mackay
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Recruitment postcode(s) [36]
38029
0
4108 - Coopers Plains
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Recruitment postcode(s) [37]
38030
0
4131 - Meadowbrook
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Recruitment postcode(s) [38]
38031
0
6008 - Subiaco
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Recruitment postcode(s) [39]
38032
0
6000 - Perth
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Recruitment postcode(s) [40]
38033
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6009 - Nedlands
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Funding & Sponsors
Funding source category [1]
311812
0
Self funded/Unfunded
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Name [1]
311812
0
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Address [1]
311812
0
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Country [1]
311812
0
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Primary sponsor type
University
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Name
Monash University
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Address
Monash University
of Wellington Road, Clayton, Victoria Australia 3800
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Country
Australia
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Secondary sponsor category [1]
313246
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None
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Name [1]
313246
0
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Address [1]
313246
0
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Country [1]
313246
0
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
311217
0
Alfred Hospital research and Ethics committee
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Ethics committee address [1]
311217
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Alfred Health 55 commercial road Melbourne 3004 Vic
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Ethics committee country [1]
311217
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Australia
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Date submitted for ethics approval [1]
311217
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06/07/2022
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Approval date [1]
311217
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Ethics approval number [1]
311217
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Summary
Brief summary
Tranexamic acid is an antifibrinolytic drug routinely used to reduce bleeding in cardiac and some orthopaedic surgery, which has also been shown to affect immune function and inflammation. There is a strong biological rationale suggesting that tranexamic acid may reduce micrometastases at the time of surgery and so reduce the risk of longer term cancer-recurrence. Therefore, the aim of this nested study is to assess the cancer-free survival of a subpopulation of participants involved in the TRIGS trial (NCT04192435) undergoing surgery for gastrointestinal cancer, who are planned to receive either tranexamic acid or placebo. Who is it for? You may be eligible for this study if you are aged 18 years or over, are enrolled in the TRIGS trial, and are scheduled for elective or semi-elective (inpatient) open or laparoscopic-assisted (i.e. keyhole) gastrointestinal cancer surgery (oesophageal, gastric, hepatobiliary, pancreatic, colorectal). Study details All participants will be assessed for cancer-free survival at 5 years after gastrointestinal surgery using state cancer registries to determine the incidence of all-cause mortality and overall survival at 5 years post-surgery. It is hoped that this study may show tranexamic acid improves cancer-free survival, improves overall survival, and reduces all-cause mortality when administered at the time of gastrointestinal cancer surgery, which may help to guide the treatment of gastrointestinal cancer patients in future.
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Trial website
www.trigs.org.au
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
120366
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Prof Paul Myles
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Address
120366
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Department of Anaesthesiology and Perioperative Medicine
55 Commercial Road
Melbourne VIC 3004
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Country
120366
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Australia
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Phone
120366
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+613 90762651
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Fax
120366
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+613390768076
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Email
120366
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[email protected]
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Contact person for public queries
Name
120367
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Sophie Wallace
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Address
120367
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Department of Anaesthesiology and Perioperative Medicine
55 Commercial Road
Melbourne VIC 3004
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Country
120367
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Australia
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Phone
120367
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+61 390762651
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Fax
120367
0
+613390768076
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Email
120367
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[email protected]
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Contact person for scientific queries
Name
120368
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Paul Myles
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Address
120368
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Department of Anaesthesiology and Perioperative Medicine
55 Commercial Road
Melbourne VIC 3004
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Country
120368
0
Australia
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Phone
120368
0
+613 90763176
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Fax
120368
0
+613390768076
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Email
120368
0
[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Initial approval from AIHW will be required prior to IPD sharing to be ticked
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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
No additional documents have been identified.
Download to PDF