Anticoagulants and Bleeding Disorders
Conditions
Keywords
Haemorrhage, Anticoagulant, Emergency, Quantra analyzer
Brief summary
The quality of the reversion of these serious hemorrhagic accidents under oral anticoagulants depends on the adequate use of reversion products but also on the speed of obtaining hemostasis data allowing to evaluate the effectiveness of this chemical hemostasis. . Clot formation can be studied using different visco-elastic methodologies (thromboelastography or thromboelastometry) with a detectable change in clot formation with oral anticoagulants. These techniques have been proven in patients who are often unstable and present with severe trauma with hemorrhagic shock, thus making it possible to guide the transfusion protocol. However, the level of recommendations in these patients, who are often polyhydrated and poly-transfused, is grade 1c due to small-scale studies with difficulty in analyzing the values of the visco-elasticity parameters in these patients. In addition, these methods are little used in current practice because of their difficult reading. The use of visco-elastic methods in patients on oral anticoagulants has been little studied. However, taking an oral anticoagulant mainly causes coagulation disorders. The use of these methods would make it possible to assess the impact of the anticoagulant on hemostasis and to verify the correct reversion of hemostasis parameters. Quantra®, one of the visco-elastic methods, would make it possible to speed up the evaluation in the context of biology relocated to the patient's bed with a simplified reading of the factors involved in the formation of the clot in order to allow an immediate evaluation the quality of the reversion performed which may have an impact on the re-administration of reversion products or even an adaptation of the dose of reversion products according to the initial parameters at the time of severe bleeding before reversion. The objective of this pilot study is to study the metrological evolution, before and after reversion, of the hemostasis parameters evaluated by the Quantra® system from HemoSonics in a patient being his own control in the context of a severe hemorrhage occurring on oral anticoagulants (VKA or DOA).
Detailed description
This multicenter, prospective, cohort pilot study of physiopathology and physio-pharmacology, testing the added value of innovative functional exploration in addition to routine monitoring, in patients eligible for urgent reversion from anticoagulant therapy. This study is part of the patient's routine care without modifying his management. In fact, eligible patients with severe bleeding under oral anticoagulant therapy will be treated according to departmental habits. The study will only consist of the addition of the analysis of a blood sample using the Quantra® before and after reversion without modification of the management. All patients will be followed for the duration of hospitalization. Primary objective : The objective of this pilot study is to study the behavior of viscoelastic hemostasis parameters assessed by the Quantra® System in the context of severe bleeding occurring under oral anticoagulants (VKA or DOA). Secondary objectives : To study the effect of reversion of oral anticoagulants on hemostasis parameters assessed by the Quantra® system in the context of severe bleeding. To study, in the context of severe bleeding, the relationship between the hemostasis parameters assessed by the Quantra® system and: * conventional hemostasis parameters, * the severity of the bleeding events before reversion, in the context of severe bleeding, * recurrent bleeding or thrombotic events occurring during hospitalization. The primary endpoint will be all of the Quantra® parameter values measured during the patient's therapeutic monitoring (before and after) without prioritization. The parameters of Quantra® are: * CT: Clotting time (in seconds) * CTH: Clotting time with Heparinase (in seconds) * CTR: CT / CTH ratio clotting time * CS: overall stiffness of the clot (hPa) * PCS: Contribution of platelets to clot stiffness (hPa) FCS: Contribution of fibrinogen to clot stiffness (hPa) Secondary endpoints: * Classic coagulation tests: (TP / INR), TCA, Fibrinogen, FII, FV, FVII, FX * Drug concentration (for DOA) by dilute thrombin time or specific anti-Xa activity * Type and volume of filling solutes before reversion * Assessment of blood loss (Hb, size of the hematoma) * Clinical outcome of reversion: haemostatic efficacy rate at 24 hours, occurrence of haemorrhagic or thrombotic recurrences during hospitalization * Duration of hospitalization
Interventions
DEVICEQuantra analyzer
one additional tube will be collected during the usual blood test at two different time and analyzed by Quantra ®
Sponsors
Hôpital Edouard Herriot
University Hospital of Saint-Etienne
University Hospital, Grenoble
University Hospital, Tours
Pitié-Salpêtrière Hospital
University Hospital, Clermont-Ferrand
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
No masking
Intervention model description
H0 : blood analyse with Quantra® H0+30 min : blood analyse with Quantra® D0+30 : end of study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Adult patient, male or female, treated long term with an oral anticoagulant (anti-vitamin K or direct), admitted to a hospital emergency department for intracerebral, digestive or intramuscular hemorrhage, defined as major according to the criteria of the International Society of Thrombosis and Haemostasis1. These three sites of bleeding are the most common. 2. Capable of giving informed consent to participate in research or in the event of emergency care for a reference person. 3. Affiliated with a Social Security scheme.
Exclusion criteria
1. Incapable major. 2. Administration within the last 24 hours of parenteral anticoagulant. 3. Refusal of participation. 4. Pregnant or breast feeding mother
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in viscoelastic hemostasis parameters assessed by the Quantra® system in the context of severe bleeding occurring under oral anticoagulants (VKA or DOA) | Hour 0 and Hour 0+30min | Quantra® parameters were measured during the patient's therapeutic monitoring (before and after) without prioritization. The parameters of Quantra® are: CT / CTH ratio clotting time overall stiffness of the clot (hPa) Contribution of platelets to clot stiffness (hPa) Contribution of fibrinogen to clot stiffness (hPa) |
| Change in viscoelastic hemostasis parameters assessed by the Quantra® system in the context of severe bleeding occurring under oral anticoagulants (VKA or DOA) | Hour 0 and Hour 0+30min | Quantra® parameters were measured during the patient's therapeutic monitoring (before and after) without prioritization. The parameters of Quantra® are: CT : clotting time (in seconds) CTH clotting time with heparinase (in seconds) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Type of filling solutes before reversion | Hour 0 | Type of filling solutes before reversion |
| Volume of filling solutes before reversion | Hour 0 | Volume of filling solutes before reversion |
| Evaluation of blood loss | Hour 0 | haemoglobin concentration |
| Coagulation test | Hour 0; Hour 0+30min; Hour 0+6 hours | change in activated partial thromboplastin time (APTT) measures |
| Clinical issue of reversion | Hour 0+24 | efficacy haemostatic rate at 24 hours |
| Duration of hospitalization | at the end of hospitalization | how many days the patient is hospitalized |
| phone call | Month 0+1 | report of any adverse event occured in the month after the end of hospitalization |
| Clinical haemostasis evolution | Hour 0+24 | haematoma volume |
| anti-factor Xa activity measurement | Hour 0; Hour 0+30min; Hour 0+6 hours | change in anti-factor Xa activity measurement |
Countries
France
Outcome results
None listed