Pacemaker Implantation Clinical Trial
Official title:
Pocket Haematoma Prevention in Patients Who Required Implantation/Replacement of a Pacemaker or Implantable Cardiac Defibrillator (ICD) During Dual Antiplatelet or Anticoagulant Therapy. A Prospective Randomized Trial. The PHP Study.
The aim of this study is to demonstrate the efficacy of fibrin sealant (Tissucol-Baxter) in
preventing pocket haematoma and subsequent complications in patients undergoing pacemaker or
ICD implantation/replacement which cannot discontinue dual antiplatelet therapy (i.e. ASA
and clopidogrel, ASA and prasugrel) or anticoagulant therapy (i.e. warfarin, heparin, low
molecular weight heparin).
Fibrin-based sealant is available for local haemostasis. A recent study (Milic DJ et al,
2005 Europace, 7: 374-379) has shown the efficacy of the fibrin sealant in prevention of
pacemaker pocket haematoma in 40 patients undergoing pacemaker implantation who are
receiving anticoagulant treatment.
Patients with dual antiplatelet therapy (DAT) are prone to a high risk of bleeding during
surgical procedures. Thus, the routine use is the discontinuation of DAT al least 4-7 days
before the intervention. This practice may result in a high risk of thrombotic events in
patients with coronary stenting.
Recently, in our Center we started the use of a fibrin sealant for local haemostasis
(Tissucol Baxter), and the investigators observed a reduction in the incidence of pocket
haematoma complication, the need of vacuum drainage system, and the reduction of hospital
stay.
Purpose of the study. The purpose of this study is to demonstrate the efficacy of a fibrin
sealant (Tissucol-Baxter) in prevention pocket haematoma and subsequent complications in
patients who required implantation/replacement of a pacemaker or ICD wich cannot discontinue
dual antiplatelet or anticoagulant therapy.
Target. The primary endpoint is to test the impact of pocket haematoma in patients treated
with tissucol compared to a conventional treatment with vacuum drainage system without dual
antiplatelet or anticoagulant therapy discontinuation.
The secondary endpoint is to compare the length of hospitalization between the two groups.
Type of study. Prospective, randomized, single center, open label.
Materials and methods. Will be consecutively enrolled approximately 100 patients.
Inclusion criteria: patients over the age of eighteen who require an initial implantation or
replacement of a device (pacemaker, biventricular pacemaker, ICD) treated with:
- dual antiplatelet therapy (clopidogrel or prasugrel or ticlopidine, and acetylsalicylic
acid) or
- anticoagulants (warfarin or heparin or low molecular weight heparin). Patients Do not
discontinue the antiplatelet or anticoagulant therapy.
According to a randomization list, patients will be assigned to tissucol treatment or vacuum
drainage system:
- 50 patients: treated with local application of tissucol in the pocket of pacemaker/ICD;
- 50 patients: treated with vacuum drainage system.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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