Sulodexide, VESSEL®, for the Prevention of Recurrent Venous Thromboembolism (The Jason Study)

Phase 3

Recruiting

• Conditions: Venous Thromboembolism; Anticoagulant; Elderly
• Interventions: Drug: Sulodexide and placebo; Drug: Placebo; Drug: Sulodexide

• Registration Number: NCT04257487
• Lead Sponsor: Arianna Anticoagulazione Foundation

Brief Summary

The study aims at optimizing extended management of elderly patients (\> 75 years) with at least one of the known bleeding risk factor, who suffered from first episode of venous thromboembolism of the lower extremity (proximal deep vein thrombosis with or without pulmonary embolism) (VTE). Patients were randomized to receive three different treatment: Sulodexide 250 mg BIS in die; Sulodexide 500 BID in die or indistinguishable placebo to verify the efficacy and safety of extended treatment for 12 months with Sulodexide (Vessel®) in the secondary prevention of Deep Vein Thrombosis / Pulmonary Embolism (DVT/PE) recurrence.

Detailed Description

This prospective cohort study aims to assess the efficacy and safety of the extended treatment with Sulodexide (Vessel®) in the secondary prevention of DVT / PE recurrence in elderly outpatients (≥ 75 years old at the time of inclusion) ), with at least one of the known bleeding risk factor, who had a first episode of lower extremity proximal DVT and / or PE, idiopathic or associated with weak or removed risk factors, and who have received standard treatment with any oral anticoagulant drug lasting at least 3 months. The study seeks to verify the safety of the Sulodexide therapy, demonstrating non-inferiority compared to placebo, with an incidence of major bleeding around 1% (upper confidence limit not \> 3%).

Study Timeline

• Study First Submitted: 2020-02-04
• Study First Submitted QC: 2020-02-04
• Study First Posted: 2020-02-06
• Study Start: 2020-12-21
• Status Verified: 2024-07
• Last Update Submitted: 2024-07-30
• Last Update Posted: 2024-07-31
• Primary Completion: 2025-12-31
• Study Completion: 2027-01-02

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 1455

Inclusion Criteria

1. Patients with a first event of proximal lower extremity DVT and / or PE, idiopathic or associated with weak or removed risk factors.

2. Patients aged ≥75 years at the time of enrolment

3. Patients with at least one of the known risk factors of bleeding (APPENDIX 1):

   1. Hypertension
   2. Renal failure
   3. Thrombocytopenia
   4. Diabetes
   5. Antiplatelet therapy (ASA maximum 140 mg/die)
   6. Frequent falls (>2 /years)
   7. Nonsteroidal anti-inflammatory drug
   8. Liver failure
   9. Previous Stroke
   10. Anemia
   11. Poor anticoagulant control
   12. Alcohol abuse

4. Patients of both sexes.

5. Patients who at the time of enrolment have already undergone a period of anticoagulant therapy (AT, with any medication) of at least 3 months and the therapy has not been suspended for more than 30 days.

6. Patients with no other AT indications.

7. Patients capable and able to provide informed consent

Exclusion Criteria

1. Patients aged <75 years at the time of the recruitment visit.

2. "Provoked" index event, which occurred:

   • Within 3 months of surgery or major trauma,
   • Bed Rest > 4 days,
   • Cast / immobility within 3 months.

3. Index event represented by severe PE, with life threatening risk or treated with thrombolytic therapy.

4. Index event represented by isolated distal DVT or superficial venous thrombosis.

5. Thrombotic event in sites other than the deep proximal veins of the lower limbs.

6. Anticoagulant therapy for less than 3 months at the time of enrolment.

7. Discontinuation of anticoagulant therapy for over thirty days at the time of enrolment

8. Recurrent episodes of DVT ± PE

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Treatment B	Sulodexide and placebo	Sulodexide (Vessel) 1 capsule of 250 LSU and 1 indistinguishable placebo capsule BID., for 12 months
Treatment C	Placebo	2 indistinguishable placebo capsules BID, for 12 months
Treatment B	Placebo	Sulodexide (Vessel) 1 capsule of 250 LSU and 1 indistinguishable placebo capsule BID., for 12 months
Treatment A	Sulodexide	Sulodexide (Vessel) 2 capsules of 250 LSU BID, for 12 months

Primary Outcome Measures

Name	Time	Method
Number and rate of patients with confirmed recurrent VTE and VTE-related death (efficacy).	From date of enrollment until the date of first documented event assessed up to 12 months	The occurrence of proximal deep vein thrombosis with or without pulmonary embolism (new or recurrent episode) wil be recorded in all patients
Number and rate of major Bleeding events (defined according to International Society on Thrombosis and Haemostasis guidelines (safety)	From date of enrollment until the date of first documented event assessed up to 12 months	Fatal bleeding; intracranial; intraspinal; intraocular; pericardial; intra-articular; intramuscular with compartment syndrome; retroperitoneal,; acute clinically overt bleeding will be recorded in all patients

Secondary Outcome Measures

Name	Time	Method
Number of and rate of thromboembolic events	From date of enrollment until the date of first documented event assessed up to 12 months	Transient ischemic attack (TIA), Stroke, Myocardial infarction will be recorded in all patients
Number and rate of non major bleeding complications	From date of enrollment until the date of first documented event assessed up to 12 months	In all patients will be recorded any sign or symptom of hemorrhage that does not fit the criteria for the definition of major bleeding but does meet at least one of the following criteria: 1)requiring medical intervention by a healthcare professional; 2) leading to hospitalization or increased level of care;3) prompting a face to face evaluation
Number and rate of dead patients (overall mortality)	From date of enrollment until the date of first documented event assessed up to 12 months	VTE-related death; cardiovascular related-death; bleeding-related death; death for: cancer, infectious disease and unknown cause; sudden death will be recorded in all patients
Presence of severe post-thrombotic syndrome according to Villalta Score	12 months	Patient with deep vein thrombosis as index event will be evaluated, at the and of follow-up, applying Villalta score, commonly used to diagnose post-thrombotic syndrome in the subacute phase of thrombosis. The presence of venous ulcer of the leg or a score \> of 15 points indicate the occurrence of severe post-thrombotic syndrome. The maximum score is 33. The score from 5 to 9 points indicate mild post-thrombotic syndrome and from 10 to 15 points indicate moderate post-thrombotic syndrome

Trial Locations

Locations (1)

Corrado Lodigiani; 🇮🇹 Rozzano, Italy