Therapeutic Anticoagulation Strategy for Acute Chest Syndrome

Phase 3

Completed

• Conditions: Sickle Cell; Acute Chest Syndrome; Anemia; Low-Molecular-Weight Heparin
• Interventions: Drug: Curative anticoagulation ( INNOHEP®); Drug: Prophylactic anticoagulation ( INNOHEP®)

• Registration Number: NCT02580773
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

Acute Chest Syndrome (ACS) is a pulmonary complication of sickle cell disease (SCD) representing the leading cause of death and the second cause of hospitalization among adult patients. Pulmonary vaso-occlusion is one of the main pathophysiologic hypotheses during ACS. Our hypothesis is that therapeutic anticoagulation may reduce the severity of ACS via the alleviation of pulmonary thrombosis. The main objective of this prospective, randomized, double-blind study is to test the efficacy and safety of a curative anticoagulation strategy during ACS. The main efficacy endpoint is time to ACS resolution. The main safety endpoint is number of major bleedings.

A thoracic CT scan will be performed to check for pulmonary artery thrombosis. If the CT scan is positive (thrombosis within a large elastic artery), the patient will not be randomized and will be treated with a curative anticoagulation. If the CT scan is negative, the patient will be randomized to receive subcutaneous anticoagulation with low molecular weight heparin (tinzaparin) either at a curative dose (175 Unit International (UI)/kg/day for 7 days) or at a prophylactic dose (4500 UI/day).

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2015-10-05
• Study First Submitted QC: 2015-10-18
• Study First Posted: 2015-10-20
• Study Start: 2016-12-16
• Status Verified: 2020-04
• Primary Completion: 2021-02-04
• Study Completion: 2021-09-15
• Last Update Submitted: 2024-02-07
• Last Update Posted: 2024-02-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 198

Inclusion Criteria

• Age ≥ 18 years
• Major sickle cell syndrome (SS, SC, Sβ)
• ACS defined by the association of a new infiltrate on chest X-ray or CT scan and a respiratory symptom or abnormal chest auscultation
• Written, informed consent

Main

Exclusion Criteria

• Pregnancy, post-partum
• Iodine allergy
• Extreme weight (<40 kg or > 100 kg)
• Moderate to severe renal insufficiency
• Moya-moya disease
• Symptomatic cerebral aneurysm
• Major transfusional risk
• Uncontrolled severe retinopathy
• All other contra-indications to curative anti-coagulation by tinzaparin.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Curative anticoagulation	Curative anticoagulation ( INNOHEP®)	-
Prophylactic anticoagulation	Prophylactic anticoagulation ( INNOHEP®)	-

Primary Outcome Measures

Name	Time	Method
Number of major bleedings	up to 15 days
The main efficacy endpoint is time to ACS resolution	up to 15 days	The delay between randomization and ACS resolution

Secondary Outcome Measures

Name	Time	Method
Number of complicated ACS	up to 15 days
Blood volume exchanged	up to 15 days
Cumulative dose of opioids	up to 15 days
Duration of hospital stay	up to 15 days
Hospital mortality	up to 15 days
Number of non-major bleedings	up to 15 days
Number of readmissions and thromboembolic events within 6 months	at 6 months

Trial Locations

Locations (1)

Henri Mondor Hospital; 🇫🇷 Creteil, France