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PeproStat as a Topical Agent Used to Stop Bleeding in Patients Undergoing Surgery

Primary Purpose

Bleeding

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
PeproStat
Saline
Sponsored by
Haemostatix Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bleeding

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: At screening and baseline:

  1. Subject is undergoing a planned open liver/soft tissue surgery, vascular surgery or spine surgery.
  2. Subjects are able and willing to provide written informed consent to participate in this study.
  3. Adult males and females ≥18 years of age at screening.
  4. Willing and able to comply with all protocol requirements including follow-up assessments.
  5. Male subjects must be willing and able to use adequate contraception from enrollment through to the 30 day follow-up visit.
  6. Women of childbearing potential (WCBP)C have to use highly effective methods of contraception from enrollment through to the 30 day follow-up visit.

    Intraoperative:

  7. The subject presents an identified target bleeding site with mild or moderate bleeding, which conventional surgical techniques are insufficient to control or are inappropriate and would otherwise be a candidate for standard haemostats.
  8. The subject presents no intraoperative complications, other than bleeding, that may interfere with study assessments as judged by the Investigator.
  9. The subject presents no contaminated areas of the body, signs of infection or abscess development.
  10. Total target bleeding site surface area of ≤ 70 cm2, defined within one or two TBSs.

Exclusion Criteria:

  1. Subject is undergoing emergency surgical procedure.
  2. Use of study treatment and sponge in

    • Closure of skin incisions as the sponge may interfere with the healing of skin edges.
    • Intravascular compartments because of the risk of embolization following sponge application.
  3. Recipient of an organ transplant.
  4. Haematologic, biochemistry and coagulation panel thresholds at screening:

    • Haemoglobin ≤ 9.0 g/dL.
    • Platelet count ≤100,000/mm3 (≤ 100 x 109/L).
    • International Normalized Ratio (INR) > 2.0 or activated Partial Thromboplastin Time (aPTT) ratio > 2.0.
    • Fibrinogen level < 1.5 g/L.
    • Aspartate Aminotransferase (AST) or Alanine aminotransferase (ALT) ≥ 3 times the upper limit normal range, except for subjects undergoing liver resection surgery where there is no upper limit for these analytes due to the nature of their disease.
  5. Severe renal failure.
  6. Any other disease or condition that may affect normal blood clotting, for example thrombocytopenia, as judged by the Investigator.
  7. A known history of anaphylaxis or allergic reaction to human albumin, PEGylated proteins, yeast or moulds, porcine products or other components in the study medication or sponge.
  8. Participation in another investigational drug or device research study within 30 days before and after enrolment in the current study.
  9. Current known or suspected alcohol and/or drug abuse or dependence at the time of screening.
  10. Any concurrent medical, surgical, or psychiatric condition that may, in the Investigator's opinion, affect the subject's willingness or ability to meet all study requirements during the study duration.
  11. Known HIV, Hepatitis B virus or Hepatitis C Virus infection.
  12. During the surgery, subject presents severe bleeding where use of a topical haemostat would be inappropriate.
  13. Anti-platelets/oral anticoagulants treatment:

    1. Soft tissue/liver and neurosurgery: Subject is taking anti-platelet agents or oral anticoagulants within 7 days of surgery
    2. Vascular surgery: Subject is taking dual anti-platelet treatment or oral anticoagulants within 7 days of surgery. One anti-platelet agent is allowed perioperatively.
  14. Heparin treatment:

    c. Soft tissue/liver and neurosurgery only: Subject is receiving therapeutic doses of heparin perioperatively. Only prophylactic Low Molecular Weight Heparin is allowed.

  15. Pregnant or breast-feeding subject.

Sites / Locations

  • University Clinical Hospital, Bolnicka 25
  • University Clinical Hospital Centre "Sestre Milosrdnice", Vinogradska cesta 29
  • Klinika Neurochirurgii Gdanskie Centrum Kliniczne, ul. Dębinki 7
  • Clinical centre of Serbia, Clinic for vascular and endovascular surgery, Koste Todorovica Street 8
  • Addenbrookes Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

PeproStat

Saline

Arm Description

PeproStat 2.5mg/mL soaked into haemostatic gelatin sponge, applied to a target bleeding site

Saline soaked into haemostatic gelatin sponge, applied to a target bleeding site

Outcomes

Primary Outcome Measures

The difference in time to hemostasis in minutes when using verum vs placebo
Efficacy in terms of Time to hemostasis, mean (mTTH) at the primary target bleed site (TBS),measured in minutes from the start of treatment application (TxStart) at the TBS to the achievement of haemostasis at that site or to the end of the 10-minute assessment period if haemostasis has not yet been achieved.

Secondary Outcome Measures

Percentage of subjects achieving hemostasis at 1 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Percentage of subjects achieving haemostasis within 1 minute from application of treatment
Percentage of subjects achieving hemostasis at 2 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Percentage of subjects achieving haemostasis within 2 minutes from application of treatment
Percentage of subjects achieving hemostasis at 3 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Percentage of subjects achieving haemostasis within 3 minutes from application of treatment
Percentage of subjects achieving hemostasis at 5 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Percentage of subjects achieving haemostasis within 5 minutes from application of treatment
Percentage of subjects achieving hemostasis at 7 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Percentage of subjects achieving haemostasis within 7 minutes from application of treatment
Percentage of subjects achieving hemostasis at 10 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Percentage of subjects achieving haemostasis within 10 minutes from application of treatment
Median time to hemostasis in minutes from TxStart to the achievement of hemostasis or to the end of the 10-minute assessment period if hemostasis has not yet been achieved
Median time for haemostasis to be achieved
Number/rate of subjects who do not achieve hemostasis within 10 min
Number/rate of subjects who do not achieve hemostasis within 10 min
Number of sponges applied at Target Bleeding Site (TBS)
Number of sponges used at TBS, 1 or 2
Dose of PeproStat determined by number and size (if cut to size) of PeproStat soaked sponges applied at TBS
Dose of PeproStat determined by number and size (if cut to size) of PeproStat soaked sponges applied at TBS
Number/rate of treatment failures
Number of participants not achieving haemostasis within 10 minutes at primary, secondary or both TBS's
Use of alternative haemostatic agents at the TBS
Number of participants requiring use of other haemostats at the TBS
Investigator assessment of efficacy to obtain haemostasis
Investigator's assessment of the efficacy of the treatment with a score of 1-5, where 5 is very effective
Investigator assessment ease of use of study treatment
Investigator assessment ease of use of study treatment with a score of 1-5, where 5 is very effective
Adverse Events
Number of Adverse Events (AEs) including adverse events of special interest: Bleeding at the TBS after 10-minute assessment period during or after surgery (if re-operation is required) and transfusion requirement
Heparin usage
Number of participants with Heparin usage
Antiplatelet usage
Number of participants with Antiplatelet usage
Laboratory safety parameters
Changes in Laboratory safety parameters at day 5 vs. screening
Laboratory safety parameters
Laboratory safety parameters at day 30 vs. screening
Immunogenicity testing
Immunogenicity testing
Vital signs
Changes in vital signs
Vital signs
Changes in vital signs
Vital signs
Changes in vital signs
Vital signs
Changes in vital signs
Vital signs
Changes in vital signs
Vital signs
Changes in vital signs
12-lead electrocardiogram
Abnormalities in 12-lead electrocardiogram
12-lead electrocardiogram
Abnormalities in 12-lead electrocardiogram

Full Information

First Posted
March 27, 2017
Last Updated
February 26, 2018
Sponsor
Haemostatix Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT03131336
Brief Title
PeproStat as a Topical Agent Used to Stop Bleeding in Patients Undergoing Surgery
Official Title
A Controlled, Randomized, Multi-centre, Double Blind, Phase II Study to Evaluate Efficacy and Safety of Topical PeproStat in Intraoperative Surgical Haemostasis
Study Type
Interventional

2. Study Status

Record Verification Date
February 2018
Overall Recruitment Status
Completed
Study Start Date
March 31, 2017 (Actual)
Primary Completion Date
August 23, 2017 (Actual)
Study Completion Date
October 11, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Haemostatix Ltd

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to test the effectiveness and safety of a new peptide-based coagulant, PeproStat. The study drug will be applied to patients undergoing liver/soft tissue surgery, vascular surgery or spine surgery. The speed of action of the new coagulant, that is applied with a gelatin sponge, will be compared to the same sponge but with saline (a commonly used standard of care).
Detailed Description
PeproStat is a new class of topical haemostatic agent composed of recombinant human albumin (rHA) conjugated with fibrinogen-binding peptides. The conjugate polymerises fibrinogen into a fibrin-like clot without the need for thrombin. PeproStat is formulated in a liquid, and is soaked into a haemostatic gelatin sponge in the operating theatre, and applied directly to the site of bleeding. The gelatin sponge (Spongostan ) is an approved "passive" haemostat i.e., PeproStat is an adjunct to a passive haemostat. The study is designed in a 2:1 randomization (verum:placebo) to investigate the efficacy in terms of Time to hemostasis, mean (mTTH) at the primary target bleed site (TBS), measured in minutes (min) from the start of treatment application (TxStart) at the TBS to the achievement of hemostasis at that site or to the end of the 10-minute assessment period if hemostasis has not yet been achieved.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bleeding

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Prospective, interventional, randomized, controlled, double-blind, parallel group
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
169 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PeproStat
Arm Type
Experimental
Arm Description
PeproStat 2.5mg/mL soaked into haemostatic gelatin sponge, applied to a target bleeding site
Arm Title
Saline
Arm Type
Placebo Comparator
Arm Description
Saline soaked into haemostatic gelatin sponge, applied to a target bleeding site
Intervention Type
Drug
Intervention Name(s)
PeproStat
Other Intervention Name(s)
PeproStat 2.5 mg/mL, soaked into Spongostan
Intervention Description
solution for local application
Intervention Type
Drug
Intervention Name(s)
Saline
Other Intervention Name(s)
Absorbable gelatin sponge (Spongostan) soaked with saline
Intervention Description
solution for local application
Primary Outcome Measure Information:
Title
The difference in time to hemostasis in minutes when using verum vs placebo
Description
Efficacy in terms of Time to hemostasis, mean (mTTH) at the primary target bleed site (TBS),measured in minutes from the start of treatment application (TxStart) at the TBS to the achievement of haemostasis at that site or to the end of the 10-minute assessment period if haemostasis has not yet been achieved.
Time Frame
10 minutes after application
Secondary Outcome Measure Information:
Title
Percentage of subjects achieving hemostasis at 1 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Description
Percentage of subjects achieving haemostasis within 1 minute from application of treatment
Time Frame
1 minute after start of treatment
Title
Percentage of subjects achieving hemostasis at 2 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Description
Percentage of subjects achieving haemostasis within 2 minutes from application of treatment
Time Frame
2 minutes after start of treatment
Title
Percentage of subjects achieving hemostasis at 3 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Description
Percentage of subjects achieving haemostasis within 3 minutes from application of treatment
Time Frame
3 minutes after start of treatment
Title
Percentage of subjects achieving hemostasis at 5 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Description
Percentage of subjects achieving haemostasis within 5 minutes from application of treatment
Time Frame
5 minutes after start of treatment
Title
Percentage of subjects achieving hemostasis at 7 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Description
Percentage of subjects achieving haemostasis within 7 minutes from application of treatment
Time Frame
7 minutes after start of treatment
Title
Percentage of subjects achieving hemostasis at 10 min haemostasis in adult subjects undergoing open liver/soft tissue, vascular and spine surgery using descriptive statistics
Description
Percentage of subjects achieving haemostasis within 10 minutes from application of treatment
Time Frame
10 minutes after start of treatment
Title
Median time to hemostasis in minutes from TxStart to the achievement of hemostasis or to the end of the 10-minute assessment period if hemostasis has not yet been achieved
Description
Median time for haemostasis to be achieved
Time Frame
10 minutes after start of treatment
Title
Number/rate of subjects who do not achieve hemostasis within 10 min
Description
Number/rate of subjects who do not achieve hemostasis within 10 min
Time Frame
10 minutes after start of treatment
Title
Number of sponges applied at Target Bleeding Site (TBS)
Description
Number of sponges used at TBS, 1 or 2
Time Frame
Counted on Day of surgery
Title
Dose of PeproStat determined by number and size (if cut to size) of PeproStat soaked sponges applied at TBS
Description
Dose of PeproStat determined by number and size (if cut to size) of PeproStat soaked sponges applied at TBS
Time Frame
Measured on day of surgery
Title
Number/rate of treatment failures
Description
Number of participants not achieving haemostasis within 10 minutes at primary, secondary or both TBS's
Time Frame
10 minutes after start of treatment
Title
Use of alternative haemostatic agents at the TBS
Description
Number of participants requiring use of other haemostats at the TBS
Time Frame
Documented on the day of surgery
Title
Investigator assessment of efficacy to obtain haemostasis
Description
Investigator's assessment of the efficacy of the treatment with a score of 1-5, where 5 is very effective
Time Frame
Documented on the day of surgery
Title
Investigator assessment ease of use of study treatment
Description
Investigator assessment ease of use of study treatment with a score of 1-5, where 5 is very effective
Time Frame
Documented on the day of surgery
Title
Adverse Events
Description
Number of Adverse Events (AEs) including adverse events of special interest: Bleeding at the TBS after 10-minute assessment period during or after surgery (if re-operation is required) and transfusion requirement
Time Frame
Measured from the point of consent to Day 30
Title
Heparin usage
Description
Number of participants with Heparin usage
Time Frame
Measured from the point of consent to Day 30
Title
Antiplatelet usage
Description
Number of participants with Antiplatelet usage
Time Frame
Measured from the point of consent to Day 30
Title
Laboratory safety parameters
Description
Changes in Laboratory safety parameters at day 5 vs. screening
Time Frame
Measured at Day 5
Title
Laboratory safety parameters
Description
Laboratory safety parameters at day 30 vs. screening
Time Frame
Measured at screening, Day 30
Title
Immunogenicity testing
Description
Immunogenicity testing
Time Frame
Measured at screening and Day 30
Title
Vital signs
Description
Changes in vital signs
Time Frame
Measured before surgery vs. screening
Title
Vital signs
Description
Changes in vital signs
Time Frame
Measured during surgery (before treatment) vs. screening
Title
Vital signs
Description
Changes in vital signs
Time Frame
Measured during surgery (15 minutes after treatment) vs. screening
Title
Vital signs
Description
Changes in vital signs
Time Frame
Measured at 4 hours after surgery vs. screening
Title
Vital signs
Description
Changes in vital signs
Time Frame
Measured at 8 hours after surgery vs. screening
Title
Vital signs
Description
Changes in vital signs
Time Frame
Measured at 16 hours after surgery vs. screening
Title
12-lead electrocardiogram
Description
Abnormalities in 12-lead electrocardiogram
Time Frame
measured at Day 5
Title
12-lead electrocardiogram
Description
Abnormalities in 12-lead electrocardiogram
Time Frame
measured at Day 30 (if medically indicated)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: At screening and baseline: Subject is undergoing a planned open liver/soft tissue surgery, vascular surgery or spine surgery. Subjects are able and willing to provide written informed consent to participate in this study. Adult males and females ≥18 years of age at screening. Willing and able to comply with all protocol requirements including follow-up assessments. Male subjects must be willing and able to use adequate contraception from enrollment through to the 30 day follow-up visit. Women of childbearing potential (WCBP)C have to use highly effective methods of contraception from enrollment through to the 30 day follow-up visit. Intraoperative: The subject presents an identified target bleeding site with mild or moderate bleeding, which conventional surgical techniques are insufficient to control or are inappropriate and would otherwise be a candidate for standard haemostats. The subject presents no intraoperative complications, other than bleeding, that may interfere with study assessments as judged by the Investigator. The subject presents no contaminated areas of the body, signs of infection or abscess development. Total target bleeding site surface area of ≤ 70 cm2, defined within one or two TBSs. Exclusion Criteria: Subject is undergoing emergency surgical procedure. Use of study treatment and sponge in Closure of skin incisions as the sponge may interfere with the healing of skin edges. Intravascular compartments because of the risk of embolization following sponge application. Recipient of an organ transplant. Haematologic, biochemistry and coagulation panel thresholds at screening: Haemoglobin ≤ 9.0 g/dL. Platelet count ≤100,000/mm3 (≤ 100 x 109/L). International Normalized Ratio (INR) > 2.0 or activated Partial Thromboplastin Time (aPTT) ratio > 2.0. Fibrinogen level < 1.5 g/L. Aspartate Aminotransferase (AST) or Alanine aminotransferase (ALT) ≥ 3 times the upper limit normal range, except for subjects undergoing liver resection surgery where there is no upper limit for these analytes due to the nature of their disease. Severe renal failure. Any other disease or condition that may affect normal blood clotting, for example thrombocytopenia, as judged by the Investigator. A known history of anaphylaxis or allergic reaction to human albumin, PEGylated proteins, yeast or moulds, porcine products or other components in the study medication or sponge. Participation in another investigational drug or device research study within 30 days before and after enrolment in the current study. Current known or suspected alcohol and/or drug abuse or dependence at the time of screening. Any concurrent medical, surgical, or psychiatric condition that may, in the Investigator's opinion, affect the subject's willingness or ability to meet all study requirements during the study duration. Known HIV, Hepatitis B virus or Hepatitis C Virus infection. During the surgery, subject presents severe bleeding where use of a topical haemostat would be inappropriate. Anti-platelets/oral anticoagulants treatment: Soft tissue/liver and neurosurgery: Subject is taking anti-platelet agents or oral anticoagulants within 7 days of surgery Vascular surgery: Subject is taking dual anti-platelet treatment or oral anticoagulants within 7 days of surgery. One anti-platelet agent is allowed perioperatively. Heparin treatment: c. Soft tissue/liver and neurosurgery only: Subject is receiving therapeutic doses of heparin perioperatively. Only prophylactic Low Molecular Weight Heparin is allowed. Pregnant or breast-feeding subject.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul Hayes
Organizational Affiliation
Addenbrookes NHS Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Clinical Hospital, Bolnicka 25
City
Sarajevo
ZIP/Postal Code
71000
Country
Bosnia and Herzegovina
Facility Name
University Clinical Hospital Centre "Sestre Milosrdnice", Vinogradska cesta 29
City
Zagreb
ZIP/Postal Code
10000
Country
Croatia
Facility Name
Klinika Neurochirurgii Gdanskie Centrum Kliniczne, ul. Dębinki 7
City
Gdańsk
ZIP/Postal Code
80-952
Country
Poland
Facility Name
Clinical centre of Serbia, Clinic for vascular and endovascular surgery, Koste Todorovica Street 8
City
Belgrade
ZIP/Postal Code
11000
Country
Serbia
Facility Name
Addenbrookes Hospital
City
Cambridge
ZIP/Postal Code
CB2 0QQ
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No

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PeproStat as a Topical Agent Used to Stop Bleeding in Patients Undergoing Surgery

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