High Dose Versus Low Dose Heparinization in Patients Undergoing Offpump Coronary Artery Bypass
试验速览
- 阶段
- 4 期
- 发起方
- 入组人数
- 900
- 试验地点
- 3
- 主要终点
- Composite vascular
研究概览
简要总结
The RATIO Study is a multicenter, nationwide, randomized, controlled, single blinded, unfunded trial of n. 900 patients undergoing multivessel OPCAB (≥2 grafts). This study is designed to test in patients undergoing off-pump coronary artery bypass surgery the hypothesis that full (high dose, 300 U/kg) and half (low dose,150 U/kg) heparinization are not different in terms of thrombotic complications and major perioperative bleeding events (null hypothesis).
详细描述
Off-pump coronary artery bypass grafting (OPCAB) is an established alternative to on-pump coronary artery bypass grafting (CABG). OPCAB determines a pro-coagulant state potentially deleterious on grafts patency, that is not counterbalanced by the adverse effects of cardiopulmonary bypass on coagulation occurring in CABG, and that lasts as long as one month. Therefore in OPCAB systemic heparinization is necessary to prevent thrombotic complications during transitory occlusion of coronary arteries and grafts. An internationally accepted standard intra-operative anticoagulation protocol for OPCAB has not yet been defined, and heparinization in OPCAB is a highly variable practice. The intraoperative anticoagulation regimen adopted in patients undergoing OPCAB may influence major postoperative outcomes, such as bleeding, transfusion requirements, inflammatory response, myocardial ischemia and grafts patency, but it has never been the object of large-scale randomized controlled trial (RCT). The 2 most widespread intraoperative anticoagulation protocols in OPCAB are represented by full (300 U/kg) or half (150 U/kg) heparinization, with target ACT ranging from 200 sec to >480 sec.
Patients enrolled in the study will be randomized to receive full or half heparinization in a 1:1 ratio using a randomization schedule blocked by site. Randomization will take place in the operatory room by the anesthesiologist, and will be blinded to the surgeon.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Investigator)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Consecutive patients electively undergoing multivessel OPCAB
排除标准
- •Acute coronary syndrome, on-going double anti-platelets treatment (the second antiplatelet drug should be suspended 5 days before surgery), on-going intravenous heparin or sub-cutaneous low molecular weight heparin, known coagulopathy, documented liver disease, chronic renal failure (creatinine ≥ 2 mg/dl) or previous renal transplantation surgery, previous cardiac surgery.
研究组 & 干预措施
half heparinization
heparin I.V. 150 U/kg
干预措施: Heparin (Drug)
full heparinization (300 U/kg)
heparin I.V. 300 U/kg
干预措施: Heparin (Drug)
结局指标
主要结局
Composite vascular
时间窗: 30 days post-operatively
Death from vascular causes, perioperative myocardial infarction, stroke.
Composite major bleeding
时间窗: 48 hours post-operatively
Redo for excessive bleeding, cardiac tamponade, transfusion ≥3 Units of packed red cells or of platelets.
次要结局
- Post-operative bleeding(48 hours post-operatively)
- Transfusion of packed red cells (<3 Units) or of platelets(30 days post-operatively)
- Peak value of cardiac biomarker(30 days post-operatively)
- Transient ischemic cerebral attack(30 days post-operatively)
- Mesenteric ischemia (angiography or CT scan)(30 days post-operatively)
- Pulmonary embolus (angiography or CT scan)(30 days post-operatively)
研究者
Michele Triggiani
MD, PhD
Azienda Ospedaliera di Lecco