Study Comparing Desirudin With Heparin to Prevent Vein Clots After Heart and Lung Surgery

Washington University School of Medicine120 enrolled

Overview

A blood clot in the veins, also known as deep venous thrombosis (DVT), is one of the most common complications after surgery. This may result in death if a clot breaks off and travel to the lungs; this is referred to as pulmonary embolism (PE). After heart surgery the incidence of DVT ranges from 20-48% and following lung surgery the incidence is 19-26%. In order to decrease the likelihood of this complication, patients receive by injection a blood thinning medicine. Heparin is the usual medicine used for this purpose following heart and lung surgery. Recently there have been reports that other medicines may be more effective than heparin for this purpose. Also there have been reports that some patients develop antibodies to heparin. When this occurs, this may prevent the heparin from being effective and may even promote the formation of blood clots. Antibodies to heparin may be present more often following heart and lung surgery than other types of surgery. There is a new medicine called desirudin (Iprivask), which may be used instead of heparin to prevent blood clots following heart and lung surgery. Desirudin is currently approved by the FDA to prevent blood clots following hip surgery. The purpose of this study is to compare desirudin with heparin for the prevention of vein clots after heart and lung surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Enrollment

120

Conditions

Deep Venous Thrombosis

Interventions

Desirudin (Iprivask™)DRUG

Patients who are randomized to the desirudin (study) group will receive 15 mg of subcutaneous desirudin twice a day (at 0900 and 2100). These patients will also receive an injection of normal saline placebo at 1300 so that patients in both groups will receive three injections at the same time points.

HeparinDRUG

The patients who are randomized to the Heparin (standard of care) group will receive subcutaneous injections of heparin three times a day (0900, 1300 and 2100).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients who are scheduled for elective Cardiac or Thoracic Surgery. * Age \> 18 years of age. Exclusion Criteria: * Patients with a clinical suspicion or a documented history of DVT/PE * Patients who may require anticoagulation during the post-op period. (i.e. Patients with a history of A-fib, scheduled for a MAZE procedure or placement of a mechanical valve, or those on Coumadin/IV heparin preoperatively) * Patients who have a history of HIT or if there is a suspicion of the patient having HIT pre-operatively. * Documented allergy to heparin, desirudin, or lepirudin * Patients with a history of coagulation disorder * Platelet count\< 100 X109 /dl * Active bleeding * Serum Creatinine ≥ 1.5 mg/dl or CrCl ≤ 30 ml/min * Patients with a baseline coagulopathy (INR \> 1.5 or aPTT \> 45 sec) * Patients with liver disease * Pregnancy * Patients who require ventricular assist devices before or after surgery

Outcomes

Primary Outcomes

The Primary Outcome Measure Was the Number of Participants With New Heparin Platelet Factor 4 (HIT Positive) Antibodies in Each Group Within 30 Days Following Surgery.

Blood samples were collected and tested in singlet for the presence of PF4/heparin antibodies. Samples were collected for each participant on PDD (Post-study Drug initiation Day) 2, PDD 7 or at hospital discharge, and at 30 days post surgery.

Time frame: 30 days after surgery

Secondary Outcomes

The Incidence of DVTs in Each Group.

Time frame: 7 days after surgery

The Incidence of Bleeding in Each Group.

Time frame: Up to 30 days after surgery