Clinical Investigation of Safety and Performance of a Medical Device (ClearPlasma) for the Treatment of Patients With Acute Upper Gastrointestinal Hemorrhage.

Acute Upper Gastrointestinal Hemorrhage Clinical Trial

Official title:

MULTI-CENTER,DOUBLE-BLIND, RANDOMIZED, TWO-ARMS, CONTROLLED, PROSPECTIVE CLINICAL INVESTIGATION ASSESSING THE SAFETY AND PERFORMANCE OF A CLASS IIb MEDICAL DEVICE (CLEARPLASMATM) FOR THE TREATMENT OF PATIENTS WITH ACUTE UPPER GASTROINTESTINAL HEMORRHAGE.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04174989
• Other study ID #: PLAS-01-2019
• Status: Completed
• Phase: N/A
• Start date: October 24, 2020
• Est. completion date: November 13, 2022

Study information

• Verified date: November 2022
• Source: PlasFree Ltd.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Pre-market, multi-center, international, double-blind, randomized, controlled, prospective, first-in-human clinical investigation of a Class IIb Investigational Medical Device, in which Patients presenting with acute upper gastrointestinal hemorrhage (AUGIH) and due to undergo a plasma transfusion, will be randomized to receive a one-time infusion (up to 8 hours) of up to two 250 mL units of plasminogen-depleted plasma (PDP) or fresh-frozen plasma (FFP). In case of transfusions needing more than two units, the third unit and above will consist in regular plasma for both treatment groups. Patients will be continuously monitored for 8 hours following the transfusion, and will be assessed between 8-12 hours after plasma transfusion or the following morning (the earlier of the two options), between 24-48 hours after plasma transfusion or at discharge (the earlier of the two options) and after 30+/-3 days after transfusion.

Description:

Upper gastrointestinal hemorrhage (UGIH) is one of the most common gastrointestinal emergencies, and is associated with significant morbidity and mortality. Acute upper gastrointestinal hemorrhage (AUGIH) management guidelines call for aggressive hemodynamic resuscitation, prevention and treatment of complications and treatment of bleeding, which generally includes endoscopic intervention and transfusion of appropriate blood components. However, in many cases, spontaneous hyperfibrinolysis occurs, jeopardizing pharmacological control of AUGIH. Antifibrinolytic drugs are considered effective in counteracting hyperfibrinolysis, but are associated with various side effects, such as neurotoxicity and accelerated fibrinolysis upon prolonged use. Fibrin clot breakdown is actively mediated by plasmin, a serine protease which cleaves fibrin. Administration of plasma depleted of plasminogen, the precursor of plasmin, may shift the balance towards coagulation. PlasFree Ltd. has developed ClearPlasma, a single-use, extracorporeal plasma filtration device which extracts plasminogen from plasma to reduce fibrinolysis. The resulting plasminogen-depleted plasma (PDP) is expected to reduce risk of fibrinolysis and re-bleeding in Patients undergoing plasma transfusions. The Primary Objective of this trial is to assess the safety profile of a one-time infusion of up to two units of PDP obtained through filtration with ClearPlasma in Patients presenting with acute upper gastrointestinal hemorrhage and to compare it to the same procedure carried out using FFP units. The Secondary Objective of this trial is to assess the efficacy of a one-time infusion of up to two units of PDP obtained through filtration with ClearPlasma in the reduction of re-bleeding in Patients presenting with acute upper gastrointestinal hemorrhage (as a measure of the performance of ClearPlasma) and to compare it to the same procedure carried out using FFP units.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 53
• Est. completion date: November 13, 2022
• Est. primary completion date: June 30, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Male or female Patients.

2. Patients aged = 18 and = 80 years old.

3. Patients presenting with acute upper gastrointestinal hemorrhage (> 0.5 L), diagnosed by presence of blood in gastric lavage, hematemesis or melena within no longer than 24 h before enrolment.

4. Patients presenting with acute upper gastrointestinal hemorrhage (< 24 h) for which fresh frozen plasma (FFP) has been ordered.

5. Patients understanding the nature of the study and providing their informed consent to participation.

6. Patients willing and able to attend the follow-up visits and procedures foreseen by study protocol.

Exclusion Criteria:

1. Patients who underwent a plasma infusion in the 30 days before enrolment.

2. Patients in a life-threatening condition at the time of enrolment.

3. Patient on anticoagulant therapy at the time of enrolment.

4. Patients with known renal failure (creatinine clearance < 30 mL/min) at the time of enrolment.

5. Patients suffering of Hemophilia A or B.

6. Patients suffering of venous and arterial thromboembolic events within 3 months before the enrolment.

7. Patients with history of allergic reaction to plasma, polyethersyplone or polycarbonate.

8. Patients suffering of IgA deficiency at the time of enrolment.

9. Patients with history of hemorrhage while on anticoagulant treatment (warfarin, apixaban, rivaroxaban, dabigatran, low molecular weight heparin).

10. Patients identified by the Investigator to have any underlying medical conditions that may preclude conduct of study procedure (i.e. making the administration of study treatment hazardous) or obscure the interpretation of safety objectives.

11. Patients who are participating or have participated in other clinical studies within the 30 days before the study enrolment.

12. Women who are pregnant or breast-feeding or who wish to become pregnant during the period of the clinical investigation and for 3 months later.

13. Female Patients of childbearing age (less than 24 months after the last menstrual cycle) who do not use adequate contraception *.

• Methods at low risk of contraceptive failure (less than 1% per year) when used consistently, including: combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable), some intra-uterine devices.

Related Conditions & MeSH terms

• Acute Upper Gastrointestinal Bleeding
• Acute Upper Gastrointestinal Hemorrhage
• Gastrointestinal Hemorrhage
• Hemorrhage

Intervention

Other:
• Plasma treated with ClearPlasma (Extra-corporeal plasma filtration device)
ClearPlasma is designed to specifically extract plasminogen, a protein that drives fibrinolysis, from up to 250 mL of plasma. ClearPlasma is a non-pyrogenic, sterile, single-use medical device that is indicated for use in conditions where massive bleeding situations exist.
• Regular fresh-frozen plasma (not treated)
Regular fresh-frozen plasma (not treated)

Locations

Country	Name	City	State
Czechia	Charles University Teaching Hospital	Hradec Králové
Czechia	University Hospital in Olomouc	Olomouc
Czechia	University Hospital Ostrava	Ostrava
Israel	Wolfson Medical center	Holon
Israel	Department of Surgery B, Meir Medical Center Kfar Saba	Kfar Saba
Israel	Department of Surgery, Rabin Medical Center	Petah Tikva
Italy	S.C. di Anestesia e Rianimazione 1, Azienda Ospedaliera Universitaria Policlinico di Modena	Modena
Italy	Area Medicina D'Urgenza e Pronto Soccorso, Fondazione Policlinico Universitario A. Gemelli	Roma

Sponsors (2)

Lead Sponsor	Collaborator
PlasFree Ltd.	KCRI

Countries where clinical trial is conducted

Czechia,  Israel,  Italy, 

References & Publications (10)

Arya RC, Wander G, Gupta P. Blood component therapy: Which, when and how much. J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):278-84. doi: 10.4103/0970-9185.81849. — View Citation

Association of Anaesthetists of Great Britain and Ireland, Thomas D, Wee M, Clyburn P, Walker I, Brohi K, Collins P, Doughty H, Isaac J, Mahoney PM, Shewry L. Blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia. 2010 Nov;65(11):1153-61. — View Citation

Demarmels Biasiutti F, Sulzer I, Stucki B, Wuillemin WA, Furlan M, Lämmle B. Is plasminogen deficiency a thrombotic risk factor? A study on 23 thrombophilic patients and their family members. Thromb Haemost. 1998 Jul;80(1):167-70. — View Citation

Hirayama F. Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment. Br J Haematol. 2013 Feb;160(4):434-44. doi: 10.1111/bjh.12150. Epub 2012 Dec 6. Review. — View Citation

Matei D, Groza I, Furnea B, Puie L, Levi C, Chiru A, Cruciat C, Mester G, Vesa SC, Tantau M. Predictors of variceal or nonvariceal source of upper gastrointestinal bleeding. An etiology predictive score established and validated in a tertiary referral center. J Gastrointestin Liver Dis. 2013 Dec;22(4):379-84. — View Citation

Pandey S, Vyas GN. Adverse effects of plasma transfusion. Transfusion. 2012 May;52 Suppl 1:65S-79S. doi: 10.1111/j.1537-2995.2012.03663.x. Review. — View Citation

Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995 Jul 22;311(6999):222-6. — View Citation

Rubinstein LV, Steinberg SM, Kummar S, Kinders R, Parchment RE, Murgo AJ, Tomaszewski JE, Doroshow JH. The statistics of phase 0 trials. Stat Med. 2010 May 10;29(10):1072-6. doi: 10.1002/sim.3840. — View Citation

Schuster V, Hügle B, Tefs K. Plasminogen deficiency. J Thromb Haemost. 2007 Dec;5(12):2315-22. Epub 2007 Sep 26. Review. — View Citation

Wilkins T, Khan N, Nabh A, Schade RR. Diagnosis and management of upper gastrointestinal bleeding. Am Fam Physician. 2012 Mar 1;85(5):469-76. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety Profile in Patients treated with PDP versus FFP.	Comparison of adverse events rate during the study period and within 30±3 days after transfusion with PDP (group A) or FFP (group B). All adverse occurrences (serious/non-serious or device-related/non-device related) will be recorded prospectively, categorized and evaluated for causality using defined criteria.	Entire Study Period (up to 1 month per patient).
Secondary	Incidence of re-bleeding episodes in Patients treated with PDP versus FFP.	Comparison of the number of re-bleeding episodes occurring for the Patient throughout the study period and within 30±3 days after transfusion with PDP (group A) or FFP (group B).	Entire Study Period (up to 1 month per patient).
Secondary	Duration of hospital stay in Patients treated with PDP versus FFP.	Comparison of the duration of the hospital stay for the Patient up to 30±3 days after transfusion with PDP (group A) or FFP (group B).	Entire Study Period (up to 1 month per patient) or until patient discharge.
Secondary	CBC profile in Patients treated with PDP versus FFP.	Comparison of complete blood count (CBC) profiles between Patients who received transfusion with PDP (group A) or FFP (group B) at baseline (Screening Visit) versus T=8-12h, T=24-48h and End of Study Visit.	Entire Study Period (up to 1 month per patient).
Secondary	D-dimer profile in Patients treated with PDP versus FFP.	Comparison of D-dimer profiles between Patients who received transfusion with PDP (group A) or FFP (group B) at baseline (Screening Visit) versus T=8-12h, T=24-48h and End of Study Visit.	Entire Study Period (up to 1 month per patient).
Secondary	PT/INR (blood coagulation parameter) measurement in Patients treated with PDP versus FFP.	Comparison of Prothrombin Time and International Normalized Ratio (PT/INR) between Patients who received transfusion with PDP (group A) or FFP (group B) until Patient discharge from hospital.	Entire Study Period (up to 1 month per patient) or until patient discharge.
Secondary	aPTT (blood coagulation parameter) measurement in Patients treated with PDP versus FFP.	Comparison of Activated Partial Thromboplastin Time (aPTT) between Patients who received transfusion with PDP (group A) or FFP (group B) until Patient discharge from hospital.	Entire Study Period (up to 1 month per patient) or until patient discharge.
Secondary	Incidence of venous and arterial thromboembolic events in Patients treated with PDP versus FFP.	Comparison of the incidence of venous and arterial thromboembolic events during the study period and within 30±3 days after transfusion with PDP (group A) or FFP (group B).	Entire Study Period (up to 1 month per patient).
Secondary	Plasma transfusion-related mortality in Patients treated with PDP versus FFP.	Comparison of the plasma transfusion-related mortality during the study period and within 30±3 days after transfusion with PDP (group A) or FFP (group B).	Entire Study Period (up to 1 month per patient).
Secondary	Total blood loss from transfusion in Patients treated with PDP versus FFP.	Comparison of total blood loss from transfusion with PDP (group A) or FFP (group B) until Patient discharge from hospital, as measured by: Red blood cells (RBC) units transfused; Plasma units transfused; Platelet units transfused; Hemoglobin levels.	Entire Study Period (up to 1 month per patient) or until patient discharge.

External Links

•   PlasFree Ltd. official website