Tranexamic Acid to Prevent Bleeding After Endoscopic Resection of Large Colorectal Polyps: A Pilot Project

NCT04559880 | Completed Phase 4

• 1 other identifier: 6029804
• Study Type: interventional
• Target: 25
• Locations: 1 country
• Sites: 1

Brief Summary

Colorectal cancer is the second most common cancer in Canada. Colonoscopy and removal of precancerous polyps (polypectomy) reduces the incidence and mortality associated with colorectal cancer. However, polypectomy is associated with adverse events. Post-polypectomy bleeding has a significant impact on the life of the patient as it can require hospitalization, transfusions, repeat colonoscopy and rarely death. It is also a substantial cost to the health care system. There currently is no standard of care to prevent bleeding after polypectomy. Tranexamic acid reduces fibrinolysis by slowing down the conversion of plasminogen to plasmin which may prevent bleeding. Although this medication is used extensively for other purposes, it has not been studied before to prevent post-polypectomy bleeding. This pilot study will examine factors involved in the feasibility of conducting a large-scale randomized controlled trial (RCT). This pilot study will include 25 consecutive patients who are treated with tranexamic acid after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCP's) to prevent PPDB.

Conditions

Polyp, Colorectal

Keywords

Endoscopic Mucosal Resection (EMR); Tranexamic Acid; Colonoscopy

Outcome Measures

Primary Outcomes (4)

• Enrollment frequency

  How many participants are enrolled each week

  Through study completion, an average of 6 months

• Study drug compliance rates

  Number of participants that receive the intravenous tranexamic acid within 2 hours of polyp removal and the number of participants that receive every scheduled dose of the tranexamic acid at home

  Through study completion, an average of 6 months

• Recruitment rates

  How many eligible patients decide to participate in the study

  Through study completion, an average of 6 months

• Follow-up rates

  How many participants complete all follow-up phone calls

  Through study completion, an average of 6 months

Secondary Outcomes (2)

• Adverse events

  Up to 30 days

• Post-procedure bleeding

  Up to 30 days

Study Arms (1)

Tranexamic Acid

EXPERIMENTAL

Intra-procedural tranexamic acid (TXA) - 1 gram, IV Post-procedural tranexamic acid (TXA) - 1 gram, oral, three times per day for 5 days

Drug: Tranexamic Acid Injection [Cyklokapron]

Interventions

Tranexamic Acid Injection [Cyklokapron] DRUG

Intra-procedurally, participants will receive 1 gram of intravenous tranexamic acid immediately following the polypectomy. Participants will also take oral tranexamic acid tablets (three times per day) at home for the five days following the procedure.

Also known as: Tranexamic Acid Oral Tablets [Cyklokapron]

Tranexamic Acid

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged over 18 who have non-pedunculated colorectal polyps,
• Polyps ≥2cm,
• Polyps removed by endoscopic mucosal resection (EMR),
• Agree to be followed up by phone,
• Ability to read and understand the English language.

You may not qualify if:

• Patients who have inflammatory bowel disease,
• Diagnosed bleeding disorder,
• Ulcerated morphology of polyps or those with proven invasive cancer,
• Patients with a history of or are at higher risk of thromboembolic events (atrial fibrillation on anticoagulation, history of stroke, transient ischemic attack (TIA), pulmonary embolism, deep vein thrombosis, hypercoagulable state, oral contraceptive pill (OCP) or hormone replacement therapy use, mechanical heart valve on anticoagulation, myocardial infarction in the last twelve months, retinal vein or retinal artery occlusion),
• Unable to provide follow up,
• Unable to provide consent,
• Pregnancy,
• Patients undergoing endoscopic submucosal dissection (ESD),
• Seizure disorder,
• Ureteral obstruction within past 6 months,
• Subarachnoid hemorrhage within past 6 months,
• A diagnosed acquired defective colour vision disorder.

Sponsors & Collaborators

• Lawrence Charles Hookey: lead
• Queen's University: collaborator

Study Sites (1)

Kingston Health Sciences Centre - Hotel Dieu Hospital Site

Kingston, Ontario, K7L 5G2, Canada

Location

Related Publications (14)

• Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013 Sep 19;369(12):1095-105. doi: 10.1056/NEJMoa1301969.

  PMID: 24047059 RESULT

• ASGE Standards of Practice Committee; Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, Evans JA, Fanelli RD, Fukami N, Hwang JH, Jain R, Jue TL, Khan KM, Malpas PM, Sharaf RN, Shergill AK, Dominitz JA. Complications of colonoscopy. Gastrointest Endosc. 2011 Oct;74(4):745-52. doi: 10.1016/j.gie.2011.07.025. No abstract available.

  PMID: 21951473 RESULT

• Albeniz E, Fraile M, Ibanez B, Alonso-Aguirre P, Martinez-Ares D, Soto S, Gargallo CJ, Ramos Zabala F, Alvarez MA, Rodriguez-Sanchez J, Mugica F, Nogales O, Herreros de Tejada A, Redondo E, Pin N, Leon-Brito H, Pardeiro R, Lopez-Roses L, Rodriguez-Tellez M, Jimenez A, Martinez-Alcala F, Garcia O, de la Pena J, Ono A, Alberca de Las Parras F, Pellise M, Rivero L, Saperas E, Perez-Roldan F, Pueyo Royo A, Eguaras Ros J, Zuniga Ripa A, Concepcion-Martin M, Huelin-Alvarez P, Colan-Hernandez J, Cubiella J, Remedios D, Bessa I Caserras X, Lopez-Viedma B, Cobian J, Gonzalez-Haba M, Santiago J, Martinez-Cara JG, Valdivielso E, Guarner-Argente C; Endoscopic Mucosal Resection Endoscopic Spanish Society Group. A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions. Clin Gastroenterol Hepatol. 2016 Aug;14(8):1140-7. doi: 10.1016/j.cgh.2016.03.021. Epub 2016 Mar 24.

  PMID: 27033428 RESULT

• Pohl H, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, Khashab MA, Sanaei O, Al-Kawas FH, Gordon SR, Mathew A, Levenick JM, Aslanian HR, Antaki F, von Renteln D, Crockett SD, Rastogi A, Gill JA, Law RJ, Elias PA, Pellise M, Wallace MB, Mackenzie TA, Rex DK. Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial. Gastroenterology. 2019 Oct;157(4):977-984.e3. doi: 10.1053/j.gastro.2019.03.019. Epub 2019 Mar 15.

  PMID: 30885778 RESULT

• Feagins LA. Colonoscopy, Polypectomy, and the Risk of Bleeding. Med Clin North Am. 2019 Jan;103(1):125-135. doi: 10.1016/j.mcna.2018.08.003. Epub 2018 Nov 1.

  PMID: 30466669 RESULT

• Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, Senore C, Spada C, Bellisario C, Bhandari P, Rex DK. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut. 2016 May;65(5):806-20. doi: 10.1136/gutjnl-2014-308481. Epub 2015 Feb 13.

  PMID: 25681402 RESULT

• Burgess NG, Metz AJ, Williams SJ, Singh R, Tam W, Hourigan LF, Zanati SA, Brown GJ, Sonson R, Bourke MJ. Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol. 2014 Apr;12(4):651-61.e1-3. doi: 10.1016/j.cgh.2013.09.049. Epub 2013 Oct 1.

  PMID: 24090728 RESULT

• Forbes N, Frehlich L, James MT, Hilsden RJ, Kaplan GG, Wilson TA, Lorenzetti DL, Tate DJ, Bourke MJ, Heitman SJ. Routine Prophylactic Endoscopic Clipping Is Not Efficacious in the Prevention of Delayed Post-Polypectomy Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Can Assoc Gastroenterol. 2019 Aug;2(3):105-117. doi: 10.1093/jcag/gwy033. Epub 2018 Jul 20.

  PMID: 31294373 RESULT

• Albeniz E, Alvarez MA, Espinos JC, Nogales O, Guarner C, Alonso P, Rodriguez-Tellez M, Herreros de Tejada A, Santiago J, Bustamante-Balen M, Rodriguez Sanchez J, Ramos-Zabala F, Valdivielso E, Martinez-Alcala F, Fraile M, Elosua A, Guerra Veloz MF, Ibanez Beroiz B, Capdevila F, Enguita-German M. Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding. Gastroenterology. 2019 Nov;157(5):1213-1221.e4. doi: 10.1053/j.gastro.2019.07.037. Epub 2019 Jul 27.

  PMID: 31362007 RESULT

• Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013 Mar;17(10):1-79. doi: 10.3310/hta17100.

  PMID: 23477634 RESULT

• WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017 May 27;389(10084):2105-2116. doi: 10.1016/S0140-6736(17)30638-4. Epub 2017 Apr 26.

  PMID: 28456509 RESULT

• Bennett C, Klingenberg SL, Langholz E, Gluud LL. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2014 Nov 21;2014(11):CD006640. doi: 10.1002/14651858.CD006640.pub3.

  PMID: 25414987 RESULT

• Smith SR, Murray D, Pockney PG, Bendinelli C, Draganic BD, Carroll R. Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial. Dis Colon Rectum. 2018 Jan;61(1):99-106. doi: 10.1097/DCR.0000000000000943.

  PMID: 29215478 RESULT

• Grass F, Braafladt S, Alabbad J, Lovely JK, Kelley SR, Mathis KL, Huebner M, Larson DW. The effects of tranexamic acid on blood loss and transfusion rate in colorectal surgery. Am J Surg. 2019 Nov;218(5):876-880. doi: 10.1016/j.amjsurg.2019.03.013. Epub 2019 Mar 15.

  PMID: 30926155 RESULT

MeSH Terms

Conditions

Polyps

Interventions

Tranexamic Acid

Condition Hierarchy (Ancestors)

Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Cyclohexanecarboxylic Acids; Acids, Carbocyclic; Carboxylic Acids; Organic Chemicals

Study Officials

• Robert Bechara, MD

  Queen's University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NA
• Masking: NONE
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Director, Endoscopy

Model Details: 25 consecutive patients treated with tranexamic acid after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCP's) to prevent post-polypectomy delayed bleeding (PPDB).

Study Record Dates

• First Submitted: September 10, 2020
• First Posted: September 23, 2020
• Study Start: September 10, 2020
• Primary Completion: October 10, 2021
• Study Completion: April 1, 2023
• Last Updated: April 3, 2024

Record last verified: 2024-04

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)