Cirrhosis and Coagulation
Conditions
Brief summary
Prospectively evaluation of the incidence of thromboembolic events in hospitalized cirrhotic patients. 2. Efficacy and safety of use of bemiparin in preventing peripheral and portal thrombosis. 3. Monitoring antiXa levels.
Detailed description
PRIMARY OBJECTIVE: To evaluate the safety of prophylactic anticoagulation Bemiparina (HIBOR®) for the prevention of peripheral and portal vein thrombosis in cirrhotic patients with prolonged hospitalization. Secondary objectives are the following: 1. To evaluate the incidence of thrombotic events in hospitalized cirrhotic patients. 2. To evaluate the efficacy of low molecular weight heparin (HIBOR 3.500UI) in preventing thrombotic events in hospitalized cirrhotic patients. 3. To identify risk factors for development of portal vein thrombosis and deep vein thrombosis in hospitalized patients. 4. Evaluate the morbidity and mortality associated with thromboembolic events. 5. Evaluate prophylactic anticoagulation levels by determining antiXa and antithrombin III. 6. To study the expression profile and functionality of Toll-like receptors as factors intimately involved in the inflammatory response, as well as the variability of different serum markers associated with proinflammatory state: I-FABP / IL6-IL8 / NO, endothelin and LPS-binding protein. 7. Evaluate the effect on liver fibrosis (by Fibroscan®) and serum TGF 8. Evolution of hepatocellular function estimated by the scores of Child-Pugh and MELD.
Interventions
DRUGBemiparin
Bemiparin subcutaneus administration
Sponsors
Instituto de Investigación Marqués de Valdecilla
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Liver cirrhosis of any etiology diagnosed by previous biopsy or clinical, laboratory and sonographic criteria 2. Hospital admission at least 3 days, because of decompensated liver disease (ascites, encephalopathy, controlled gastrointestinal bleeding, spontaneous bacterial peritonitis) 3. signed written consent 4. Women of child-bearing age use effective contraception
Exclusion criteria
1. Age \<18 and \>80 years 2. contraindication to treatment with heparins 3. uncontrolled hemorrhage 4. Any comorbidity involving a therapeutic limitation and / or a life expectancy \<6 months 5. concomitant antiplatelet therapy (aspirin, clopidogrel, ticlopidine, dipyridamole, sulfinpyrazone, dextran 40, or other anticoagulants 6. and continued concomitant NSAIDs, salicylates, corticosteroids 7. existence of clinically significant esophageal varices / severe gastropathy of portal hypertension without their having been previously treated with primary / secondary prophylaxis (endoscopic variceal ligation / non cardioselective beta blockers) 8. Refusal to participate in the study, or to sing informed consent 9. Pregnancy or lactation 10. HIV infection 11. platelet count \<20,000 platelets / dl 12. renal clearance below 30ml / min 13. portal vein thrombosis or peripheral thrombosis diagnosed at admission 14. presence of procoagulant factor previously known
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with bleeding and liver toxicity under Bemiparin treatment (HIBOR®) for the prevention of DVT / portal vein thrombosis. | 90 days | The bleeding will be classificated in two grades ( mild/ severe) and hepatoxicty were asses according to NCI CTCAE Version 3.0 |
Secondary
| Measure | Time frame |
|---|---|
| Number of thrombotic events in cirrhotic hospitalized patients | 90 days |
Outcome results
None listed