Major Trauma Clinical Trial
Official title:
RETIC Trial: Reversal of Trauma Induced Coagulopathy Using Coagulation Factor Concentrates or Fresh Frozen Plasma
Severe traumatized patients (ISS > 15) admitted to emergency department (ED) University
Hospital Innsbruck with obvious bleeding and/or who are at risk for significant hemorrhage
will be screened by rotational thrombelastometry (ROTEM) assays during ED treatment and
subsequent surgical/radiological interventions for having coagulopathy (T0). If a patient
meets the inclusion criteria (T1) and is recruited for the study, a first study related
blood sample (40mL) will be drawn, and data collected. Subsequently, 100 patients will be
randomized to receive Fibrinogen concentrate and/or Prothrombin complex concentrate and/or
FXIII concentrate for reversal of coagulopathy, while the other 100 patients will receive
fresh frozen plasma (FFP),respectively.
Treatment failure will be registered if bleeding persists and ROTEM parameters do not
improve after two times dosages of study drug. In these cases haemostatic rescue therapy
will be administered. CFC (fibrinogen concentrate and/or PCC, and/or FXIII concentrate) will
be administered to patients randomized to receive FFP and FFP will be administered to
patients of the CFC group.
In cases unresponsive to comprehensive treatment or normal ROTEM combined with diffuse
bleeding, other haemostatic medications can be administered (e.g rFVIIa, DDAVP, VWF/FVIII
concentrate) as judged by the anesthetist in charge. The need and type of any rescue therapy
will be documented and a ROTEM will be performed thereafter.
At admission to ICU (T0 ICU), 24h (T24 ICU) and 48h(T48 ICU) thereafter further study
related blood samples are drawn (40mL each).
The indications for transfusion of red blood cells or platelets, administration of
antifibrinolytics, treatment of acidosis, hypothermia, hypocalcemia and volume replacement
are similar for both groups and treatment is performed according to clinical routine.
Besides coagulation management during ED treatment until 24h on ICU, patient's care is not
influenced by the study and follows clinical routine.
Status | Terminated |
Enrollment | 100 |
Est. completion date | February 2016 |
Est. primary completion date | February 2016 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years to 80 Years |
Eligibility |
Inclusion Criteria: 1. Male and female subjects =/> 18 years and =/< 80 years 2. Major trauma (ISS > 15) 3. Clinical signs of ongoing bleeding or patients who are at risk for significant haemorrhage assessed and judged by the ED team in charge of patient 4. Presence of coagulopathy defined by ROTEM assays as follows, - Patients with concomitant decreased fibrinogen polymerisation (ROTEMĀ® FibTEM A10 of < 7 mm after 10 min) - Patients with concomitant decreased coagulation factor levels (ROTEMĀ® ExTEM CT of > 90 sec) Exclusion Criteria: 1. Lethal injury 2. CPR on the scene, 3. Isolated brain injury, burn injury 4. Avalanche injury 5. Administration of FFP or coagulation factor concentrates before ED admission 6. Delayed (> 6hours after trauma) admittance to ED 7. Known use of oral anticoagulants, or platelet aggregation inhibitors within 5 days before injury 8. Known history of severe allergic reaction to plasma products 9. Known history of congenital hemostasis disturbance, IgA or Protein C deficiency 10. Patients with a history of thromboembolic events or heparin induced thrombocytopenia (HIT) type 2 within the last year 11. Patients with a body weight < 45kg and > 150kg 12. Patients that are known to be pregnant 13. Jehova's Witness 14. Known participation in another clinical trial 15. Patient with known refusal of a participation in this clinical trial |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
Austria | Medical University Innsbruck / Department for Anesthesia and Intensive Care Medicine | Innsbruck | Tyrol |
Lead Sponsor | Collaborator |
---|---|
Medical University Innsbruck |
Austria,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Multiple Organ Failure (MOF) | Difference in the MOF as assessed by the Sequential Organ Failure Assessment score (SOFA) between treatment groups. | Variable until 24h on ICU at the end of the IMP-administration | No |
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