The purpose of this study is to demonstrate that periprocedural infusion of escalating doses of MDCO-2010 is safe and tolerated in patients undergoing elective CABG surgery, to characterize the single dose pharmacokinetics of MDCO-2010, to investigate the effect of MDCO-2010 on pharmacodynamics (biomarkers of fibrinolysis and coagulation parameters), and to investigate the effect on exploratory clinical endpoints of bleeding, transfusion requirements and reexploration.

This protocol describes a study of the investigational drug MDCO-2010 as a haemostasis modulator in patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery involving a cardiopulmonary bypass (CPB).

Perioperative bleeding is a serious complication that adversely affects the morbidity and mortality of cardiac surgery. To alleviate this complication, prophylactic antifibrinolytic therapies are now widely accepted as a strategy to inhibit excessive fibrinolysis.

MDCO-2010, a synthetic small molecule, is a direct inhibitor of plasmin and plasma kallikrein. Both of these have been implicated with impaired haemostasis. In addition, potent inhibition of coagulation factors Xa, XIa and activated Protein C has been demonstrated. Thus, MDCO-2010 has the potential to mitigate excessive fibrinolysis and thrombin generation during cardiac surgery involving a cardiopulmonary bypass. In particular the latter is supposed to provide additional benefits beyond reducing transfusion requirements.

Inclusion Criteria

• Men, aged 18 to 80 years or
• Post-menopausal women, aged up to 80 years. Postmenopausal status defined as ≥ 1 year since last menstruation in women with no medical history of hysterectomy or women with a medical history of bilateral oophorectomy
• Planned elective, isolated primary CABG surgery with more than 1 graft, including the use of cardiopulmonary bypass
• Written informed consent prior to any study-related procedure not part of normal medical care

Exclusion Criteria

Patients may not meet any of the following exclusion criteria:

• Planned concomitant surgery including atrial septal defect (ASD) repair, valve replacement, carotid endarterectomy, aortic surgery, any combined procedure or any repeat sternotomy

• Planned Off-pump CABG

• Body weight < 55 kg or > 110 kg

• Planned hypothermia < 28°C

• Major surgical procedures within 30 days of entry

• Placement of drug-eluting stent (DES) within 12 months or of bare-metal stent (BMS) within 6 weeks of entry in a vessel which is not intended to be grafted

• Ejection fraction < 35%

• Preoperative coagulation abnormalities

  • Platelet count < 100,000/cubic mm, or
  • INR > 1.5 or Quick < 40%, or
  • activated partial thromboplastin time (aPTT) > 1.5 x upper limit of normal (ULN)

• Preoperative Hb < 11 g/dL for male patients or < 10 g/dL for female patients

• Patient refusal to receive donor blood products if necessary

• Administration of thienopyridines within 5 days prior to surgery Administration of warfarin within 5 days prior to surgery

• Administration of tirofiban or eptifibatide within 24 hours or administration of abciximab within 5 days prior to surgery

• Administration of fondaparinux within 24 hours prior to surgery

• Creatinine clearance (calculated using Cockroft-Gault equation) < 60 mL/min

• Planned intraoperative use of tranexamic acid or of ε-aminocaproic acid

• History of stroke or transient ischemic attack within 3 months prior to entry

• Known heparin-induced thrombocytopenia

• Known history of thrombophilia, eg, deep vein thrombosis (DVT) with pulmonary embolism

• Active liver disease

• Any condition requiring chronic immunosuppressive medication

• Receipt of an investigational drug or device 30 days prior to entry

• Any other condition which, in the opinion of the investigator, would prevent a patient's participation in the study