Trial Outcomes & Findings for PCC vs. FFP for Post Cardiopulmonary Bypass Coagulopathy and Bleeding (NCT NCT02557672)

NCT ID: NCT02557672

Last Updated: 2022-06-07

Results Overview

The amount of chest tube drainage output from after surgery through midnight of the next day. As measured in mL.

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

106 participants

Primary outcome timeframe

24 hours

Results posted on

2022-06-07

Participant Flow

Participant milestones

Participant milestones
Measure
Fresh Frozen Plasma
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (PCC) (Human): PCC (Kcentra)
Overall Study
STARTED
53
53
Overall Study
COMPLETED
49
51
Overall Study
NOT COMPLETED
4
2

Reasons for withdrawal

Reasons for withdrawal
Measure
Fresh Frozen Plasma
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (PCC) (Human): PCC (Kcentra)
Overall Study
Withdrawal by Subject
4
2

Baseline Characteristics

PCC vs. FFP for Post Cardiopulmonary Bypass Coagulopathy and Bleeding

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Fresh Frozen Plasma
n=49 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Total
n=100 Participants
Total of all reporting groups
Age, Continuous
65.6 years
STANDARD_DEVIATION 14.6 • n=39 Participants
68.1 years
STANDARD_DEVIATION 12.8 • n=41 Participants
66.8 years
STANDARD_DEVIATION 13.7 • n=35 Participants
Sex: Female, Male
Female
14 Participants
n=39 Participants
25 Participants
n=41 Participants
39 Participants
n=35 Participants
Sex: Female, Male
Male
35 Participants
n=39 Participants
26 Participants
n=41 Participants
61 Participants
n=35 Participants
Race/Ethnicity, Customized
White
48 Participants
n=39 Participants
50 Participants
n=41 Participants
98 Participants
n=35 Participants
Race/Ethnicity, Customized
Hispanic or Latino
1 Participants
n=39 Participants
0 Participants
n=41 Participants
1 Participants
n=35 Participants
Race/Ethnicity, Customized
Black or African American
0 Participants
n=39 Participants
1 Participants
n=41 Participants
1 Participants
n=35 Participants
Region of Enrollment
United States
49 participants
n=39 Participants
51 participants
n=41 Participants
100 participants
n=35 Participants

PRIMARY outcome

Timeframe: 24 hours

Population: 1 subject's data was not collected nor analyzed for the FFP arm

The amount of chest tube drainage output from after surgery through midnight of the next day. As measured in mL.

Outcome measures

Outcome measures
Measure
Fresh Frozen Plasma
n=48 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Chest Tube Output
1022 mL
Interval 799.0 to 1575.0
937 mL
Interval 708.0 to 1443.0

PRIMARY outcome

Timeframe: 24 hours

Population: 1 subject data was not collected nor analyzed for the FFP arm

The number of subject's who received 0,1,2,3 or more units of RBC's transfused from completion of study drug administration though midnight of the next day.

Outcome measures

Outcome measures
Measure
Fresh Frozen Plasma
n=48 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Red Blood Cell (RBC) Blood Product Transfusion
0 units
26 Participants
36 Participants
Red Blood Cell (RBC) Blood Product Transfusion
1 unit
11 Participants
8 Participants
Red Blood Cell (RBC) Blood Product Transfusion
2 units
6 Participants
5 Participants
Red Blood Cell (RBC) Blood Product Transfusion
3 or more units
5 Participants
2 Participants

PRIMARY outcome

Timeframe: 24 hours

Population: 1 subject's data was not collected nor analyzed for the FFP arm

The number of subject's who received 0,1,2,3 or more units of Platelets transfused from completion of study drug administration though midnight of the next day.

Outcome measures

Outcome measures
Measure
Fresh Frozen Plasma
n=48 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Platelets Blood Product Transfusion
0 units
30 Participants
36 Participants
Platelets Blood Product Transfusion
1 unit
13 Participants
9 Participants
Platelets Blood Product Transfusion
2 units
3 Participants
3 Participants
Platelets Blood Product Transfusion
3 or more units
2 Participants
3 Participants

PRIMARY outcome

Timeframe: 24 hours

Population: 1 subject's data was not collected nor analyzed for the FFP arm

The number of subject's who received 0,1,2,3 or more units of Cryo's transfused from completion of study drug administration though midnight of the next day.

Outcome measures

Outcome measures
Measure
Fresh Frozen Plasma
n=48 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Cryoprecipitate (Cryo) Blood Product Transfusion
0 units
40 Participants
40 Participants
Cryoprecipitate (Cryo) Blood Product Transfusion
1 unit
2 Participants
2 Participants
Cryoprecipitate (Cryo) Blood Product Transfusion
2 units
5 Participants
8 Participants
Cryoprecipitate (Cryo) Blood Product Transfusion
3 or more units
1 Participants
1 Participants

PRIMARY outcome

Timeframe: 24 hours

Population: 1 subject's data was not collected nor analyzed for the FFP arm

The number of subject's who received 0,1,2,3 or more units of FFP's transfused from completion of study drug administration though midnight of the next day.

Outcome measures

Outcome measures
Measure
Fresh Frozen Plasma
n=48 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 Participants
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Fresh Frozen Plasma (FFP) Blood Product Transfusion
0 units
43 Participants
48 Participants
Fresh Frozen Plasma (FFP) Blood Product Transfusion
1 unit
0 Participants
1 Participants
Fresh Frozen Plasma (FFP) Blood Product Transfusion
2 units
4 Participants
2 Participants
Fresh Frozen Plasma (FFP) Blood Product Transfusion
3 or more units
1 Participants
0 Participants

Adverse Events

Fresh Frozen Plasma

Serious events: 44 serious events
Other events: 0 other events
Deaths: 2 deaths

Prothrombin Complex Concentrate

Serious events: 45 serious events
Other events: 0 other events
Deaths: 1 deaths

Serious adverse events

Serious adverse events
Measure
Fresh Frozen Plasma
n=49 participants at risk
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received fresh frozen plasma as this is standard therapy per our institutional algorithm at a dose of 10-15 mL/kg rounded up to the nearest unit. Fresh frozen plasma (FFP): FFP
Prothrombin Complex Concentrate
n=51 participants at risk
After cardiopulmonary bypass, patients received protamine at dose 0.01 mg/unit of heparin given with target activated clotting time (ACT) within 10% of baseline value. After protamine administration the ACT, complete blood count (CBC), prothrombin time (PT)/ international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen, were collected via preexisting arterial access. If ACT \>10% baseline additional protamine was given at the anesthesiologists discretion. Evaluation and determination of excessive microvascular bleeding in the surgical field occurred 10 minutes after return of ACT to within 10% of baseline. Patients with clinical evidence of excessive microvascular bleeding in the surgical field as determined by the surgical team, along with a PT \>16.6 sec/ INR \>1.6 sec received Prothrombin complex concentrate (Human) 15 units/kg. Prothrombin complex concentrate (Human): PCC (Kcentra)
Immune system disorders
Anaphylactic or allergic reaction
2.0%
1/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
0.00%
0/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Vascular disorders
Thromboembolic event
4.1%
2/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
2.0%
1/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Vascular disorders
DVT
0.00%
0/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
2.0%
1/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Vascular disorders
Mesenteric ischemia
6.1%
3/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
2.0%
1/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Nervous system disorders
Stroke/TIA
2.0%
1/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
3.9%
2/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Cardiac disorders
STEMI
2.0%
1/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
0.00%
0/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Renal and urinary disorders
Renal Failure
36.7%
18/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
41.2%
21/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Renal and urinary disorders
Renal Failure requiring dialysis
8.2%
4/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
9.8%
5/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Respiratory, thoracic and mediastinal disorders
ARDS
8.2%
4/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
7.8%
4/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
Respiratory, thoracic and mediastinal disorders
Prolonged mechanical ventilation
10.2%
5/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
13.7%
7/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
General disorders
Re-operation
10.2%
5/49 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days
5.9%
3/51 • Adverse Events were collected for each subject from baseline to end of study, approximately 30 days

Other adverse events

Adverse event data not reported

Additional Information

Gregory A. Nuttall, M.D.

Mayo Clinic

Phone: (507) 255-3298

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place