Routine versus selective protamine administration to reduce bleeding complications after transcatheter aortic valve implantation

2023-504205-36-00 Protocol 2023-504205-36-00 Phase III and Phase IV (Integrated) Ended

Start 1 Nov 2023 · End 2 Jan 2026 · Status Ended · 2 EU/EEA countries · 6 sites · Protocol 2023-504205-36-00

Overview

Sponsor-declared trial summary

Phase Phase III and Phase IV (Integrated)
Status Ended
Participants planned 800
Countries 2
Sites 6

Aortic stenosis

To determine if routine protamine administration, compared with selective protamine administration, reduces the risk of the composite endpoint of all-cause death or clinically relevant bleeding within 30 days after TAVI.

Key facts

Sponsor
St Antonius Hospital
Participant type
Patients
Age range
18-64 years, 65+ years
Gender
Male and Female
Therapeutic area
Diseases [C] - Cardiovascular Diseases [C14], Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] - Therapeutics [E02]
Trial duration
1 Nov 2023 → 2 Jan 2026
Decision date (initial)
2023-10-10
Transition trial
No
Low-intervention
Yes
Rare-disease indication
No
Vulnerable population
No
Funding sources
St. Antonius Research Fund

External identifiers

EU CT number
2023-504205-36-00
WHO UTN
U1111-1289-5421
ClinicalTrials.gov
NCT05774691

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Safety, Efficacy, Therapy

To determine if routine protamine administration, compared with selective protamine administration, reduces the risk of the composite endpoint of all-cause death or clinically relevant bleeding within 30 days after TAVI.

Secondary objectives 5

  1. The risk of all bleeding (VARC-3 type 1-4)
  2. The risk of major bleeding, life-threatening or fatal bleeding (VARC-3 type 2-4)
  3. The risk of major vascular complications (VARC-3)
  4. The risk of cardiovascular mortality (VARC-3)
  5. The risk of all-cause mortality (VARC-3)

Conditions and MedDRA coding

Aortic stenosis

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 3

  1. Aged > 18 years
  2. Undergoing transfemoral TAVI with any commercially available transcatheter heart valve
  3. Provided written informed consent

Exclusion criteria 3

  1. Documented protamine allergy or anaphylaxis
  2. Recent PCI (< 3 months before TAVI)
  3. Planned arterial access via surgical cut-down

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

  1. The composite of cardiovascular mortality or clinically relevant bleeding (VARC-3 type 1-4) within 30 days after TAVI procedure.

Secondary endpoints 5

  1. All bleeding (VARC-3 type 1-4)
  2. Major, life-threatening or fatal bleeding (VARC-3 type 2-4)
  3. Major vascular complications (VARC-3)
  4. Cardiovascular mortality (VARC-3)
  5. All-cause mortality

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 1

Protamine sulfaat LEO Pharma 1400 anti-heparine IE/ml oplossing voor injectie en infusie

PRD427827 · Product

Active substance
Protamine Sulfate
Substance synonyms
PROTAMINE SULPHATE
Pharmaceutical form
SOLUTION FOR INJECTION/INFUSION
Route of administration
DIRECT INTRAVENOUS INJECTION
Max daily dose
14000 IU international unit(s)
Max total dose
14000 IU international unit(s)
Max treatment duration
1 Day(s)
Authorisation status
Authorised
ATC code
V03AB14 — PROTAMINE
Marketing authorisation
BE316985
MA holder
LEO PHARMA A/S
MA country
Belgium
Paediatric formulation
No
Orphan designation
No
Modified vs. Marketing Authorisation
No

Placebo 1

NaCl 0,9 % B. Braun, oplossing voor infusie

PRD5372758 · Product

Active substance
Sodium Chloride
Pharmaceutical form
SOLUTION FOR INJECTION/INFUSION
Route of administration
INTRAVENOUS BOLUS INJECTION/IV INFUSION
Max daily dose
10 ml millilitre(s)
Max total dose
10 ml millilitre(s)
Max treatment duration
1 Day(s)
Authorisation status
Authorised
ATC code
B05BB01 — ELECTROLYTES
Marketing authorisation
BE138476
MA holder
B.BRAUN MELSUNGEN AG
MA country
Belgium
Paediatric formulation
No
Orphan designation
No
Modified vs. Marketing Authorisation
No

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

St Antonius Hospital

Sponsor organisation
St Antonius Hospital
Address
Koekoekslaan 1
City
Nieuwegein
Postcode
3435 CM
Country
Netherlands

Scientific contact point

Organisation
St Antonius Hospital
Contact name
Dirk-Jan van Ginkel

Public contact point

Organisation
St Antonius Hospital
Contact name
Dirk-Jan van Ginkel

Locations

2 EU/EEA countries · 6 investigational sites

By country

CountryMS statusPlanned subjectsSites
Belgium Ended 200 2
Netherlands Ended 600 4
Rest of world 0

Investigational sites

Belgium

2 sites · Ended
Algemeen Stedelijk Ziekenhuis Campus Aalst
Cardiology, Merestraat 80, 9300, Aalst
UZ Leuven
Cardiology, Herestraat 49, 3000, Leuven

Netherlands

4 sites · Ended
St Antonius Hospital
Cardiology, Koekoekslaan 1, 3435 CM, Nieuwegein
Leiden University Medical Center
Cardiology, Albinusdreef 2, 2333 ZA, Leiden
Academic Medical Center At The University Of Amsterdam
Cardiology, Meibergdreef 9, 1105 AZ, Amsterdam
Academisch Ziekenhuis Maastricht
Cardiology, P. O. Box 616, 6200 MD, Maastricht

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Country Trial startTrial end Recruitment startRecruitment end Early termination
Belgium 2024-03-01 2025-11-12 2024-03-01 2025-09-18
Netherlands 2023-11-01 2026-01-02 2023-11-01 2025-09-18

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 7 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

TypeTitleVersion
Protocol (for publication) D1 Protocol 2023-504205-36-00 2.1
Summary of Product Characteristics (SmPC) (for publication) G2 SmPC NaCl 1
Summary of Product Characteristics (SmPC) (for publication) G2 SmPC Protamine sulfaat 1
Synopsis of the protocol (for publication) D1 Protocol synopsis DE 2023-504205-36-00 2
Synopsis of the protocol (for publication) D1 Protocol Synopsis ENG 2023-504205-36-00 3
Synopsis of the protocol (for publication) D1 Protocol synopsis FR 2023-504205-36-00 2
Synopsis of the protocol (for publication) D1 Protocol Synopsis NL 2023-504205-36-00 3

Application history

5 submissions — initial application plus substantial / non-substantial modifications

#TypeCodeSubmittedReference MSConclusionDecision date
1 INITIAL IN 2023-03-23 Netherlands Acceptable
2023-06-13
2023-06-13
2 SUBSEQUENT ADDITION OF MSC APP-2 2023-08-01 2023-10-10
3 SUBSTANTIAL MODIFICATION SM-6 2023-11-23 Netherlands Acceptable
2024-01-23
2024-01-23
4 SUBSTANTIAL MODIFICATION SM-7 2024-04-02 Netherlands Acceptable 2024-04-23
5 SUBSTANTIAL MODIFICATION SM-9 2025-08-29 Netherlands Acceptable
2025-11-19
2025-11-20