Personalized ViscoElastic Testing-guided Bleeding Management In Liver Surgery, Neurosurgery and Obstetrics

Trial statusRecruiting
Trial phaseNot listed
Trial typeObservational
Biological sexAll
Age18+
SponsorMedical University of Vienna

About this trial

The ClotPro analyzer is a new generation viscoelastic analyzer for the in vitro assessment of blood coagulation. This study aims to assess the agreement of ClotPro 6.0, ROTEM delta, and TEG 6s in three distinct cohorts: i) patients with liver disease undergoing liver surgery, ii) pregnant women undergoing elective cesarean section, and iii) patients undergoing elective intracranial neurosurgery. Further coagulation tests will be performed (standard laboratory coagulation tests, thrombin and plasmin generation tests) in an exploratory fashion to compare them with viscoelastic test results. The obtained test results will not result in any diagnostic or therapeutic consequences for patients included in this study.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Vulnerable patient cohorts

Liver resection (anatomic or non-anatomic segmental resection, right or left hepatectomy, right or left extended hepatectomy),

Orthotopic liver transplantation,

Pregnant women undergoing an elective caesarean section, and

Disqualifiers

None

Trial population

The study population will be comprised of three groups: 1. Patients with liver disease undergoing elective liver surgery defined as one of the following invasive procedures a) liver resection (anatomic or non-anatomic segmental resection, right or left hepatectomy, right or left extended hepatectomy) or b) orthotopic liver transplantation. 2. Pregnant women undergoing elective cesarean section. 3. Patients undergoing elective intracranial neurosurgery

Trial design

Design model

Cohort

Time perspective

Prospective

Treatments tested in this trial

  • Viscoelastic testing

    Diagnostic test

    viscoelasting testing refers to a global hemostatic assay,that quantifies the viscoelastic properties of citrated whole blood

Treatment groups

240 Participants
are divided into 3 treatment groups
Group A: Patients with functional liver disease undergoing liver surgery1 intervention
Group B: neurosurgical patients undergoing intracranial procedures1 intervention
Group C: pregnant women undergoing cesarean section1 intervention

Trial outcomes

Primary outcomes

1

Limits of agreement viscoelastic test parameters

Calculate limits of agreement between the following corresponding viscoelastic test parameters: * EX-test- clotting time vs. EXTEM-clotting time vs. citrated rapid TEG r time * EX-test- maxium clot firmness vs. EXTEM-maximum clot firmness vs. citrated rapid TEG-maximum amplitude * FIB-test-clotting time vs. FIBTEM-clotting time vs. citrated functional fibrinogen r time * FIB-test-maxium clot firmness vs. FIBTEM-maxium clot firmness vs. citrated functional fibrinogen-maximal amplitude

Time frame
Baseline (immediately after induction of general anaesthesia / prior to regional anesthesia); end of the surgery / intervention (assessed up to 1h); Day 1: 1. postoperative day (assessed within 24h) ; Day 3: 3. postoperative day (assessed within 24)

Secondary outcomes

1

In depth hemostatic assessment: Viscoelastic tests (VET) & thrombin generation assay (with thrombmodulin)

Correlation between the following viscoelastic test parameters and thrombin generation (TG) measurements: \- Ex-test clotting time, citrated rapid TEG r time and the ratio of endogenous thrombin potential derived by TG assay using thrombomodulin

Time frame
Baseline (immediately after induction of general anaesthesia / prior to regional anesthesia); end of the surgery / intervention (assessed up to 1h); Day 1: 1. postoperative day (assessed within 24h) ; Day 3: 3. postoperative day (assessed within 24)
2

In depth hemostatic assessment: Viscoelastic tests (VET) & standard laboratory coagulation tests (SLT)

Correlation between the following VET parameters and SLT measurements: * EX-test clotting time and citrated rapid TEG r time vs. prothrombin time and * FIB-test maximum clot firmness, citrated functional fibrinogen-maximal amplitude and citrated functional fibrinoge- functional level of fibrinogen vs. Clauss fibrinogen.

Time frame
Baseline (immediately after induction of general anaesthesia / prior to regional anesthesia); end of the surgery / intervention (assessed up to 1h); Day 1: 1. postoperative day (assessed within 24h) ; Day 3: 3. postoperative day (assessed within 24)
3

In depth hemostatic assessment: Viscoelastic tests & plasmin generation (PG)

Correlation between the viscoelastic test parameters TPA-lysis time and TPA-maximal lysis with the endogenous plasmin potential derived by plasmin generation measurements.

Time frame
Baseline (immediately after induction of general anaesthesia / prior to regional anesthesia); end of the surgery / intervention (assessed up to 1h); Day 1: 1. postoperative day (assessed within 24h) ; Day 3: 3. postoperative day (assessed within 24)
4

Patient cohort-specific reference ranges

This anaylsis aims to investigate whether there is a need for cohort-specific reference ranges for ClotPro by assessing the distributional differences of ClotPro results between three patient cohorts (patients undergoing liver surgery, pregnant women undergoing elective cesarean section, patients undergoing an elective intracranial neurosurgery)

Time frame
Baseline (immediately after induction of general anaesthesia / prior to regional anesthesia); end of the surgery / intervention (assessed up to 1h); Day 1: 1. postoperative day (assessed within 24h) ; Day 3: 3. postoperative day (assessed within 24)

Other outcomes

Sponsors and contacts

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Medical University of Vienna

Lead sponsor

Synapse - Research Institute Maastricht

Collaborator