Clinical Trial Results:
Efficacy and safety of two dose regimens of Octaplex in patients with intracranial haemorrhage related to oral anticoagulant therapy: a multicentre, prospective, randomised, open-label study.
Summary
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EudraCT number |
2007-000602-73 |
Trial protocol |
FR |
Global end of trial date |
16 Apr 2011
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Results information
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Results version number |
v1(current) |
This version publication date |
04 Jan 2017
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First version publication date |
04 Jan 2017
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
LEX-206
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Octapharma France SAS
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Sponsor organisation address |
62bis Avenue André Morizet, Boulogne-Billancourt, France, 92100
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Public contact |
Mag. Friedrich W. Kursten
, Octapharma Pharmazeutika Produktionsges.m.b.H.
, +43 161 032 1245, friedrich.kursten@octapharma.com
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Scientific contact |
Mag. Friedrich W. Kursten
, Octapharma Pharmazeutika Produktionsges.m.b.H.
, +43 161 032 1245, friedrich.kursten@octapharma.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
26 Jan 2012
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
16 Apr 2011
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The primary study objective was to compare the efficacy of two dose regimens of Octaplex on the INR at 10 ± 5 minutes after the end of injection in patients with intracranial haemorrhage related to oral anticoagulant therapy.
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Protection of trial subjects |
The study was conducted in accordance with the ethical principles of the Declaration of Helsinki, and ICH-GCP, and national regulatory requirements. In- and exclusion criteria were carefully defined in order to protect subjects from contraindications, interactions with other medication and safety factors associated with the investigational medicinal product. Throughout the study safety was assessed, such as occurrence of adverse events, lab values, vital signs and physical examinations.
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Background therapy |
Octaplex was administered as a single dose, by intravenous infusion. All patients were also given 5 mg vitamin K. | ||
Evidence for comparator |
N.A. | ||
Actual start date of recruitment |
07 Nov 2008
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
France: 59
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Worldwide total number of subjects |
59
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EEA total number of subjects |
59
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
7
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From 65 to 84 years |
38
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85 years and over |
14
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Recruitment
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Recruitment details |
Studied Period: FPI 07-NOV-2008 and LPO 16-APR-2011. In total 59 patients suffering from intracranial haemorrhage related to oral anticoagulant therapy were enrolled from 15 active study sites in France. | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
Patients of 18 years of age or older, Intracranial haemorrhage (intracerebral and acute subdural) confirmed by medical imaging (CT-scan only), use of oral anticoagulant, vitamin K antagonists only, written informed consent from the patient or a legally acceptable representative. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Not blinded | ||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Octaplex 25 IU/kg | ||||||||||||||||||||||||
Arm description |
Octaplex was administered as a single dose by intravenous infusion (at the standard dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Octaplex
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Investigational medicinal product code |
ATC B02BD01
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Other name |
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Pharmaceutical forms |
Infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Standard dose (25 IU/kg).
There were only two infusion speed groups: the low (≥3 mL/min and <8 mL/min) and the high (≥8 mL/min) infusion speed group, which included 20 and 39 patients, respectively, in the FAS and 18 and 35 patients, respectively, in the PP Set.
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Arm title
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Octaplex 40 IU/kg | ||||||||||||||||||||||||
Arm description |
Octaplex was administered as a single dose by intravenous infusion (at the high dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. less | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Octaplex
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
High dose (40 IU/kg).
There were only two infusion speed groups: the low (≥3 mL/min and <8 mL/min) and the high (≥8 mL/min) infusion speed group, which included 20 and 39 patients, respectively, in the FAS and 18 and 35 patients, respectively, in the PP Set.
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Baseline characteristics reporting groups
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Reporting group title |
Octaplex 25 IU/kg
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Reporting group description |
Octaplex was administered as a single dose by intravenous infusion (at the standard dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. | ||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Octaplex 40 IU/kg
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Reporting group description |
Octaplex was administered as a single dose by intravenous infusion (at the high dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. less | ||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Full Analysis Set (FAS) - Octaplex 25 IU/kg
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Subject analysis set type |
Full analysis | ||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All randomised patients who received at least one infusion of study medication.
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Subject analysis set title |
Full Analysis Set (FAS) - Octaplex 40 IU/kg
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Subject analysis set type |
Full analysis | ||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
All randomised patients who received at least one infusion of study medication.
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End points reporting groups
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Reporting group title |
Octaplex 25 IU/kg
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Reporting group description |
Octaplex was administered as a single dose by intravenous infusion (at the standard dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. | ||
Reporting group title |
Octaplex 40 IU/kg
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Reporting group description |
Octaplex was administered as a single dose by intravenous infusion (at the high dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. less | ||
Subject analysis set title |
Full Analysis Set (FAS) - Octaplex 25 IU/kg
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
All randomised patients who received at least one infusion of study medication.
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Subject analysis set title |
Full Analysis Set (FAS) - Octaplex 40 IU/kg
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Subject analysis set type |
Full analysis | ||
Subject analysis set description |
All randomised patients who received at least one infusion of study medication.
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End point title |
INR at 10 +/- 5 minutes [1] | ||||||||||||
End point description |
The primary study objective was to compare the efficacy of two dose regimens of Octaplex on the INR (International normalised ratio) at 10 ± 5 minutes after the end of injection in patients with intracranial haemorrhage related to oral anticoagulant therapy.
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End point type |
Primary
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End point timeframe |
after the end of injection
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: No inferential statistical analysis was pre-planned for this study, but the endpoint was to be presented descriptively only. |
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Notes [2] - there were missing values for primary endpoint data in 3 patients, which were not replaced. [3] - there were missing values for primary endpoint data in 3 patient, which were not replaced. |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Adverse events were assessed throughout the whole study.
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Adverse event reporting additional description |
All SAEs, whether suspected to be related to study treatment or not, are reported by telephone, fax or e-mail immediately to the responsible Clinical Project Manager, study monitor, or to the responsible local CRO.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
11.0
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Reporting groups
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Reporting group title |
Octaplex 25 IU/kg
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Reporting group description |
Octaplex was administered as a single dose by intravenous infusion (at the standard dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Octaplex 40 IU/kg
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Reporting group description |
Octaplex was administered as a single dose by intravenous infusion (at the high dose) in accordance with the randomisation. All patients were also given 5 mg vitamin K. Throughout the stay in the hospital, efficacy and safety assessments were performed at precise time points calculated from the end of Octaplex infusion: The medical part of the study ended on Day 30 (or the last day of hospitalisation if the patient was discharged earlier) after the Octaplex infusion. Three months after the Octaplex infusion, patients had to complete a quality of life (SF-36) and a pharmaco-economic self-questionnaire. less | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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30 Jun 2008 |
Amendment No. 1
• The CT scan imaging technique only was allowed at inclusion to confirm diagnosis and at 48 hours to evaluate the haematoma volume. The same technique had to be used at inclusion and 48 hours. If CT scan and MRI are commonly used to confirm diagnosis, CT scan is preferred at 48 hours for control imaging.
• Modification of the exclusion criteria: Some exclusion criteria needed an explanation for a better understanding. General seizure has been deleted as they are frequently associated with intracranial haemorrhage.
• Modification of Octaplex administration: According to Scientific Committee members request (Pr P. Coriat, principal investigator and Pr B. Riou, investigator, Dr B. Vigué and Pr. C Négrier), an additional Octaplex dose could be administered at 10 ± 5 minutes and at 6 hours after the first Octaplex infusion, following precise recommendation and not at the discretion of the investigator. The recommendation was 1.5 as target INR for the first rescue dose. The table has been simplified to facilitate the additional dose calculation by the investigators.
• Modification of Octaplex infusion rate: The context of very high emergency implies to shorten all the delays in patient care including treatment administration.
• Update of information on Octaplex storage (new Octaplex variation approved by reference member state via Mutual Recognition Procedure in 30-Nov-2007).
• New laboratory parameters: Digital glucose was performed instead of being analysed in the laboratory. Additional laboratory tests were done (liver function, haematology) in order to follow the overall safety data. |
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30 Jun 2008 |
Amendment No. 2
• Modification of the informed consent procedure: The previous procedure was not adapted to the emergency situation. According to the law, in emergency situations, if prior informed consent of the patient is not possible and the patient’s legally acceptable representative is not available, the patient can be enrolled without prior informed consent. The informed consent procedure was modified in consequence: if the patient’s legally acceptable representative was not available, the patient could be included by the investigator in presence of a witness independent from the investigator and the Sponsor.
• Because of the change of the informed consent procedure, the patient concomitant disability could not be assessed by the physician if the patient’s legally acceptable representative was absent. This exclusion criterion was thus suppressed.
• Population of the study better defined: The type of intracranial haemorrhage has been precisely defined for a better understanding.
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22 Aug 2008 |
Amendment No. 3
• Modification of biological analyses: Some of the centralised analyses (fibrin degradation products and thrombin-prothrombin complexes) have been cancelled with the agreement of the central laboratory, in order to lighten plasma tubes preparation for local laboratories. Moreover, central laboratory analyses were only to be performed in the centres that possessed laboratory facilities (adequate devices and personnel during night and day) to prepare plasma tubes. The laboratory parameters analysis was performed locally or centrally upon local laboratory facilities.
• ECG surveillance: ECG is monitored continuously during the whole stay in the investigator’s ward, thus the surveillance at 48 hours was added.
• Modification of the determination of sample size based on the results obtained from previous studies with Octaplex.
• Precision of the anticoagulant therapy: The type of anticoagulant therapy has been added. Only patients under vitamin K antagonist therapy were admitted.
• Precision of the type of subdural haematoma: Only patients with acute subdural haematoma were admitted. This criterion was assessed by CT scan. |
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17 Dec 2008 |
Amendment No. 5
• Change of Sponsor: Octapharma France SAS (Boulogne-Billancourt, France) replaced Octapharma AG (Lachen, Switzerland).
• Modification of the sample labels for investigational medicinal products: Addition of FIX content in Octaplex and change of Sponsor.
• Modification of the study duration: Due to the late clinical study start, the study duration was prolonged accordingly. |
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03 Aug 2009 |
Amendment No. 6
• In the entire text, thrombin generation assay (TGA) analysis was suppressed. The results of TGA analysis in the first patients included in the study were not interpretable due to a bad plasma preparation. As this test was still experimental, it was decided to stop this analysis in agreement with Pr Negrier (Head of Central Laboratory).
• In the entire text, a time window of 15 minutes before and 15 minutes after the fixed time points 1 hour, 3 hours, 6 hours and 24 hours was added. As this study was carried out in a context of emergency, it appeared that greater flexibility in the times of blood sample collection was appropriate to avoid protocol deviations and give more comfort
to the investigator during the care of patient.
• In the entire text, the National Institute of Health (NIH) stroke scale was suppressed. As the NIH stroke scale was not usually used by most study investigators and requires a specific training, it was decided to not perform this scale anymore. Alternatively, the neurological worsening was assessed by a routine neurological examination.
• An English translation, certified by a sworn translator, of the Informed consent and the Patient information approved by the IEC on 01-Jul-2008 was added to Appendix 2 of the protocol. This translation was supplied, for information, to two patients speaking English. |
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18 Nov 2009 |
Amendment No. 7
• Modification of the study duration: Due to a recruitment rate below what was expected, the duration of the study had to be extended accordingly. |
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15 Sep 2010 |
Amendment No. 8
• Modification of the study duration: Due to a recruitment rate below what was expected, the duration of the study had to be extended accordingly. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |