Protection of the Heart With Doxycycline During Coronary Artery Bypass Grafting

University of Alberta

Status and phase: Completed; Phase 2

Conditions: Cardiopulmonary Bypass; Reperfusion Injury; Coronary Artery Bypass Grafting

Treatments: Drug: Placebo Oral Tablet; Drug: Periostat

Study type: Interventional

Funder types: Other

Identifiers

NCT00246740

Protect Study Protocol

Details and patient eligibility

About

The purpose of this study is to determine whether doxycycline (Periostat) at a sub-antimicrobial dose will decrease reperfusion injury after coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).

Full description

This proposal is for a randomized, placebo-controlled, double-blinded study of the use of doxycycline in patients requiring CABG surgery. Patients will be randomized 1:1 to receive either doxycycline or placebo.

This study will be conducted in a blinded manner. The pharmacy will randomize patients and will have the randomization code. The code will only be broken in the case of an emergency and the event will be fully documented.

In addition to standard care, patients will receive oral administration of 20 mg of doxycycline or placebo twice a day at least 2 days prior to surgery, on the day of surgery, and on postoperative days 1, 2, and 3.

Myocardial atrial biopsies will be taken at 2 time points during the CABG procedure: during cannulation of the right atrium and 10 minutes after cross-clamp release. Tissue will be analyzed for MMP-2 and -9 activity and TnI and MLC-1 levels.

A Swan-Ganz-Catheter will be placed in the pulmonary artery over 24 hours to measure hemodynamics (LVSWI).

A coronary sinus catheter will be placed under echocardiographic guidance prior to initiation of CPB (will be removed 20 minutes after cross-clamp release).

Patients will have an additional ECG on post-operative days 1 and 3.

Additional blood will be drawn to determine doxycycline plasma levels, MMP-2 and -9 activity, total gelatinolytic activity, and levels of troponin I and T products at the following time points: pre-induction, prior to initiation of CPB, 10 and 20 minutes following the release of the aortic cross clamp (arterial and venous) and 3, 6, 24 and 72 hours post aortic cross clamp removal (venous). Each of the above samples will require 6 mL of blood for a study total of 72 mL. At the time of each blood draw we will measure and record the hematocrit value.

Enrollment: 56 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Written informed consent
• Aged 18 through 80 years, inclusive
• Scheduled for primary CABG surgery with CPB

Exclusion criteria

• Females of childbearing potential
• Emergency CABG
• Previous sternotomy
• Planned simultaneous surgery (i.e. valve repair or carotid endarterectomy)
• Myocardial infarction within 48 hours
• Pre-operative atrial fibrillation
• Pre-operative ventricular pacing or left bundle branch block (LBBB)
• Known hypersensitivity to tetracycline class antibiotics
• Renal failure requiring dialysis

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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56 participants in 2 patient groups, including a placebo group

Placebo oral tablet

Placebo Comparator group

Description:

Patients received oral administration of matching placebo pills, twice a day at least 2 days prior to surgery, on the day of surgery, and for the first 3 postoperative days (via a nasogastric tube or orally when patients tolerated it).

Treatment:

Drug: Placebo Oral Tablet

Periostat

Experimental group

Description:

Patients received oral administration of 20 mg of doxycycline, twice a day at least 2 days prior to surgery, on the day of surgery, and for the first 3 postoperative days (via a nasogastric tube or orally when patients tolerated it).

Treatment:

Drug: Periostat