ID

38417

Beschrijving

Study ID: 103414 Clinical Study ID: 103414 Study Title: A Multicenter, Randomized, Double-blind, Parallel Group Trial to Demonstrate the Efficacy of Fondaparinux Sodium in Association With Intermittent Pneumatic Compression (IPC) Versus IPC Used Alone for the Prevention of Venous Thromboembolic Events in Subjects at Increased Risk Undergoing Major Abdominal surgery Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00038961 https://clinicaltrials.gov/ct2/show/NCT00038961 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Fondaparinux Sodium Trade Name: Fondaparinux Sodium Study Indication: Thrombosis This phase III placebo-controlled trial studies the efficacy and safety of Fondaparinux as an additional prevention measure of venous thromboembolic events (VTE) in patients above the age of 40 with intermediate or high VTE risk undergoing abdominal surgery. The study consists of a Screening Visit (Visit 0), the baseline visit on Day 1, the day of the surgery (Visit 1), the treatment period (denoted in its entirety as Visit 2) consisting of administration of Fondaparinux (2.5mg subcutaneously once daily) or placebo starting on Day 1 and continuing at least up to Day 5, possibly up to Day 9, in parallel to intermittent pneumatic compression and possibly elastic stockings, followed by a mandatory bilateral venography no longer than 24 hours after study drug cessation, and finally a Follow-up Visit (Visit 3) on Day 30 +/- 2. This form contains information on symptoms, diagnostics and treatment in case of a symptomatic DVT, and is to be filled in as appropriate during the study.

Link

https://clinicaltrials.gov/ct2/show/NCT00038961

Trefwoorden

Versies (1)
  1. 16-10-19 16-10-19 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

16 oktober 2019

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Fondaparinux in Addition to Intermittent Pneumatic Compression in Abdominal Surgery Patients at VTE Risk - NCT00038961

Engels

Unscheduled Assessment of Symptomatic DVT

1 Formulieren  
Administrative data
Beschrijving

Administrative data

Alias
UMLS CUI-1
C1320722
Country No.
Beschrijving

Country No.

Datatype

integer

Alias
UMLS CUI [1,1]
C0454664
UMLS CUI [1,2]
C0600091
Centre No.
Beschrijving

Centre No.

Datatype

integer

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Subject No.
Beschrijving

Clinical Trial Subject Unique Identifier

Datatype

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Beschrijving

Subject Initials

Datatype

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
General DVT Information
Beschrijving

General DVT Information

Alias
UMLS CUI-1
C1508263
UMLS CUI-2
C0149871
Date of first clinical signs/symptoms of DVT
Beschrijving

Date of first DVT signs/symptoms

Datatype

date

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0037088
Side: Left
Beschrijving

DVT left side?

Datatype

boolean

Alias
UMLS CUI [1,1]
C0205091
UMLS CUI [1,2]
C0149871
UMLS CUI [1,3]
C0441987
Side: Right
Beschrijving

DVT right side?

Datatype

boolean

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0441987
UMLS CUI [1,3]
C0205090
Ultrasonography
Beschrijving

Ultrasonography

Alias
UMLS CUI-1
C0041618
Not done
Beschrijving

If done, record date

Datatype

boolean

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C1272696
Date performed
Beschrijving

Ultrasonography date

Datatype

date

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C0011008
Ultrasonography Result of Left Common Femoral
Beschrijving

Ultrasonography Result of Left Common Femoral

Datatype

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C1275667
UMLS CUI [1,3]
C0205091
UMLS CUI [1,4]
C1274040
Ultrasonography Result of Left Popliteal
Beschrijving

Ultrasonography Result of Left Popliteal

Datatype

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C0032652
UMLS CUI [1,3]
C0205091
UMLS CUI [1,4]
C1274040
Ultrasonography Result of Right Common Femoral
Beschrijving

Ultrasonography Result of Right Common Femoral

Datatype

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C1275667
UMLS CUI [1,3]
C0205090
UMLS CUI [1,4]
C1274040
Ultrasonography Result of Right Popliteal
Beschrijving

Ultrasonography Result of Right Popliteal

Datatype

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C0032652
UMLS CUI [1,3]
C0205090
UMLS CUI [1,4]
C1274040
Venography
Beschrijving

Venography

Alias
UMLS CUI-1
C0031545
Venography Type
Beschrijving

For bilateral/left leg/right leg, record date in next item. For not done/left leg/right leg, record primary reason.

Datatype

text

Alias
UMLS CUI [1,1]
C0031545
UMLS CUI [1,2]
C0332307
Date performed
Beschrijving

Venography Date

Datatype

date

Alias
UMLS CUI [1,1]
C0031545
UMLS CUI [1,2]
C0011008
If NOT BILATERAL or NOT DONE, select the primary reason
Beschrijving

if other reason, specify in next item

Datatype

text

Alias
UMLS CUI [1,1]
C1549995
UMLS CUI [1,2]
C0031545
UMLS CUI [1,3]
C1272696
UMLS CUI [2,1]
C1549995
UMLS CUI [2,2]
C0205092
UMLS CUI [2,3]
C0031545
Specify other primary reason NOT BILATERAL or NOT DONE
Beschrijving

if applicable

Datatype

text

Alias
UMLS CUI [1,1]
C1521902
UMLS CUI [1,2]
C3840932
UMLS CUI [1,3]
C0031545
UMLS CUI [1,4]
C1272696
UMLS CUI [2,1]
C1521902
UMLS CUI [2,2]
C3840932
UMLS CUI [2,3]
C0205092
UMLS CUI [2,4]
C0031545
Treatment
Beschrijving

Treatment

Alias
UMLS CUI-1
C0087111
Based on signs and symptoms, ultrasound and/or venogram results, was medication given to treat DVT?
Beschrijving

If medication was given, record in the medication form

Datatype

boolean

Alias
UMLS CUI [1,1]
C0013216
UMLS CUI [1,2]
C0149871
UMLS CUI [1,3]
C0566251
UMLS CUI [1,4]
C0037088
UMLS CUI [2,1]
C0013216
UMLS CUI [2,2]
C0149871
UMLS CUI [2,3]
C0566251
UMLS CUI [2,4]
C0041618
UMLS CUI [3,1]
C0013216
UMLS CUI [3,2]
C0149871
UMLS CUI [3,3]
C0566251
UMLS CUI [3,4]
C0031545
Terug naar het begin van de pagina

Similar models

Unscheduled Assessment of Symptomatic DVT

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Country No.
Item
Country No.
integer
C0454664 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Centre No.
Item
Centre No.
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Clinical Trial Subject Unique Identifier
Item
Subject No.
integer
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Item Group
General DVT Information
C1508263 (UMLS CUI-1)
C0149871 (UMLS CUI-2)
Date of first DVT signs/symptoms
Item
Date of first clinical signs/symptoms of DVT
date
C0149871 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0037088 (UMLS CUI [1,3])
DVT left side?
Item
Side: Left
boolean
C0205091 (UMLS CUI [1,1])
C0149871 (UMLS CUI [1,2])
C0441987 (UMLS CUI [1,3])
DVT right side?
Item
Side: Right
boolean
C0149871 (UMLS CUI [1,1])
C0441987 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
Item Group
Ultrasonography
C0041618 (UMLS CUI-1)
Ultrasonography not done
Item
Not done
boolean
C0041618 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Ultrasonography date
Item
Date performed
date
C0041618 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Ultrasonography Result of Left Common Femoral
text
C0041618 (UMLS CUI [1,1])
C1275667 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Left Common Femoral
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item
Ultrasonography Result of Left Popliteal
text
C0041618 (UMLS CUI [1,1])
C0032652 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Left Popliteal
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item
Ultrasonography Result of Right Common Femoral
text
C0041618 (UMLS CUI [1,1])
C1275667 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Right Common Femoral
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item
Ultrasonography Result of Right Popliteal
text
C0041618 (UMLS CUI [1,1])
C0032652 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Right Popliteal
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item Group
Venography
C0031545 (UMLS CUI-1)
Item
Venography Type
text
C0031545 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Venography Type
Code List
Venography Type
CL Item
Not done (ND)
CL Item
Bilateral (BI)
CL Item
Left leg (L)
CL Item
Right leg (R)
Venography Date
Item
Date performed
date
C0031545 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
If NOT BILATERAL or NOT DONE, select the primary reason
text
C1549995 (UMLS CUI [1,1])
C0031545 (UMLS CUI [1,2])
C1272696 (UMLS CUI [1,3])
C1549995 (UMLS CUI [2,1])
C0205092 (UMLS CUI [2,2])
C0031545 (UMLS CUI [2,3])
Venography; Indication
Code List
If NOT BILATERAL or NOT DONE, select the primary reason
CL Item
Failed venous access (Failed venous access)
CL Item
Subject refused/withdrew consent (Subject refused/withdrew consent)
CL Item
Subject amputee (Subject amputee)
CL Item
Other, specify (Other, specify)
Specify other reason venography not done/unilateral
Item
Specify other primary reason NOT BILATERAL or NOT DONE
text
C1521902 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
C0031545 (UMLS CUI [1,3])
C1272696 (UMLS CUI [1,4])
C1521902 (UMLS CUI [2,1])
C3840932 (UMLS CUI [2,2])
C0205092 (UMLS CUI [2,3])
C0031545 (UMLS CUI [2,4])
Item Group
Treatment
C0087111 (UMLS CUI-1)
Medication for DVT treatment given due to signs/symptoms/ultrasound/venography?
Item
Based on signs and symptoms, ultrasound and/or venogram results, was medication given to treat DVT?
boolean
C0013216 (UMLS CUI [1,1])
C0149871 (UMLS CUI [1,2])
C0566251 (UMLS CUI [1,3])
C0037088 (UMLS CUI [1,4])
C0013216 (UMLS CUI [2,1])
C0149871 (UMLS CUI [2,2])
C0566251 (UMLS CUI [2,3])
C0041618 (UMLS CUI [2,4])
C0013216 (UMLS CUI [3,1])
C0149871 (UMLS CUI [3,2])
C0566251 (UMLS CUI [3,3])
C0031545 (UMLS CUI [3,4])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial