NCT00420667

Brief Summary

Because the impairment of platelet function may cause excess peri-operative bleeding, pre-operative aspirin discontinuation and heparin bridging are common at cardiac surgery. We aimed to evaluate the impact of a low-molecular-weight-heparin (LMWH), enoxaparin, and unfractionated heparin (UFH) on coagulation parameters and peri-operative bleeding in patients undergoing elective coronary artery bypass grafting (CABG) surgery after aspirin discontinuation. The specific hypothesis of this study was that a 12 h interval is sufficient not to cause excess peri-operative bleeding, and is therefore an optimal compromise between antithrombotic efficacy and haemorrhagic safety.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
43

participants targeted

Target at P25-P50 for not_applicable

Timeline
Completed

Started Nov 2004

Shorter than P25 for not_applicable

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

November 1, 2004

Completed
4 months until next milestone

Primary Completion

Last participant's last visit for primary outcome

March 1, 2005

Completed
2 months until next milestone

Study Completion

Last participant's last visit for all outcomes

May 1, 2005

Completed
1.7 years until next milestone

First Submitted

Initial submission to the registry

January 8, 2007

Completed
3 days until next milestone

First Posted

Study publicly available on registry

January 11, 2007

Completed
Last Updated

November 14, 2022

Status Verified

January 1, 2007

Enrollment Period

4 months

First QC Date

January 8, 2007

Last Update Submit

November 7, 2022

Conditions

Coronary DiseaseCoronary Artery Bypass Grafting

Keywords

unfractionated heparinenoxaparinlow molecular weight heparinbypass surgerybleeding

Outcome Measures

Primary Outcomes (4)

  • Haemoglobin Concentration

  • Haematocrit

  • Platelet count

  • Transfusion Units

Interventions

EnoxaparinDRUG

Eligibility Criteria

Age35 Years - 75 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Patients aged 35-75 years with 3-vessel coronary artery disease (CAD)
  • Candidates to elective CABG

You may not qualify if:

  • Other additional (valve, carotid, etc.) simultaneous surgery required,
  • Off-pump surgery,
  • Any altered liver and kidney laboratory parameters,
  • A history of any haemorrhagic disorders,
  • Platelet count \<100,000 and \>450.000/μL,
  • Treatment with ticlopidine or clopidogrel in the last month.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Institute of Cardiology - S. Camillo Hospital

Chieti, CH, 66100, Italy

Location

Related Publications (16)

  • Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, Hart JC, Herrmann HC, Hillis LD, Hutter AM Jr, Lytle BW, Marlow RA, Nugent WC, Orszulak TA; American College of Cardiology; American Heart Association. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004 Oct 5;110(14):e340-437. No abstract available.

    PMID: 15466654BACKGROUND

  • Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, Thottapurathu L, Krasnicka B, Ellis N, Anderson RJ, Henderson W; VA Cooperative Study Group #207/297/364. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004 Dec 7;44(11):2149-56. doi: 10.1016/j.jacc.2004.08.064.

    PMID: 15582312BACKGROUND

  • Mangano DT; Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002 Oct 24;347(17):1309-17. doi: 10.1056/NEJMoa020798.

    PMID: 12397188BACKGROUND

  • Dacey LJ, Munoz JJ, Johnson ER, Leavitt BJ, Maloney CT, Morton JR, Olmstead EM, Birkmeyer JD, O'Connor GT; Northern New England Cardiovascular Disease Study Group. Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients. Ann Thorac Surg. 2000 Dec;70(6):1986-90. doi: 10.1016/s0003-4975(00)02133-0.

    PMID: 11156107BACKGROUND

  • Ferraris VA, Ferraris SP. 1988: Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting. Updated in 1995. Ann Thorac Surg. 1995 Apr;59(4):1036-7. doi: 10.1016/0003-4975(95)00023-e. No abstract available.

    PMID: 7695387BACKGROUND

  • Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004 Aug;78(2):527-34; discussion 534. doi: 10.1016/j.athoracsur.2004.02.088.

    PMID: 15276512BACKGROUND

  • Sethi GK, Copeland JG, Goldman S, Moritz T, Zadina K, Henderson WG. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy. J Am Coll Cardiol. 1990 Jan;15(1):15-20. doi: 10.1016/0735-1097(90)90168-o.

    PMID: 2404046BACKGROUND

  • Sirvinskas E, Veikutiene A, Grybauskas P, Cimbolaityte J, Mongirdiene A, Veikutis V, Raliene L. Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery. Perfusion. 2006 Jan;21(1):61-6. doi: 10.1191/0267659106pf845oa.

    PMID: 16485701BACKGROUND

  • Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):188S-203S. doi: 10.1378/chest.126.3_suppl.188S.

    PMID: 15383472BACKGROUND

  • Petersen JL, Mahaffey KW, Hasselblad V, Antman EM, Cohen M, Goodman SG, Langer A, Blazing MA, Le-Moigne-Amrani A, de Lemos JA, Nessel CC, Harrington RA, Ferguson JJ, Braunwald E, Califf RM. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes: a systematic overview. JAMA. 2004 Jul 7;292(1):89-96. doi: 10.1001/jama.292.1.89.

    PMID: 15238596BACKGROUND

  • Clark SC, Vitale N, Zacharias J, Forty J. Effect of low molecular weight heparin (fragmin) on bleeding after cardiac surgery. Ann Thorac Surg. 2000 Mar;69(3):762-4; discussion 764-5. doi: 10.1016/s0003-4975(99)01366-1.

    PMID: 10750757BACKGROUND

  • Prandoni P. Heparins and venous thromboembolism: current practice and future directions. Thromb Haemost. 2001 Jul;86(1):488-98.

    PMID: 11487039BACKGROUND

  • Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg. 2001 Jul;88(7):913-30. doi: 10.1046/j.0007-1323.2001.01800.x.

    PMID: 11442521BACKGROUND

  • Jones HU, Muhlestein JB, Jones KW, Bair TL, Lavasani F, Sohrevardi M, Horne BD, Doty D, Lappe DL. Preoperative use of enoxaparin compared with unfractionated heparin increases the incidence of re-exploration for postoperative bleeding after open-heart surgery in patients who present with an acute coronary syndrome: clinical investigation and reports. Circulation. 2002 Sep 24;106(12 Suppl 1):I19-22.

    PMID: 12354703BACKGROUND

  • Burger W, Chemnitius JM, Kneissl GD, Rucker G. Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis. J Intern Med. 2005 May;257(5):399-414. doi: 10.1111/j.1365-2796.2005.01477.x.

    PMID: 15836656BACKGROUND

  • Sun JC, Crowther MA, Warkentin TE, Lamy A, Teoh KH. Should aspirin be discontinued before coronary artery bypass surgery? Circulation. 2005 Aug 16;112(7):e85-90. doi: 10.1161/CIRCULATIONAHA.105.546697. No abstract available.

    PMID: 16103244BACKGROUND

MeSH Terms

Conditions

Coronary DiseaseHemorrhage

Interventions

Enoxaparin

Condition Hierarchy (Ancestors)

Myocardial IschemiaHeart DiseasesCardiovascular DiseasesVascular DiseasesPathologic ProcessesPathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Heparin, Low-Molecular-WeightHeparinGlycosaminoglycansPolysaccharidesCarbohydrates

Study Officials

  • Raffaele De Caterina, MD, PhD

    Institute of Cardiology - G. d'Annunzio University, Chieti

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Professor

Study Record Dates

First Submitted

January 8, 2007

First Posted

January 11, 2007

Study Start

November 1, 2004

Primary Completion

March 1, 2005

Study Completion

May 1, 2005

Last Updated

November 14, 2022

Record last verified: 2007-01

Locations

IT(1)