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Chronic Kidney DiseasesPhase 3BRACKETSNCT06337838

Bleeding Reduction in Acute and Chronic Kidney Patients Having Surgery (BRACKETS) Pilot Trial

A Phase 3 study testing Desmopressin Injectable Solution and Tranexamic Acid Injectable Product in people with Chronic Kidney Diseases and Acute Kidney Injury, run by Hamilton Health Sciences Corporation at 3 sites in Canada.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The BRACKETS pilot study is a multicentre, prospective, randomized controlled trial of prophylactic preoperative tranexamic acid (TXA) versus placebo and, using a partial factorial design, of prophylactic preoperative desmopressin versus placebo. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Desmopressin Injectable Solution and Tranexamic Acid Injectable Product
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
100 participants
Where
3 sitesCanada
Study dates
9 Jun 2025to Jun 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

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

  • 1. Included in the TXA factorial.

Who cannot join

  • Undergoing cardiac surgery;
  • Undergoing intracranial neurosurgery;
  • Undergoing surgery for creation or revision of arteriovenous fistula or graft for dialysis access;
  • Planned use of prophylactic systemic TXA or ϵ-aminocaproic acid;
  • Hypersensitivity or known allergy to TXA;
  • History of seizure disorder;
Show all 16Show fewer
  • Recent (within 90 days) stroke, myocardial infarction, acute arterial thrombosis, deep venous thrombosis, pulmonary embolism, or thrombosis of an arteriovenous fistula or graft;
  • History of thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome, or antiphospholipid antibody syndrome;
  • Women who are known to be pregnant, breastfeeding, or who meet both of the following criteria: i) are of childbearing potential and do not have a negative pregnancy test documented in the 7 days before surgery, AND ii) are not using effective contraception; or
  • Previously enrolled in the BRACKETS-Pilot Trial.
  • Eligibility criteria specific to the desmopressin factorial component of trial
  • The hospital does not have access to desmopressin;
  • Planned use of prophylactic desmopressin;
  • Most recent serum sodium concentration < 130 mEq/L;
  • Known or suspected von Willebrand disease (any kind), hemophilia, or platelet function disorder; or
  • Hypersensitivity or known allergy to desmopressin.

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Ingrid Copland contact

905-296-5754

brackets@phri.ca

Canada3 sites, 2 recruiting
  • London Health Sciences Centre

    London, Ontario, N6A 5A5

    Cadence Baker, 519-685-8500 ext. 34769, cadence.baker@lhsc.on.ca

    Pavel Roshanov, MD

    Recruiting
  • Centre Hospitalier de L'Universite de Montreal (CHUM)

    Montreal, Quebec, H2X 0A9

    Active, not recruiting
  • McGill University University Health Centre

    Montreal, Quebec, H3H 2R9

    Lin Jawhar

    Shaifali Sandal, MD

    Recruiting

Other trials in Canada

About this study

Official title: Bleeding Reduction in Acute and Chronic KidnEy patienTs Having Surgery (BRACKETS) Pilot Trial

The BRACKETS pilot study is a multicentre, prospective, randomized controlled trial of prophylactic preoperative tranexamic acid (TXA) versus placebo and, using a partial factorial design, of prophylactic preoperative desmopressin versus placebo.

Read the detailed description

Perioperative administration of TXA reduces bleeding risk in surgical patients. However, large clinical trials have excluded patients with advanced kidney disease, so the benefits remain uncertain in this population, and there is potential for harm. The benefit of desmopressin, which is purported to more directly address the defect of primary hemostasis believed important in severe kidney disease more directly than TXA, has not been examined in adequate randomized control trials (RCTs). Both medications are generic and have been available for many years. To convincingly test these medications in patients with severe kidney disease, large, global trials are required. This pilot-phase trial will 1) inform the feasibility and design of a large international trial to evaluate the efficacy and safety of TXA and desmopressin in patients with advanced kidney disease undergoing noncardiac surgery, 2) provide preliminary data regarding the efficacy and safety of TXA and desmopressin in people with advanced kidney disease having noncardiac surgery, and 3) provide pharmacokinetic data to inform dose selection.

Being tested
Desmopressin Injectable Solution, Tranexamic Acid Injectable Product, Placebo
Keywords
Major Noncardiac Surgery, Tranexamic Acid, Desmopressin
Medical subject headings
Renal Insufficiency, Chronic, Acute Kidney Injury, Hemorrhage

What participants receive

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

  • Desmopressin Injectable SolutionDrug

    Also called DDAVP

    Intravenous desmopressin, 20 mcg, single dose administration.

  • Tranexamic Acid Injectable ProductDrug

    Also called Cyklokapron

    Intravenous tranexamic acid, 1000 mg single dose administration for patients with eGFR<25 not yet receiving dialysis OR 500 mg single dose administration for patients receiving dialysis.

  • PlaceboOther

    Intravenous 0.9% saline solution

Study groups in NCT06337838
Study groupRoleWhat they receive
Prophylactic intravenous tranexamic acid and prophylactic intravenous desmopressin.ExperimentalWithin 20 minutes preceding anticipated skin incision, patients will receive preoperative prophylactic intravenous tranexamic acid at a dose of 1000 mg infused over 10 minutes for patients with estimated glomerular filtration rate (eGFR) <25 ml/min/1.73m2 who do not receive dialysis before surgery and 500 mg infused over 10 minutes for patients who receive dialysis. Within 20 minutes preceding anticipated skin incision, patients allocated to the desmopressin intervention group will receive intravenous desmopressin at a dose of 20 mcg over 30 minutes.
Receives: Drug: Desmopressin Injectable Solution; Drug: Tranexamic Acid Injectable Product
Prophylactic intravenous tranexamic acid and placebo.ExperimentalWithin 20 minutes preceding anticipated skin incision, patients will receive preoperative prophylactic intravenous tranexamic acid at a dose of 1000 mg infused over 10 minutes for patients with eGFR <25 ml/min/1.73m2 who do not receive dialysis before surgery and 500 mg infused over 10 minutes for patients who receive dialysis. Within 20 minutes preceding anticipated skin incision, patients allocated to the desmopressin control group will receive an intravenous infusion of 0.9% saline solution, administered over a duration of 30 minutes.
Receives: Drug: Tranexamic Acid Injectable Product; Other: Placebo
Prophylactic intravenous desmopressin and placebo.ExperimentalWithin 20 minutes preceding anticipated skin incision, patients will receive intravenous desmopressin at a dose of 20 mcg over 30 minutes. Patients will not receive prophylactic tranexamic acid. Within 20 minutes preceding anticipated skin incision, patients allocated to the tranexamic acid control group will receive an intravenous infusion of 0.9% saline solution. This saline solution will be administered over a duration of 10 minutes in a volume equivalent to that received by patients in the tranexamic acid intervention group.
Receives: Drug: Desmopressin Injectable Solution; Other: Placebo
Placebo and placebo.Placebo comparatorWithin 20 minutes preceding anticipated skin incision, patients allocated to the tranexamic acid control group will receive an intravenous infusion of 0.9% saline solution. This saline solution will be administered over a duration of 10 minutes in a volume equivalent to that received by patients in the tranexamic acid intervention group. Within 20 minutes preceding anticipated skin incision, patients allocated to the desmopressin control group will receive an intravenous infusion of 0.9% saline solution, administered over a duration of 30 minutes.
Receives: Other: Placebo

What is being measured

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

  1. Rate of recruitment

    A rate of 0.25 patients per study site per week

    Measured: Through study completion, an average of 1.5 years

  2. Receipt of the allocated study drug within 1 hour before start of surgery for the tranexamic acid factorial

    Account of whether the patient began to receive study drug for the TXA factorial within an hour before skin incision. Target ≥80% of participants

    Measured: Day of surgery

  3. Receipt of the allocated study drug within 1 hour before start of surgery for the desmopressin factorial

    Account of whether the patient began to receive study drug for the desmopressin factorial within an hour before skin incision. Target ≥80% of participants

    Measured: Day of surgery

  4. Completion of 30-day follow-up

    Account of whether the patient or their next-of-kin could be contacted and completed the 30-day post-randomization assessment. Target ≥80% of participants

    Measured: 30 days after randomization

Secondary outcomes (46)
  1. Bleeding Independently Associated with Mortality after noncardiac Surgery (BIMS)

    Number of patients who experience BIMS

    Measured: 30 days after randomization

  2. Bleeding Score

    10-category ordinal score. Minimum scores mean a better outcome. 0 denotes no bleeding or bleeding in which the nadir hemoglobin is ≥70 g/L, no red blood transfusion was given, no reoperation for reasons of bleeding occurred, and there was no death imminently or directly caused by bleeding.

    1. denotes bleeding and post-operative hemoglobin <70 g/L or 1 unit of blood (red blood cells or whole blood) transfused.
    2. denotes bleeding and 2 units transfused.
    3. denotes bleeding and 3 units transfused.
    4. denotes bleeding and 4 units transfused
    5. denotes bleeding and 5 units transfused.
    6. denotes bleeding and 6 units transfused.
    7. denotes bleeding and 7 units transfused.
    8. denotes bleeding and 8 or more units of blood transfused.
    9. denotes reoperation for reasons of bleeding.
    10. denotes death imminently or directly caused by bleeding.

    Measured: 30 days after randomization

  3. Reoperation for reasons of bleeding

    Number of patients who return to the operating room for surgical management of suspected documented bleeding

    Measured: 30 days after randomization

  4. Blood (red blood cells or whole blood) transfused

    Number of units of blood transfused.

    Measured: 30 days after randomization

  5. Blood (red blood cells or whole blood) transfused

    Number of units of blood transfused.

    Measured: Up to and including postoperative day 3 after surgery

  6. Any blood transfusion (red blood cells or whole blood)

    Number of units of blood transfused.

    Measured: 30 days after randomization

  7. Any blood transfusion (red blood cells or whole blood)

    Number of units of blood transfused.

    Measured: Up to and including postoperative day 3

  8. Lowest measured hemoglobin concentration

    The mean absolute difference for continuous outcomes using linear regression with treatment allocation

    Measured: 30 days after randomization

  9. Most recent hemoglobin concentration

    The mean absolute difference for continuous outcomes using linear regression with treatment allocation

    Measured: 30 days after randomization

  10. Death

    Number of patients who die of any cause

    Measured: 30 days after randomization

  11. Major arterial and venous thrombosis

    (i.e., composite of myocardial injury after noncardiac surgery [MINS], stroke, peripheral arterial thrombosis, dialysis vascular access thrombosis requiring anticoagulation or intervention, and symptomatic venous thromboembolism)

    Measured: 30 days after randomization

  12. Myocardial Injury after Noncardiac Surgery (MINS)

    Number of patients who experience MINS

    Measured: 30 days after randomization

  13. Myocardial Injury after Noncardiac Surgery (MINS) that meets criteria for myocardial infarction

    Number of patients who experience MINS that meets criteria for myocardial infarction (based on the Fourth Universal Definition of myocardial infarction)

    Measured: 30 days after randomization

  14. MINS that is an isolated ischemic troponin elevation

    Number of patients who experience MINS that is an isolated ischemic troponin elevation

    Measured: 30 days after randomization

  15. Stroke

    Number of patients experiencing a stroke

    Measured: 30 days after randomization

  16. Non-hemorrhagic stroke

    Number of patients who experience a non-hemorrhagic stroke

    Measured: 30 days after randomization

  17. Hemorrhagic stroke

    Number of patients who experience a hemorrhagic stroke

    Measured: 30 days after randomization

  18. Peripheral arterial thrombosis

    Number of patients who experience a peripheral arterial thrombosis

    Measured: 30 days after randomization

  19. Thrombosis of arteriovenous fistula or graft

    Number of patients who have thrombosis of arteriovenous fistula or graft

    Measured: 30 days after randomization

  20. Symptomatic proximal venous thromboembolism

    Number of patients who experience symptomatic proximal venous thromboembolism

    Measured: 30 days after randomization

  21. Symptomatic pulmonary embolism

    Number of patients who experience a symptomatic pulmonary embolism

    Measured: 30 days after randomization

  22. Symptomatic proximal leg or arm deep venous thrombosis (DVT)

    Number of patients who experience a symptomatic proximal leg or arm DVT

    Measured: 30 days after randomization

  23. Non-fatal cardiac arrest

    Number of patients who experience non-fatal cardiac arrest

    Measured: 30 days after randomization

  24. Coronary revascularization procedure

    Number of patients who undergo coronary revascularization procedure

    Measured: 30 days after randomization

  25. Clinically important atrial fibrillation or flutter

    Number of patients who experience clinically important atrial fibrillation or flutter

    Measured: 30 days after randomization

  26. Acute heart failure or clinically important volume overload

    Number of patients who experience acute heart failure or clinically important volume overload.

    Measured: 30 days after randomization

  27. Acute kidney injury (for patients not receiving dialysis before surgery)

    Number of patients who experience an acute kidney injury

    Measured: 30 days after randomization

  28. New start of dialysis

    Number of patients who require new start of dialysis

    Measured: 30 days after randomization

  29. Seizure

    Number of patients who experience a seizure

    Measured: 30 days after randomization

  30. Clinically significant intraoperative hypotension

    Number of patients who experience clinically significant intraoperative hypotension

    Measured: 30 days after randomization

  31. Clinically significant postoperative hypotension

    Number of patients who experience clinically significant postoperative hypotension

    Measured: Up to and including the end of postoperative day 1

  32. Sepsis

    Number of patients who experience sepsis

    Measured: 30 days after randomization

  33. Duration of surgery

    The time from skin incision to closure, in minutes.

    Measured: 30 days after randomization

  34. Receipt of platelets

    Any transfusion of this blood product

    Measured: 30 days after randomization

  35. Receipt of fibrinogen

    Any transfusion of this blood product

    Measured: 30 days after randomization

  36. Receipt of fresh frozen plasma

    Any transfusion of this blood product

    Measured: 30 days after randomization

  37. Receipt of cryoprecipitate

    Any transfusion of this blood product

    Measured: 30 days after randomization

  38. Receipt of recombinant Factor VIIa

    Number of patients receiving recombinant factor VIIa

    Measured: 30 days after randomization

  39. Receipt of prothrombin complex concentrate

    Number of patients who receive prothrombin complex concentrate

    Measured: 30 days after randomization

  40. Prescribed erythropoiesis stimulating agent

    Number of patients receiving a weekly dose of erythropoiesis stimulating agent on prescription active at 30 days

    Measured: 30 days after randomization

  41. Severe hyponatremia

    Measured serum sodium concentration <125 meq/L

    Measured: Up to and including the end of postoperative day 1

  42. Duration of hospital stay after surgery

    Cumulative number of nights spent in an acute care hospital

    Measured: Day of surgery and ending the day of discharge

  43. Duration of critical care stay after surgery

    Cumulative number of nights spent in an intensive care unit

    Measured: Day of surgery and ending the day of discharge

  44. Delayed graft function after kidney transplantation

    Receipt of dialysis

    Measured: Within 7 days following kidney transplantation

  45. Persistent dialysis dependence

    Participant continues to receive dialysis after surgery.

    Measured: 30 days after randomization

  46. Incisional site pain severity

    Rating of pain using the 10-point ordinal scale where 0 corresponds to no pain and 10 corresponds to the worst pain imaginable.

    Measured: 30 days after randomization in the last 24 hours

Timeline

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

  1. First posted29 Mar 2024
  2. Study start9 Jun 2025
  3. Primary completionFeb 2027 (estimated)
  4. Study completionJun 2027 (estimated)

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Model description
2x2 partial factorial design where patients are first randomized to receive prophylactic intravenous TXA versus placebo, and (when the study drug is available) to be randomized to receive prophylactic intravenous desmopressin versus placebo before noncardiac surgery.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06337838
Sponsor's protocol ID
2024.BRACKETS-Pilot
Acronym
BRACKETS
Status last verified
May 2026
First submitted
22 Jan 2024
Last updated
22 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Desmopressin Injectable Solution and Tranexamic Acid Injectable Product in people with Chronic Kidney Diseases and Acute Kidney Injury, run by Hamilton Health Sciences Corporation at 3 sites in Canada.

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 1 inclusion and 16 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: looking for participants now, as of the sponsor's last update on 22 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Canada. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Ingrid Copland (905-296-5754, brackets@phri.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of recruitment (time frame: Through study completion, an average of 1.5 years). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 22 May 2026.

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