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Pulmonary EmbolismSLICENCT02238639

Pulmonary Embolism as a Cause of COPD Exacerbations

A study testing Diagnostic and therapeutic strategy: Highly sensitive D-dimer testing and, if positive, multidetector computed tomographic pulmonary angiography (MDCT). in people with Pulmonary Embolism and Chronic Obstructive Pulmonary Disease, run by Ministry of Health, Spain at 19 sites in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary objective is to demonstrate the clinical benefits of an active strategy for the diagnosis and treatment of PE compared to usual care in patients with unexplained exacerbations of COPD who require hospital admission. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Diagnostic and therapeutic strategy: Highly sensitive D-dimer testing and, if positive, multidetector computed tomographic pulmonary angiography (MDCT).
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
746 participants
Where
19 sitesSpain
Study dates
Oct 2014to Dec 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Confirmation of COPD according to SEPAR-ALT criteria: post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) < 0.7;
  • Hospital admission because COPD exacerbation without initial clinical suspicion of PE in the Emergency Department (according by the Emergency Department physician evaluation).

Who cannot join

  • Contraindication to multidetector computed tomographic angiography (allergy to intravenous contrast medium, or renal failure defined as a creatinine clearance less than 30 mL/min, according to the Cockcroft-Gault formula)
  • Informed consent denied
  • Pregnancy
  • Life expectancy less than 3 months
  • Anticoagulant therapy at the time of hospital admission
  • Diagnosis of pneumothorax, or pneumonia (fever, and purulent sputum, and new infiltrate in chest X-ray)
Show all 9Show fewer
  • Diagnosis of lower respiratory tract infection (fever [>37.8ºC], increased sputum volume and/or increased sputum purulence).
  • Indication of invasive mechanical ventilation at the time of hospital admission;
  • Impossibility for follow-up.

Trial locations and contacts

19 sites in 1 country.

19 sites in 1 country

Spain19 sites
  • Hospital La Coruña

    A Coruña

  • Hospital Germans Trias i Pujol

    Badalona, Barcelona

  • Hospital Galdakao

    Barakaldo

  • Clinica Nostra Senyora del Remei

    Barcelona

  • Hospital Capio Sagrat Cor

    Barcelona

  • Hospital Cruces

    Bilbao

  • Hospital San Pedro

    Logroño

  • Hospital Ramon y Cajal, IRYCIS, Alcala de Henares University

    Madrid, 28034

  • Fundacion Jimenez Diaz

    Madrid

  • Hospital Alcorcon

    Madrid

  • Hospital Doce de Octubre

    Madrid

  • Hospital Gregorio Marañon

    Madrid

  • Hospital La Paz

    Madrid

  • Complejo Hospitalario Pontevedra

    Pontevedra

  • Hospital Marques de Valdecilla

    Santander

  • Policlinico La Rosaleda

    Santiago de Compostela

  • Hospital Virgen del Rocio

    Seville

  • Hospital Txagorritxu

    Vitoria-Gasteiz

  • Hospital Lozano Blesa

    Zaragoza

Other trials in Spain

About this study

Official title: Efficacy and Safety of an Active Strategy for the Diagnosis and Treatment of Acute Pulmonary Embolism (PE) in Patients With Unexplained Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): a Randomized Clinical Trial

The primary objective is to demonstrate the clinical benefits of an active strategy for the diagnosis and treatment of PE compared to usual care in patients with unexplained exacerbations of COPD who require hospital admission.

The secondary objective is to assess the safety of an active strategy for the diagnosis and treatment of PE compared to usual care in patients with unexplained exacerbations of COPD who require hospital admission.

Being tested
Diagnostic and therapeutic strategy: Highly sensitive D-dimer testing and, if positive, multidetector computed tomographic pulmonary angiography (MDCT).
Keywords
Venous thromboembolism, COPD exacerbations, Anticoagulation, Mortality
Medical subject headings
Pulmonary Embolism, Pulmonary Disease, Chronic Obstructive, Venous Thromboembolism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Diagnostic and therapeutic strategy: Highly sensitive D-dimer testing and, if positive, multidetector computed tomographic pulmonary angiography (MDCT).Procedure or surgery

    If MDCT is positive for pulmonary embolism, patients will receive anticoagulant treatment according to updated guidelines.

    If MDCT is negative for pulmonary embolism, patients will receive standard management for their exacerbation.

Study groups in NCT02238639
Study groupRoleWhat they receive
Active search for pulmonary embolismExperimentalAll included patients will undergo D-dimer testing. A negative plasma highly sensitive D-dimer value (defined as a D-dimer level below the manufacturers assay threshold) will rule out pulmonary embolism, and no further examination will be performed. For patients with a positive D-dimer value, a multidetector computed tomographic pulmonary angiography (MDCT) will be performed.
Receives: Procedure: Diagnostic and therapeutic strategy: Highly sensitive D-dimer testing and, if positive, multidetector computed tomographic pulmonary angiography (MDCT).
Standard managementNo interventionAll included patients will undergo standard clinical management of their exacerbations, as deemed appropriate by the attending physician.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. All-cause Mortality, Symptomatic Venous Thromboembolism Recurrence, or Need for Readmission.

    Clinical composite endpoint of all-cause mortality, or symptomatic venous thromboembolism recurrence, or need for readmission.

    Measured: 90-day follow-up

Secondary outcomes (6)
  1. All-cause Mortality

    All-cause mortality.

    Measured: 90-day follow-up

  2. Symptomatic Recurrent Venous Thromboembolism

    Symptomatic venous thromboembolic recurrence confirmed by objective testing.

    Measured: 90-day follow-up

  3. Hospitalization

    Need for readmission.

    Measured: 90-day follow-up

  4. Major Bleeding

    Major bleeding (defined according to previously published criteria)

    Measured: 90-day follow-up

  5. Clinically Relevant Non Major Bleeding

    Clinically relevant non major bleeding (defined according to previously published criteria)

    Measured: 90-day follow-up

  6. Serious Adverse Events

    Serious adverse events.

    Measured: 90-day follow-up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Sep 2014 (estimated)
  2. Study startOct 2014
  3. Primary completionOct 2020
  4. Study completionDec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
746 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02238639
Sponsor's protocol ID
SLICE 1
Acronym
SLICE
Status last verified
Nov 2022
First submitted
9 Sep 2014
Last updated
1 Dec 2022
Data monitoring committee
Yes

Publications

  • Peces-Barba G, Barbera JA, Agusti A, Casanova C, Casas A, Izquierdo JL, Jardim J, Lopez Varela V, Monso E, Montemayor T, Viejo JL. [Diagnosis and management of chronic obstructive pulmonary disease: joint guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Latin American Thoracic Society (ALAT)]. Arch Bronconeumol. 2008 May;44(5):271-81. No abstract available. Spanish.

    PubMed 18448019
  • Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J; Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55. doi: 10.1164/rccm.200703-456SO. Epub 2007 May 16.

    PubMed 17507545
  • Camargo CA Jr, Roberts J, Clark S. US emergency department visits for COPD exacerbations between 1992 and 1998. Am J Epidemiol 2001; 153: S80.

  • Poulsen SH, Noer I, Moller JE, Knudsen TE, Frandsen JL. Clinical outcome of patients with suspected pulmonary embolism. A follow-up study of 588 consecutive patients. J Intern Med. 2001 Aug;250(2):137-43. doi: 10.1046/j.1365-2796.2001.00866.x.

    PubMed 11489063
  • Tillie-Leblond I, Marquette CH, Perez T, Scherpereel A, Zanetti C, Tonnel AB, Remy-Jardin M. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med. 2006 Mar 21;144(6):390-6. doi: 10.7326/0003-4819-144-6-200603210-00005.

    PubMed 16549851
  • Rizkallah J, Man SFP, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2009 Mar;135(3):786-793. doi: 10.1378/chest.08-1516. Epub 2008 Sep 23.

    PubMed 18812453
  • Anderson DR, Kahn SR, Rodger MA, Kovacs MJ, Morris T, Hirsch A, Lang E, Stiell I, Kovacs G, Dreyer J, Dennie C, Cartier Y, Barnes D, Burton E, Pleasance S, Skedgel C, O'Rouke K, Wells PS. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007 Dec 19;298(23):2743-53. doi: 10.1001/jama.298.23.2743.

    PubMed 18165667
  • Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-e496S. doi: 10.1378/chest.11-2301.

    PubMed 22315268
  • Pozo-Rodriguez F, Lopez-Campos JL, Alvarez-Martinez CJ, Castro-Acosta A, Aguero R, Hueto J, Hernandez-Hernandez J, Barron M, Abraira V, Forte A, Sanchez Nieto JM, Lopez-Gabaldon E, Cosio BG, Agusti A; AUDIPOC Study Group. Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study. PLoS One. 2012;7(7):e42156. doi: 10.1371/journal.pone.0042156. Epub 2012 Jul 31.

    PubMed 22911875
  • Najarro M, Briceno W, Rodriguez C, Muriel A, Gonzalez S, Castillo A, Jara I, Rali P, Toma C, Bikdeli B, Jimenez D. Shock score for prediction of clinical outcomes among stable patients with acute symptomatic pulmonary embolism. Thromb Res. 2024 Jan;233:18-24. doi: 10.1016/j.thromres.2023.11.011. Epub 2023 Nov 19.

    PubMed 37988846
  • Rodriguez C, Muriel A, Carrasco L, Gonzalez S, Briceno W, Duran D, Retegui A, Yusen RD, Bikdeli B, Jimenez D. National Early Warning Score-2 for Identification of Patients with Intermediate-High-Risk Pulmonary Embolism. Semin Thromb Hemost. 2023 Oct;49(7):716-724. doi: 10.1055/s-0043-1769938. Epub 2023 Jun 16.

    PubMed 37327883
  • Mirambeaux R, Rodriguez C, Muriel A, Gonzalez S, Briceno W, Duran D, Retegui A, Otero R, Bikdeli B, Jimenez D. Comparison of various prognostic scores for identification of patients with intermediate-high risk pulmonary embolism. Thromb Res. 2023 Mar;223:61-68. doi: 10.1016/j.thromres.2023.01.019. Epub 2023 Jan 23.

    PubMed 36708691
  • Rodriguez C, Jara-Palomares L, Tabernero E, Tenes A, Gonzalez S, Briceno W, Lobo JL, Morillo R, Bikdeli B, Jimenez D. Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial. Thromb J. 2022 Mar 3;20(1):10. doi: 10.1186/s12959-022-00368-0.

    PubMed 35241119
  • Jimenez D, Agusti A, Tabernero E, Jara-Palomares L, Hernando A, Ruiz-Artacho P, Perez-Penate G, Rivas-Guerrero A, Rodriguez-Nieto MJ, Ballaz A, Aguero R, Jimenez S, Calle-Rubio M, Lopez-Reyes R, Marcos-Rodriguez P, Barrios D, Rodriguez C, Muriel A, Bertoletti L, Couturaud F, Huisman M, Lobo JL, Yusen RD, Bikdeli B, Monreal M, Otero R; SLICE Trial Group. Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial. JAMA. 2021 Oct 5;326(13):1277-1285. doi: 10.1001/jama.2021.14846.

    PubMed 34609451
  • Jimenez D, Agusti A, Monreal M, Otero R, Huisman MV, Lobo JL, Quezada A, Jara-Palomares L, Hernando A, Tabernero E, Marcos P, Ruiz-Artacho P, Ballaz A, Bertoletti L, Couturaud F, Yusen R; SLICE investigators. The rationale, design, and methods of a randomized, controlled trial to evaluate the efficacy and safety of an active strategy for the diagnosis and treatment of acute pulmonary embolism during exacerbations of chronic obstructive pulmonary disease. Clin Cardiol. 2019 Mar;42(3):346-351. doi: 10.1002/clc.23161. Epub 2019 Feb 25.

    PubMed 30706520

Questions about this trial

What is this clinical trial studying?

A study testing Diagnostic and therapeutic strategy: Highly sensitive D-dimer testing and, if positive, multidetector computed tomographic pulmonary angiography (MDCT). in people with Pulmonary Embolism and Chronic Obstructive Pulmonary Disease, run by Ministry of Health, Spain at 19 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 19 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 Nov 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

All-cause Mortality, Symptomatic Venous Thromboembolism Recurrence, or Need for Readmission. (time frame: 90-day follow-up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02238639, which also lists 15 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Dec 2022.

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