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Impact on Morbidity and Mortality of Prophylactic Dosing of Low Molecular Heparin in Child-Pugh B Cirrhotic Patients (Childbenox)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02271295
Recruitment Status : Suspended (Premature discontinuation of inclusions by the sponsor for low inclusion)
First Posted : October 22, 2014
Last Update Posted : February 27, 2018
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris

Brief Summary:
Thrombosis occurring in the small intrahepatic, as well as in the large vessels is involved in the progression of cirrhosis. Anticoagulation could reduce morbidity and mortality in cirrhotic patients

Condition or disease Intervention/treatment Phase
Cirrhosis Drug: Enoxaparine Phase 3

Detailed Description:

Cirrhosis is the end-stage of all chronic liver diseases. Cirrhosis is a critical step in the natural history of liver disease, as it is associated with the occurrence of complications (so-called decompensation) and death. Life expectancy varies from 12-14 years in patients with compensated cirrhosis, to 2-4 years after decompensation.

Cirrhosis is associated with thrombosis of the intrahepatic portal and hepatic venous systems leading to parenchymal extinction (atrophy), liver dysfunction and portal hypertension. Regeneration in the areas without microthrombosis, and inflammation are powerful factors inducing liver cancer. Portal and hepatic venous thrombosis have been shown to participate in remodeling the liver architecture and are associated with a worsening outcome. Thrombosis in cirrhosis is thought to result from a procoagulant state due to an imbalance between pro and anticoagulant factor plasma levels, inflammation in and around blood vessels, and a marked slowing down of venous blood flow. Heparin administration, in animal models of liver fibrosis, decreases extra cellular matrix protein synthesis and fibrous tissue deposition. Recently, a reduction in liver decompensation and mortality has been shown in Child-Pugh B7-C10 cirrhotic patients assigned to receive a low dose of enoxaparin (4000IU/d), a low molecular weight heparin, for 48 weeks, compared to patients receiving no anticoagulation therapy.

These results are in line with the hypothesis of a protective role of anticoagulation in liver disease progression and a strong association between thrombosis and liver fibrosis.

So the main objective of the study is to compare the effect of a 2-year low dosing of Enoxaparin (4000 IU/day) versus no treatment on morbidity and mortality in patients with Child B7-C10 cirrhosis.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 16 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Impact on Morbidity and Mortality of Prophylactic Dosing of Low Molecular Weight Heparin in Child-Pugh B Cirrhotic Patients: a Randomized Controlled Study
Actual Study Start Date : July 27, 2015
Estimated Primary Completion Date : July 2, 2019
Estimated Study Completion Date : July 2, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Blood Thinners
Drug Information available for: Heparin

Arm Intervention/treatment
Experimental: Enoxaparine
69 Child Pugh B7-C10, cirrhotic patients receiving anticoagulation treatment (daily subcutaneous injection of enoxaparin 4000UI/day) during 24 months
Drug: Enoxaparine
Enoxaparine 4000UI/day during 24 months
Other Name: LOVENOX® 4000UI/day

No Intervention: Control
69 Child Pugh B7-C10, cirrhotic patients not receiving anticoagulation treatment

Primary Outcome Measures :
  1. Morbidity and mortality at 24 months [ Time Frame: 24 months ]
    To compare the effect of a 2-year low dosing of Enoxaparin (4000 IU/day) versus no treatment on morbidity and mortality in patients with Child B7-C10 cirrhosis.

Secondary Outcome Measures :
  1. Mortality liver-related or not at 24 months [ Time Frame: 24 months ]
    Two year overall survival and two year liver related survival considering non-liver death as a competive event.

  2. Adverse events at 24 months [ Time Frame: 24 months ]
    percentage of bleeding episodes not reported to portal hypertension, percentage of heparin induced thrombocytopenia, variation of bone mineral density (M24-M0/M0) and percentage of occurrence of osteoporosis at dual energy X-ray absorptiometry

  3. Liver function and fibrosis at 24 months [ Time Frame: 24 months ]
    • Variation of liver function tests (M24-M0/M0): PT, albumin and T bilirubin levels, Child-Pugh and MELD score
    • Variation of non-invasive tests of liver fibrosis (M24-M0/M0): fibrometer and cirrhometer scores, liver stiffness measurement using transient elastography.

  4. Thrombosis at 24 months [ Time Frame: 24 months ]
    Occurrence of portal vein (PV) thrombosis at Doppler ultrasound evaluation performed every 3 months or CT scan performed at M-1 and M24 (appendix 2) or hepatocellular carcinoma at Doppler ultrasound evaluation performed every 3 months or CT scan performed at M-1 and M24 and confirmed according to EASL recommendations

  5. Compliance [ Time Frame: 24 months ]
    record of unused packaging and information about compliance in a patient diary

  6. Survival rate without completion [ Time Frame: 30 months ]
    Survival rate without complication 6 months after completion of treatment as well as variation of liver function and portal hypertension parameters, occurrence of PV thrombosis, occurrence of bacterial infections

  7. Portal hypertension parameters [ Time Frame: 24 months ]
    Variation of portal hypertension parameters (M24-M0/M0): platelets count, esophageal varices size at endoscopic evaluation

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age ≥18 and ≤75 years old
  • A diagnosis of cirrhosis based on liver biopsy or on the combination of clinical, laboratory and imaging criteria
  • Compensated Child-Pugh B7-C10
  • Any of the following causal factors : past but controlled excessive alcohol intake (<30g/d for men and <20g/d for women), HCV infection without viral replication, HBV infection without viral replication on therapy, metabolic syndrome, biliary cirrhosis, auto-immune cirrhosis, hemochromatosis, cryptogenetic cirrhosis

Exclusion Criteria:

  • Ascites, portal hypertensive bleeding or encephalopathy within the last 3 months prior to enrolment
  • Hepatocellular carcinoma non considered in remission
  • Budd Chiari syndrome non considered in remission
  • Liver transplantation
  • F2 or F3 varices without treatment in accordance with recommended guidelines (B-blockers, ligation or both)
  • Portal vein thrombosis
  • Transjugular intrahepatic portosystemic shunt
  • Known extra-hepatic malignancies
  • PT<35%
  • Platelet count<50,000/mm3
  • Haemoglobin level < 9g/dl
  • Serum Albumin < 20g/L
  • A bone mineral density T score of less than -4.0 at the lumbar spine or total hip
  • Known HIV infection
  • Ongoing anticoagulation or antiaggregation
  • Renal insufficiency defined by creatinine clearance<60ml/mn
  • Conditions at risk for spontaneous bleeding (except for portal hypertension) or hemostatic abnormalities not related to cirrhosis
  • Pregnancy or breast-feeding

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02271295

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Hôpital Saint Antoine
Paris, France
Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
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Principal Investigator: Armelle Poujol-Robert Assistance Publique - Hôpitaux de Paris

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Responsible Party: Assistance Publique - Hôpitaux de Paris Identifier: NCT02271295     History of Changes
Other Study ID Numbers: P130926
AOM 13606 ( Other Grant/Funding Number: Ministry of Health )
First Posted: October 22, 2014    Key Record Dates
Last Update Posted: February 27, 2018
Last Verified: February 2018
Keywords provided by Assistance Publique - Hôpitaux de Paris:
Child B
portal thrombosis
Additional relevant MeSH terms:
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Pathologic Processes
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action