Overview

This trial is active, not recruiting.

Condition liver disease
Treatment fresh frozen plasma
Phase phase 4
Sponsor University of Colorado, Denver
Start date January 2012
End date January 2016
Trial size 50 participants
Trial identifier NCT02366845, 12-0064

Summary

This study plans to learn more about transfusion of a human blood component called plasma in patients who have liver problems. Patients are asked to be in this study because they have liver disease and therefore may require the transfusion of plasma.

The dose of plasma required to reach certain blood clotting laboratory targets is usually determined by clinicians. Due to the complexity of the patient's blood clotting disorder, determining the appropriate dose of plasma is very difficult. The investigators have developed a dosing table based on information from other patients with liver disease and the investigators are testing it to see if it is a more accurate dosing tool then clinician chosen dosing of plasma in patients with liver disease who need one or more plasma transfusions

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification efficacy study
Intervention model parallel assignment
Masking single blind (caregiver)
Primary purpose treatment
Arm
(Active Comparator)
Admitted University of Colorado Hospital or Denver Health bleeding patients with chronic liver disease determined to receive fresh frozen plasma (FFP) for clinical indications as determined by hospital clinician. The total dose will be determined by the physician's judgment which is the current standard of care. The physician chosen dose will be utilized but physician will be unaware of which dosing strategy has been utilized. An INR measurement will be performed within 1 hour after the entire transfusion of plasma has been administered. Primary and secondary outcome measures will be collected. No other transfused blood component, crystalloid or colloidal fluid will be infused between the first and second INR studies except plasma
fresh frozen plasma FFP
An INR dose-response curve with associated transfusion algorithm was generated for plasma in bleeding patients with chronic liver disease. In the intervention arm we will determine the plasma transfusion dose using the algorithm dosing table based on the pre-transfusion INR and the clinician chosen INR target. In the usual care group the dosing will be determined by the clinician.
(Experimental)
Admitted University of Colorado Hospital or Denver Health bleeding patients with chronic liver disease determined to receive fresh frozen plasma (FFP) for clinical indications as determined by hospital clinician. This group will receive plasma doses based on the study dosing algorithm table. A pre-transfusion INR and a target post-transfusion INR will be used to determine dose of FFP. The study table will reveal the dose in (ml/kg) of FFP to be transfused. An INR measurement will be performed within 1 hour after the entire transfusion of plasma has been administered. Primary and secondary outcome measures will be collected. No other transfused blood component,crystalloid or colloidal fluid will be infused between the first and second INR studies except plasma.
fresh frozen plasma FFP
An INR dose-response curve with associated transfusion algorithm was generated for plasma in bleeding patients with chronic liver disease. In the intervention arm we will determine the plasma transfusion dose using the algorithm dosing table based on the pre-transfusion INR and the clinician chosen INR target. In the usual care group the dosing will be determined by the clinician.

Primary Outcomes

Measure
Accuracy of Plasma Transfusion Dosing Algorithm to accurately predict necessary plasma dose required to reach INR commonly targeted compared clinician chosen dose
time frame: within 1 hour after entire plasma transfusion

Secondary Outcomes

Measure
Time (minutes) from initiation of first dose of plasma to initiation of planned procedure (in patient undergoing transfusion before a procedure) for clinician dosing compared to algorithm dosing strategies.
time frame: minutes from first dose to initiation of procedure, anticipated timeframe between 1 minute to 8 hours.
Dose difference (average # units) between clinician dosing and algorithm dosing (units of FFP) per patient.
time frame: within 1 hour after entire plasma transfusion
Hospital length of stay
time frame: Subjects will be followed for duration of hospital stay, anticipated within 1 Day to 28 Days

Eligibility Criteria

Male or female participants from 18 years up to 85 years old.

Inclusion Criteria: Subjects will be eligible to participate in the study if they meet all of the following criteria: 1. Admission to the University of Colorado Hospital or Denver Health hospital and the clinical care team plans to transfuse the patient plasma to target a specific INR value. (reason for transfusion is not considered). 2. Patient has chronic liver disease defined as 1 or more of the following: Previous diagnosis of chronic liver disease OR -Imaging or biopsy diagnosis of cirrhosis; or 3. Signs of portal hypertension (ascites, varices, hypersplenism), or 4. Laboratory evidence of synthetic dysfunction (INR>1.5, bilirubin> 2.0 mg/dL, albumin<2.5 mg/dL) AND ≥2 physical exam findings on admission associated with chronic liver disease (palmar erythema, spider angiomata, asterixis, caput medusa, gynecomastia) Exclusion Criteria Subjects will be ineligible to participate in the study if they meet any of the following criteria 1. Patient under age 18 2. Patient actively taking vitamin K antagonists 3. Inability to obtain consent 4. Clinical team does not desire to target a specific INR value 5. Pregnant patients and prisoners 6. Patients with Acute Liver Failure

Additional Information

Official title Prospective Validation of a Plasma Transfusion Dosing Algorithm in Patients With Chronic Liver Disease
Principal investigator Samuel C Berngard, MD
Description Clinicians currently transfuse plasma to International Normalized Ratio (INR) targets without an understanding of the dose response characteristics of plasma in bleeding patients with liver disease. Epidemiologic studies show that INR is infrequently corrected to target INR values after clinician chosen plasma transfusion doses in patients with liver disease. Plasma transfusion is frequently given to patients prior to procedures and during active bleeding in this patient population though there are no dosing guidelines to aid clinicians in reaching INR targets in patients with liver disease. Previous studies suggest that patients with liver disease may need more plasma then patients without liver disease to correct any given pre-transfusion INR to the same post-INR target. Current physician dosing of plasma is variable and rarely successful at reaching stated INR targets. The INR thresholds commonly used triggers for plasma transfusion by Gastro-Intestinal (GI), Hepatology and critical care physicians at our institution range from 1.5-3.0 in bleeding or pre-procedural patients with liver disease representing tremendous variability. When we evaluated plasma transfusion dosing practices in bleeding patients with liver disease over 8 years, we demonstrated that these same physicians rarely met stated theoretical targets. Over or under dosing plasma in these patient may lead to serious clinical complications.
Trial information was received from ClinicalTrials.gov and was last updated in January 2016.
Information provided to ClinicalTrials.gov by University of Colorado, Denver.