Influence of Clinical Trial Participation on Subsequent Antithrombin Use

Abstract

BackgroundResults from the Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial showed that the low‐molecular‐weight heparin (LMWH) enoxaparin was non‐inferior compared with unfractionated heparin (UFH) in patients with non‐ST‐elevation acute coronary syndromes (NSTE‐ACS) managed invasively.HypothesisWe explored the influence of SYNERGY trial site participation on subsequent patterns of heparin use for NSTE‐ACS patients treated in routine practice.MethodsWe examined temporal patterns of LMWH use compared with UFH use among 122 764 patients with NSTE‐ACS enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative between January 1, 2002 and June 30, 2006, to determine whether site participation in SYNERGY influenced the type of heparin used before and after publication of the SYNERGY results in July 2004.ResultsA total of 118 out of 388 (30%) U.S. hospitals participating in CRUSADE simultaneously participated in SYNERGY. SYNERGY sites in the CRUSADE registry were more likely to have a teaching affiliation and have more hospital beds than non‐SYNERGY centers in the registry. There was no difference in the proportion of patients treated with LMWH at SYNERGY and non‐SYNERGY sites prior to July 2004 compared with after July 2004. However, at SYNERGY sites, there was a slight decrease in the proportion of patients treated with both UFH and LMWH within 24 hours of presentation.ConclusionsThe results of the SYNERGY trial did not appear to influence temporal patterns of LMWH use at sites in the CRUSADE registry. Furthermore, site participation in the SYNERGY trial did not alter patterns of LMWH use for NSTE‐ACS after publication of the trial results in July 2004. Copyright © 2009 Wiley Periodicals, Inc.

Does recruitment for multicenter clinical trials improve dissemination and timely implementation of their results? A survey study from the Netherlands

“…Two studies in the field of cardiovascular research were unable to find an effect of recruitment for a clinical trial on the implementation rate of the trial results [12,13]. This might be explained by the fact that the clinicians were not convinced by the results of a single trial.…”

“…A study by Ketley and Woods [11] in 1993 has shown that the level of use of thrombolytic drugs was strongly associated with the extent of involvement in multicenter trials of thrombolysis: 64% of the variation in thrombolytic use between districts in that year could be accounted for by districts' participation in multicenter trials during the preceding 2 years (p = 0.003). Shah et al [12] studied the influence of participation of sites in the Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial on the type of heparin subsequently used; site participation did not alter patterns of low-molecular-weight heparin use for non-ST-elevation acute coronary syndromes after publication of the trial results.…”

Oxygen management in New Zealand and Australian intensive care units: A knowledge translation study

“…The literature to date has not demonstrated a link between participation in research and subsequent knowledge use, and no research on this topic has been conducted in Australia or NZ or in ICU. Some studies reported no increased knowledge or use of results, despite personal or institutional involvement in a clinical trial even when the RCT showed very high quality evidence (Khera et al, 2018;Majumdar et al, 2002;Shah et al, 2010), while other studies showed mixed results (Kizer et al, 1999;Litjens et al, 2013;Sweeting et al, 2020).…”

“…interventions that can easily be studied. Included in this category are multiple studies about whether doctors' participation in a drug trial changed their prescribing that drug, by reviewing prescription records (Corrigan & Glass, 2005;Ketley & Woods, 1993;Majumdar et al, 2002;Shah et al, 2010). A few studies of this nature emerged in the late 1990s and early 2000s, possibly related to the increasing evidence about drugs to successfully manage cardiac disease.…”

“…Many of the studies related to medical interventions such as the prescription of drugs or procedures which at the time of the study could only be conducted by doctors. Using registry data, some studies focussed on the practices of the overall institution (Andersen et al, 2006;Ketley & Woods, 1993;Majumdar et al, 2002;Shah et al, 2010), while others were conducted about the individual practitioner (Corrigan & Glass, 2005;Kizer et al, 1999). Midwives and nurses were included in a study about multiple RCTs set in obstetrics and gynaecology clinics, however they only represented a small proportion of the respondents (23% and 2%, respectively) (Litjens et al, 2013).…”