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| Name | Class |
|---|---|
| McMaster University | OTHER |
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Coagulopathy, bleeding, and transfusion are common in cardiac surgical patients. Our collaborator has developed a novel point of care device that can be used to assess thrombin generation in real-time in cardiac surgical patients. The investigators will measure thrombin generation using our novel device and compare it to standard methods, while examining the association of thrombin parameters with bleeding and other clinical outcomes.
This is a prospective observational cohort study of 200 cardiac surgical patients. Thrombin generation via our novel point of care thrombin generation assay as well as calibrated automated thrombography (CAT) will be measured at three time points: (1) before surgery; (2) post-CPB after heparin reversal with protamine; (3) at the time of chest closure or 60 minutes after heparin reversal with protamine. Clinicians will remain blinded to the measures. Recruitment will continue until the investigators enroll 50 patients with significant impaired thrombin generation capacity (>50% drop from baseline) and 50 patients who receive hemostatic therapies. Patients will be followed for 7 days postoperatively to assess individual products transfused.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cardiac Surgical Patients | All consenting adults undergoing cardiac surgery at Toronto General Hospital. |
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| Measure | Description | Time Frame |
|---|---|---|
| Thrombin Generation, as assessed by the Endogenous Thrombin Potential (ETP) | The primary thrombin generation parameter of interest is the endogenous thrombin potential, or ETP, expressed in nM*min. The change in thrombin generation in patients undergoing cardiac surgery before and after cardiopulmonary bypass using our new point-of-care thrombin sensor and the established laboratory-based calibrated automated thrombogram (CAT) assay will be assessed. | The change in thrombin generation will be assessed from preoperative baseline up until 12 hours post-operatively |
| Thrombin Generation, as assessed by the Lag Time | The co-primary thrombin generation parameter of interest is the Lag Time, expressed in seconds. The change in thrombin generation in patients undergoing cardiac surgery before and after cardiopulmonary bypass using our new point-of-care thrombin sensor and the established laboratory-based calibrated automated thrombogram (CAT) assay will be assessed. | The change in thrombin generation will be assessed from preoperative baseline up until 12 hours post-operatively |
| Thrombin Generation, as assessed by the Time to Peak | The co-primary thrombin generation parameter of interest is the Time to Peak, expressed in seconds. The change in thrombin generation in patients undergoing cardiac surgery before and after cardiopulmonary bypass using our new point-of-care thrombin sensor and the established laboratory-based calibrated automated thrombogram (CAT) assay will be assessed. | The change in thrombin generation will be assessed from preoperative baseline up until 12 hours post-operatively |
| Thrombin Generation, as assessed by the Peak Height | The co-primary thrombin generation parameter of interest is the Peak Height, expressed in nM. The change in thrombin generation in patients undergoing cardiac surgery before and after cardiopulmonary bypass using our new point-of-care thrombin sensor and the established laboratory-based calibrated automated thrombogram (CAT) assay will be assessed. |
| Measure | Description | Time Frame |
|---|---|---|
| Total Units of Red Blood Cells Transfused | The total number of red blood cells units transfused will be recorded | From intra-operatively up to 12 hours post-operatively |
| Total Units of Platelets Transfused |
| Measure | Description | Time Frame |
|---|---|---|
| Chest tube drainage | Blood loss from chest tube drainage will be assessed in mL | From intra-operatively to within 12 hours post-operatively |
| Return to the Operating Room for Bleeding or Delayed Chest Closure |
Inclusion Criteria:
-All adult patients (> 18 years of age) undergoing cardiac surgery at Toronto General Hospital will be offered participation.
Exclusion Criteria:
-Patients who are unable to consent to the study or who refuse participation will be excluded.
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Adult patients with cardiovascular disease undergoing cardiac surgical procedures at Toronto General Hospital.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Justyna Bartoszko, MD MSc FRCPC | Contact | 416-340-4800 | 3243 | justyna.bartoszko@uhn.ca |
| Name | Affiliation | Role |
|---|---|---|
| Justyna Bartoszko, MD MSc FRCPC | Toronto General Hospital - University Health Network | Principal Investigator |
| Keyvan Karkouti, MD MSc FRCPC | Toronto General Hospital - University Health Network | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Toronto General Hospital - University Health Network | Recruiting | Toronto | Ontario | M5G 2C4 | Canada |
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| ID | Term |
|---|---|
| D020141 | Hemostatic Disorders |
| D016063 | Blood Loss, Surgical |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D006474 | Hemorrhagic Disorders |
| D006402 | Hematologic Diseases |
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Whole blood samples will be retained for CAT analysis
| The change in thrombin generation will be assessed from preoperative baseline up until 12 hours post-operatively |
The total number of platelets units transfused will be recorded
| From intra-operatively up to 12 hours post-operatively |
| Total Units of Frozen Plasma Transfused | The total number of frozen plasma units transfused will be recorded | From intra-operatively up to 12 hours post-operatively |
| Total amount of Prothrombin Complex Concentrates transfused | The total number of prothrombin complex concentrate units will be recorded | From intra-operatively up to 12 hours post-operatively |
| Total amount of Fibrinogen Concentrate transfused | The total number of grams of fibrinogen concentrate transfused will be recorded | From intra-operatively up to 12 hours post-operatively |
Instances of return to the operating room for re-exploration or a delay in chest closure will be assessed
| From intra-operatively to within 12 hours post-operatively |
| D006425 |
| Hemic and Lymphatic Diseases |
| D006470 | Hemorrhage |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007431 | Intraoperative Complications |