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The purpose of this study was to characterize the safety and hemostatic activity of topical Fibrocaps in surgical patients when control of mild to moderate bleeding by standard surgical techniques was ineffective and/or impractical.
This was a multi-center, prospective, randomized, single-blind, controlled, comparative efficacy and safety trial in 90 subjects undergoing spinal surgery, hepatic resection, specific soft tissue dissection, or peripheral vascular surgery, ((including peripheral artery bypass and arteriovenous graft formation for hemodialysis using either Polytetrafluoroethylene (PTFE) or native grafts)). Subjects were randomized in a 2:1 ratio to Fibrocaps + Gelfoam or Gelfoam on the day of surgery.
Use of the Fibrospray device was optional for spinal and vascular surgeries, but required for the general surgery procedures. All investigators using the Fibrospray device were trained on the correct and safe set-up and use of Fibrocaps and the Fibrospray device prior to participating in this clinical trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fibrocaps + Gelfoam | Experimental | After identification of a Target Bleeding Site (TBS), topical Fibrocaps should be applied using the Fibrospray device for general surgeries; and either the Fibrospray device or direct application for spinal and vascular surgeries, followed by application of Gelfoam and manual pressure with sterile gauze. |
|
| Gelfoam | Active Comparator | Treatment is Gelfoam followed by manual pressure with sterile gauze. If hemostasis is not achieved within 10 minutes of the Start Time,the subject should be considered a treatment failure and the surgeon should implement additional hemostatic measures. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fibrocaps (fibrin sealant) | Device | Fibrocaps powder (max dose 1.5g) should be applied directly to the bleeding site or to the Gelfoam and then applied to the bleeding site. Re-application of 1.5 g of Fibrocaps is allowed. |
| Measure | Description | Time Frame |
|---|---|---|
| Mean Time to Hemostasis (TTH) | Time to hemostasis recorded from the first application of study treatment until cessation of bleeding | 0-10 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Safety | Number of participants with Adverse events and clinically-significant changes/findings on labs and physical examination as well as incidence of re-operation for bleeding at the TBS | 28 Days |
| Number of Subjects Achieving Hemostasis at 3 Minutes |
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Inclusion Criteria:
Intra-Operative inclusion criteria
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Paul Frohna, MD, PhD | Mallinckrodt | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Various sites | Indianapolis | Indiana | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38695613 | Derived | Ma GW, Kucey A, Tyagi SC, Papia G, Kucey DS, Varcoe RL, Forbes T, Neville R, Dueck AD, Kayssi A. The role of sealants for achieving anastomotic hemostasis in vascular surgery. Cochrane Database Syst Rev. 2024 May 2;5(5):CD013421. doi: 10.1002/14651858.CD013421.pub2. |
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Approximately 90 eligible subjects were planned for enrollment, randomization, and treatment. The enrollment stopped short of the targeted 90 subjects due to enrollment of more subjects in the parallel study being conducted in the Netherlands.
Enrollment commenced in February 2011 and completed in October 2011 at 8 investigative study sites in the United States.
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| ID | Title | Description |
|---|---|---|
| FG000 | Fibrocaps + Gelfoam | After identification of a Target Bleeding Site (TBS), topical Fibrocaps powder will be applied using the Fibrospray device for general surgeries; and either the Fibrospray device or direct application for spinal and vascular surgeries, followed by application of Gelfoam and manual pressure with sterile gauze. |
| FG001 | Gelfoam | Treatment will be Gelfoam followed by manual pressure with sterile gauze. If hemostasis has not been achieved within 10 minutes of the Start Time,the subject will be considered a treatment failure and the surgeon will implement additional hemostatic measures. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Fibrocaps + Gelfoam | After identification of a Target Bleeding Site (TBS), topical Fibrocaps powder will be applied using the Fibrospray device for general surgeries; and either the Fibrospray device or direct application for spinal and vascular surgeries, followed by application of Gelfoam and manual pressure with sterile gauze. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Mean Time to Hemostasis (TTH) | Time to hemostasis recorded from the first application of study treatment until cessation of bleeding | All subjects treated with a time to hemostasis were included in the analysis | Posted | Mean | Standard Deviation | minutes | 0-10 minutes |
|
Treatment emergent Adverse Events (AE) were collected for 28 days post treatment
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Fibrocaps + Gelfoam | After identification of a Target Bleeding Site (TBS), topical Fibrocaps powder will be applied using the Fibrospray device for general surgeries; and either the Fibrospray device or direct application for spinal and vascular surgeries, followed by application of Gelfoam and manual pressure with sterile gauze. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anemia | Blood and lymphatic system disorders |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Constipation | Gastrointestinal disorders |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Lawrence Hill | Mallinckrodt | 908-238-6370 | lawrence.hill@mallinckrodt.com |
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| ID | Term |
|---|---|
| D019106 | Postoperative Hemorrhage |
| ID | Term |
|---|---|
| D006470 | Hemorrhage |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011183 | Postoperative Complications |
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| ID | Term |
|---|---|
| D005781 | Gelatin Sponge, Absorbable |
| ID | Term |
|---|---|
| D015503 | Surgical Sponges |
| D013523 | Surgical Equipment |
| D004864 | Equipment and Supplies |
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|
| Gelfoam | Device | An identified Target Bleeding Site (TBS) should be treated with application of Gelfoam followed by light manual pressure with a sterile gauze. |
|
| 3 minutes |
| Number of Participants Achieving Hemostasis at 5 Minutes | 5 minutes |
| Number of Patients Achieving Hemostasis at 10 Minutes | 10 minutes |
| Gelfoam |
Treatment will be Gelfoam followed by manual pressure with sterile gauze. If hemostasis has not been achieved within 10 minutes of the Start Time,the subject will be considered a treatment failure and the surgeon will implement additional hemostatic measures. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
Treatment will be Gelfoam followed by manual pressure with sterile gauze. If hemostasis has not been achieved within 10 minutes of the Start Time,the subject will be considered a treatment failure and the surgeon will implement additional hemostatic measures.
|
|
|
| Secondary | Safety | Number of participants with Adverse events and clinically-significant changes/findings on labs and physical examination as well as incidence of re-operation for bleeding at the TBS | All subjects treated were analyzed for safety. | Posted | Number | participants | 28 Days |
|
|
|
|
| Secondary | Number of Subjects Achieving Hemostasis at 3 Minutes | Posted | Number | participants | 3 minutes |
|
|
|
|
| Secondary | Number of Participants Achieving Hemostasis at 5 Minutes | Posted | Number | participants | 5 minutes |
|
|
|
|
| Secondary | Number of Patients Achieving Hemostasis at 10 Minutes | Posted | Number | participants | 10 minutes |
|
|
|
|
| 6 |
| 47 |
| 44 |
| 47 |
| EG001 | Gelfoam | Treatment will be Gelfoam followed by manual pressure with sterile gauze. If hemostasis has not been achieved within 10 minutes of the Start Time,the subject will be considered a treatment failure and the surgeon will implement additional hemostatic measures. | 2 | 23 | 21 | 23 |
| Cellulitis | Infections and infestations |
|
| Pulmonary emobolism | Respiratory, thoracic and mediastinal disorders |
|
| Herpes zoster | Infections and infestations |
|
| Arteriovenous fistula thrombosis | Injury, poisoning and procedural complications |
|
| Hypotension | Vascular disorders |
|
| Pancreatic leak | Injury, poisoning and procedural complications |
|
| Deep cenous thrombosis | Vascular disorders |
|
| Post procedural bile leak | Injury, poisoning and procedural complications |
|
| Small bowel obstruction | Gastrointestinal disorders |
|
| Gastrointestinal bleeding | Gastrointestinal disorders |
|
| Scrotal hematoma | Injury, poisoning and procedural complications |
|
| Nausea | Gastrointestinal disorders |
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| Vomiting | Gastrointestinal disorders |
|
| Oedema peripheral | General disorders |
|
| Pyrexia | General disorders |
|
| Incision site pain | Injury, poisoning and procedural complications |
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| Procedural pain | Injury, poisoning and procedural complications |
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| Wound dehiscence | Injury, poisoning and procedural complications |
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| Hypokalaemia | Metabolism and nutrition disorders |
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| Back pain | Musculoskeletal and connective tissue disorders |
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| Muscle spasms | Musculoskeletal and connective tissue disorders |
|
| Pain in extremity | Musculoskeletal and connective tissue disorders |
|
| Headache | Nervous system disorders |
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| Hypoaesthesia | Nervous system disorders |
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| Anxiety | Psychiatric disorders |
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| Insomnia | Psychiatric disorders |
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| Oropharyngeal pain | Respiratory, thoracic and mediastinal disorders |
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| Pruritus | Skin and subcutaneous tissue disorders |
|
| Hypotension | Vascular disorders |
|
Investigators were part of the primary publication. Each investigator may publish on the data from subjects enrolled at their site after the initial publication has been submitted.