Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of MDCO-2010 in Patients Undergoing Elective Coronary Artery Bypass Graft Surgery

This protocol describes a study of the investigational drug MDCO-2010 as a haemostasis modulator in patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery involving a cardiopulmonary bypass (CPB).

Perioperative bleeding is a serious complication that adversely affects the morbidity and mortality of cardiac surgery. To alleviate this complication, prophylactic antifibrinolytic therapies are now widely accepted as a strategy to inhibit excessive fibrinolysis.

MDCO-2010, a synthetic small molecule, is a direct inhibitor of plasmin and plasma kallikrein. Both of these have been implicated with impaired haemostasis. In addition, potent inhibition of coagulation factors Xa, XIa and activated Protein C has been demonstrated. Thus, MDCO-2010 has the potential to mitigate excessive fibrinolysis and thrombin generation during cardiac surgery involving a cardiopulmonary bypass. In particular the latter is supposed to provide additional benefits beyond reducing transfusion requirements.

Inclusion criteria

• Men, aged 18 to 80 years or
• Post-menopausal women, aged up to 80 years. Postmenopausal status defined as ≥ 1 year since last menstruation in women with no medical history of hysterectomy or women with a medical history of bilateral oophorectomy
• Planned elective, isolated primary CABG surgery with more than 1 graft, including the use of cardiopulmonary bypass
• Written informed consent prior to any study-related procedure not part of normal medical care

Exclusion criteria

Patients may not meet any of the following exclusion criteria:

• Planned concomitant surgery including atrial septal defect (ASD) repair, valve replacement, carotid endarterectomy, aortic surgery, any combined procedure or any repeat sternotomy
• Planned Off-pump CABG
• Body weight < 55 kg or > 110 kg
• Planned hypothermia < 28°C
• Major surgical procedures within 30 days of entry
• Placement of drug-eluting stent (DES) within 12 months or of bare-metal stent (BMS) within 6 weeks of entry in a vessel which is not intended to be grafted
• Ejection fraction < 35%
• Preoperative coagulation abnormalities

• Platelet count < 100,000/cubic mm, or
• INR > 1.5 or Quick < 40%, or
• activated partial thromboplastin time (aPTT) > 1.5 x upper limit of normal (ULN)
• Preoperative Hb < 11 g/dL for male patients or < 10 g/dL for female patients
• Patient refusal to receive donor blood products if necessary
• Administration of thienopyridines within 5 days prior to surgery Administration of warfarin within 5 days prior to surgery
• Administration of tirofiban or eptifibatide within 24 hours or administration of abciximab within 5 days prior to surgery
• Administration of fondaparinux within 24 hours prior to surgery
• Creatinine clearance (calculated using Cockroft-Gault equation) < 60 mL/min
• Planned intraoperative use of tranexamic acid or of ε-aminocaproic acid
• History of stroke or transient ischemic attack within 3 months prior to entry
• Known heparin-induced thrombocytopenia
• Known history of thrombophilia, eg, deep vein thrombosis (DVT) with pulmonary embolism
• Active liver disease
• Any condition requiring chronic immunosuppressive medication
• Receipt of an investigational drug or device 30 days prior to entry
• Any other condition which, in the opinion of the investigator, would prevent a patient's participation in the study