No High Risk of Hemorrhage Clinical Trial
Official title:
Evaluation of Intermittent Pneumatic Compression Associated With Elastic Stockings and Anticoagulant Prophylaxis Versus Anticoagulant Prophylaxis Alone on Venous Thromboembolism Incidence in ICU Patients Without High Risk of Bleeding
This multicentre open-label randomized parallel-group trial aims to compare the association of intermittent pneumatic compression of the lower limbs + elastic stockings + anticoagulant prophylaxis to anticoagulant prophylaxis alone on the incidence of venous thromboembolism systematically evaluated at day 6, in patients hospitalized in intensive care units and without high bleeding risk.
Background: Venous thromboembolism is a leading cause of morbi-mortality for patients
hospitalized in intensive medical care units. Nevertheless, few studies evaluating
prophylactic methods exist. Data from these studies demonstrate however that unfractionated
heparin and low molecular weight heparin are effective to reduce the incident rate of
asymptomatic deep venous thrombosis (DVT) of the lower limbs by 50 % compared to the absence
of prophylaxis. Rate of asymptomatic DVT remains about 15 %. Mechanical devices such as
elastic stockings (ES) or intermittent pneumatic compression (IPC), devoid of bleeding risk,
can be associated with heparins, with good efficacy in some specific clinical settings. The
effect of combined treatment use has never been evaluated rigorously in intensive medical
care units.
Objective:
To compare the association IPC+ ES + anticoagulant prophylaxis to anticoagulant prophylaxis
alone in patients without high bleeding risk and hospitalized in medical intensive care
units on symptomatic or asymptomatic venous thromboembolism incidence, evaluated
systematically at day 6.
Design: Multicentre open-label randomized parallel-group trial with blinded evaluation of
outcomes, and an inclusion period of 24 month. Brest CIC (Centre d'Investigations cliniques,
research center) coordinates this multicentre trial.
Outcomes:
The primary endpoint is a combined criterion (blindly evaluated) between day 1 and day 6:
1) Non fatal symptomatic venous thromboembolic event (objectively confirmed) between day 1
and day 6, 2) death due to a pulmonary embolism between day 1 and day 6, and 3) asymptomatic
DVT detected by ultrasonography systematically done at day 6.
Patients number:
Assuming a DVT frequency of 10 % in the control group (anticoagulant prophylaxis alone), we
calculated that 1436 patients will be required for the study to have 80% power to detect a
40 % reduction in the relative risk with a two-sided alpha level of 5%. Because of about 20
% deaths in the first days, we decide to increase the number at 1580 subjects.
Statistical analysis:
Efficacy analysis is performed on an 'intention-to-treat' basis. The frequencies of the
combined primary outcome at day 6 are compared between groups using an exact one-sided
Fischer test. Adjustment for stratification variables used Cochran-Mantel-Haenszel test.
Relative risk and absolute risk reduction are computed with their 95% CIs. A logistic
regression model is used to take into account potential imbalance in baseline
characteristics.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment