Lowe J, Luber J, Levitsky S, Hantak E, Montgomery J, Schiestl N, Schofield N, Marra S
Duke University Medical Center, Durham, NC, USA.
J Cardiovasc Surg (Torino). 2007 Jun;48(3):323-31.
TISSEEL VH is the only commercially available fibrin sealant indicated as an adjunct to conventional methods of hemostasis during cardiac surgery. A next generation fibrin sealant (TISSEEL VH S/D) has been developed in frozen, ready-to-use form with an added virus inactivation step (solvent/detergent [S/D] treatment) to provide added safety and convenience to the currently licensed product. This study was performed to compare efficacy and safety of the two products.
Phase 3, prospective, randomized, double-blind, multicenter study to compare TISSEEL VH S/D to TISSEEL VH during cardiac surgery. The primary efficacy endpoint was the proportion of patients who achieved hemostasis at the primary treatment site within 5 min, and maintained hemostasis until surgical closure.
The proportion of patients who achieved hemostasis at the primary treatment site within 5 min, and maintained hemostasis until surgical closure was 88.2% for TISSEEL VH S/D and 89.6% for TISSEEL VH in the intent-to-treat population. The difference in proportions, TISSEEL VH S/D minus TISSEEL VH, was 1.4% with a standard error of 3.70%. The lower 97.5% confidence bound of this difference was 8.6%, which is above the predefined noninferiority margin of 15%. Therefore, TISSEEL VH S/D is at least as efficacious as TISSEEL VH. The safety profile of TISSEEL VH S/D was very similar to that of currently licensed TISSEEL VH as assessed by the safety endpoints.
TISSEEL VH S/D is safe and effective for use as an adjunct to hemostasis in patients undergoing cardiac surgery.
TISSEEL VH是唯一一种可用于心脏手术中辅助传统止血方法的市售纤维蛋白密封剂。已开发出一种下一代纤维蛋白密封剂(TISSEEL VH S/D),其为冷冻即用型,增加了病毒灭活步骤(溶剂/去污剂[S/D]处理),为当前已获许可的产品提供更高的安全性和便利性。本研究旨在比较这两种产品的疗效和安全性。
进行一项3期前瞻性随机双盲多中心研究,比较心脏手术中TISSEEL VH S/D与TISSEEL VH。主要疗效终点是在5分钟内在主要治疗部位实现止血并维持止血直至手术结束的患者比例。
在意向性治疗人群中,TISSEEL VH S/D在5分钟内在主要治疗部位实现止血并维持止血直至手术结束的患者比例为88.2%,TISSEEL VH为89.6%。比例差异(TISSEEL VH S/D减去TISSEEL VH)为1.4%,标准误为3.70%。该差异的97.5%置信下限为8.6%,高于预先定义的非劣效性界值15%。因此,TISSEEL VH S/D至少与TISSEEL VH疗效相当。根据安全性终点评估,TISSEEL VH S/D的安全性与当前已获许可的TISSEEL VH非常相似。
TISSEEL VH S/D在心脏手术患者中作为止血辅助手段使用是安全有效的。