Fibrinolysis Resistance in Infection and Trauma
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Viscoelastometric assessment of fibrinolysis.
- Who it may be relevant to
- Registry conditions: Sepsis and Septic Shock, Trauma. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Australia
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
Blood coagulation disorders are often seen in critically ill patients e.g. with severe infection or following extensive injury, that can lead to life threatening events as a result of excessive blood clot formation leading to organ failure. This study aims to use Viscoelastic Testing (VET) technology to detect patients at risk of excessive blood blot formation at the bedside, test new blood coagulation drugs, and guide life-saving use of blood modifying treatments.
Detailed description
In healthy individuals blood coagulates (clots) to minimise blood loss then, as part of the process of wound repair, blood clots are broken down in a process called fibrinolysis which involves two key proteins: tissue plasminogen activator (tPA) and plasminogen. In severe infection (sepsis) or following extensive injury (trauma), fibrinolysis abnormalities commonly develop, which include reduced fibrinolysis activity (fibrinolysis resistance) resulting in extensive clot formation and frequently leading to organ failure and death. Currently, the cause of fibrinolysis resistance in sepsis and trauma are unknown and clinical trials to address coagulopathies in sepsis have failed, likely due to inadequate disease phenotyping.
The viscoelastic testing (VET) technology ClotPro® has been used to identify fibrinolysis resistance in 55% of critically ill patients (COVID and non-COVID with acute respiratory failure) and through novel adaptation of the technology, determined that this is likely driven by reduced tPA and/or plasminogen activity. Furthermore, it has been used to detect in real time the impact of a 24 hr tPA infusion on fibrinolysis in a patient. Thus, this preliminary work has demonstrated the feasibility of a personalised treatment approach to fibrinolysis resistance management that can guide life-saving use of fibrinolysis enhancers to overcome resistance in an individualised basis that is likely to increase therapeutic efficacy and safety.
This project aims to scientifically validate the aforementioned preliminary work, increase our knowledge on the mechanisms of reduced fibrinolysis enzyme activity in severe infection and injury, discover potential treatment options, and progress these findings towards translation. The results of this project will drive future clinical trials of repurposed or novel therapies guided by VET to deliver a personalised dose to critically ill patients who demonstrate fibrinolysis resistance, which in conjunction with rapid detection, is anticipated to significantly improve patient outcomes.
Interventions
- Diagnostic test Viscoelastometric assessment of fibrinolysis
Viscoelastometric assessment of whole blood fibrinolysis using supplemental tissue plasminogen activator (tPA) and other agents ex vivo to influence fibrinolysis capacity.
Primary outcome measures
- VET testing and analysis [Time frame: From admission to ICU and at 24 hours, 48 hours, 5 days, 7 days, 10 days, and 15 days post ICU admission]
- Laboratory evaluation of fibrinolytic profile [Time frame: From admission to ICU and at 24 hours, 48 hours, 5 days, 7 days, 10 days, and 15 days post ICU admission]
Eligibility criteria
Sepsis/Septic shock Inclusion Criteria:
- Admission to ICU, needing at least one organ supportand principally for the management of clinically suspected Sepsis or Septic shock according to Spesis-3 criteria (including SARS-COV-2)
- Expected to remain in ICU and survive beyond the day after tomorrow
Sepsis Exclusion Criteria:
- On oral anticoagulant/antiplatelet therapy
- Not for full, active ICU support
- Death is deemed inevitable within 24 hrs
Trauma Inclusion Criteria:
- Trauma is the principal diagnosis on ICU admission
- Expected to remain in ICU and survive beyond the day after tomorrow
- Receiving respiratory support at the time of ICU admission - high-flow nasal prongs, non-invasive or invasive ventilation
- Already received, or considered at risk of needing a blood product transfusion within 24 hrs of injury
Trauma Exclusion Criteria:
- Nursing home resident
- Unsurvivable head injury
- Not for full, active ICU support
- Death is deemed inevitable within 24 hrs
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Observational model
- Cohort
Study locations
Australia · 4 centers
- The Canberra hospital (ICU) — Canberra
- Liverpool Hospital (ICU) — Liverpool
- Macquarie University Hospital (ICU) — Macquarie
- Royal North Shore Hospital (ICU) — St Leonards
Publications
- Coupland LA, Rabbolini DJ, Schoenecker JG, Crispin PJ, Miller JJ, Ghent T, Medcalf RL, Aneman AE. Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study. Crit Care. 2023 Feb 10;27(1):55. doi: 10.1186/s13054-023-04329-5. PMID 36765421
Identifiers
NCT: NCT06680180 · 2022/ETH02122