A Pediatric Trial Using Tranexamic Acid in Thrombocytopenia

Phase 2TerminatedNCT03806556

Meghan McCormick11 enrolled

Overview

This study evaluates the use of tranexamic acid (TXA) in addition to standard therapy in children receiving chemotherapy or blood and/or marrow transplantation to decrease the risk of bleeding. Half of participants will receive tranexamic acid and half of participants will receive placebo.

The purpose of this study is to conduct a prospective, randomized, blinded, placebo controlled trial to evaluate the safety and feasibility of the addition of antifibrinolytic therapy with tranexamic acid to the standard care in patients who are thrombocytopenic due to primary bone marrow disorders or chemotherapy, immunotherapy and/or radiation therapy in order to prevent bleeding. The results of this study will change practice by providing evidence as to whether or not TXA is effective and safe treatment when used as an adjunct to platelet transfusion therapy in the thrombocytopenic patient.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Enrollment

Conditions

Pediatric Cancer Thrombocytopenia Hemostatic Disorder Coagulation Defect; Acquired

Interventions

Tranexamic AcidDRUG

IV medication administered after patient meets inclusion/exclusion criteria

Normal salineDRUG

IV medication administered after patient meets inclusion/exclusion criteria

Eligibility

Sex: ALLMin age: 2 YearsMax age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients must have a confirmed diagnosis of hematologic malignancy or solid tumor malignancy * Patients must be undergoing or planned chemotherapy or BMT * Patients will only be eligible to receive study drug or placebo during inpatient periods * Patients must be predicted to have thrombocytopenia ≤20,000/microliter (uL) for ≥5 days * Patient must have a platelet transfusion threshold of ≤30,000/uL * Patients must be \>14 days beyond their last dose of Pegylated(PEG)-Asparaginase or \>72 hours beyond their last dose of Erwinia Asparaginase * Patients must be able to comply with treatment and monitoring Exclusion Criteria: * Diagnosis of acute promyelocytic leukemia (APL) * History of Immune Thrombocytopenic Purpura (ITP), Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS) * Diagnosis of Disseminated Intravascular Coagulopathy (DIC) * History of inherited or acquired bleeding disorder AND/OR inherited or acquired prothrombotic disorder * Patient must not have WHO Grade 2 bleeding or greater within 48 hours prior to enrollment or study drug activation * Patient must not have received PEG-Asparaginase within the 7 day period prior to enrollment. If given within the 8-14 day period prior to enrollment patients are eligible if prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR) and fibrinogen are obtained and are within 1.5 times the upper limits of normal. * Patient must not be receiving tranexamic acid or other anti-fibrinolytic agent or any other agent to promote hemostasis (which includes DDAVP, recombinant Factor VII, Prothrombin Complex Concentrate, Estrogen Derivatives and Progestins) * Patient must not be receiving therapy with anticoagulation or antiplatelet therapy (which includes heparin infusion, enoxaparin, aspirin. If anticoagulant/antiplatelet therapy is discontinued when platelet count is \<50,000/uL patient will be eligible for enrollment) * Patient must not be receiving platelet growth factors * Current thromboembolic event * History of thromboembolic event \<6 months prior to enrollment * Current/prior history of sinusoidal obstruction disease * Visible hematuria * Renal dysfunction (as defined by age-specific creatinine values calculated by Schwartz equation) or hemodialysis or anuria (defined as \<10 mL urine/hour over 24 hours) * History of seizures * Allergy to tranexamic acid * Pregnancy * Unwilling to accept blood product transfusions

Locations (1)

UPMC Childrens Hospital of Pittsburgh

Pittsburgh, Pennsylvania, United States

Outcomes

Primary Outcomes

Safety and Tolerability of Tranexamic Acid in Participants as the Number of Patients With Any Adverse Events and Serious Adverse Events (SAE) as Assessed by CTCAE v4.03

Adverse Events and Serious Adverse Events (SAE) will be collected on subjects throughout their participation in the study and up to 30 days following discontinuation of the study drug, regardless of attribution. Adverse events and serious adverse events will be tabulated by type and grade according to the NCI CTCAE v 4.03. The hypothesis is that tranexamic acid can be safely added to standard care regimens in patients with hematologic malignancies or solid tumors during periods of severe thrombocytopenia. Analysis limited to a descriptive assessment of the safety of tranexamic acid in patients with hematologic malignancies or solid tumors by reported adverse events, serious adverse events and death.

Time frame: From activation of the study drug (maximum 30 days) through 30 days from discontinuation of study drug

Feasibility of Tranexamic Acid as an Adjunct to Standard Therapy: Number of Participants Eligible and Recruited

Number of participants eligible for study enrollment and recruited. The hypothesis is that tranexamic acid can be safely added to standard care regimens in patients with hematologic malignancies or solid tumors during periods of severe thrombocytopenia. A descriptive assessment of feasibility of recruitment by monitoring number of patients screened, number of patients eligible for enrollment and rate of recruitment (both start-up and ongoing) during study period to be completed by collecting data on the number of patients screened, the number of patients eligible for study inclusion, the number of eligible patients who consent to study inclusion and the number of consented patients activated to the study drug, organized in visual form by CONSORT diagram.

Time frame: From time of recruitment of the first patient until the last patient is enrolled, up to 16 months in duration

Secondary Outcomes

World Health Organization (WHO) Bleeding Scale Grade 2 or Higher Bleeding

Proportion of patients with bleeding of WHO grade 2 or above, after activation of study drug. Bleeding graded on a scale ranging from 1 (minor bleeding) through 4 (bleeding that is fatal or life-threatening).

Data from ClinicalTrials.gov

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