- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00563602
Treatment for Prevention of Variceal Rebleeding Guided by the Hemodynamic Response
Randomized and Controlled Study of Endoscopic Ligation, Nadolol and Isosorbide Mononitrate vs Endoscopic Ligation and Nadolol Alone, or Associated With Isosorbide Mononitrate or Prazosin, Depending of the Hemodinamyc Response
This is a prospective trial of random distribution, open, parallel group, in which patients with esophagic variceal bleeding will be randomized into two treatment groups, after controlling acute bleeding. All patients received standard medical therapy with b-blockers and endoscopic ligation (LEV) of esophageal varices.
The control group will be assigned to receive LEV + Nadolol + MNI. The experimental group will be assigned to receive treatment according to the hemodynamic response.
All patients included in the experimental group received LEV and pharmacological treatment nadolol alone or combined with MNI or Prazosin (PZ)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a prospective trial of random distribution, open, parallel group, in which patients with esophagic variceal bleeding will be randomized into two treatment groups, after controlling acute bleeding. All patients received standard medical therapy with b-blockers and endoscopic ligation (LEV) of esophageal varices.
The control group will be assigned to receive LEV + Nadolol (N) + Isosorbide Mononitrate (MNI) The experimental group will be assigned to receive treatment according to the hemodynamic response.
All patients included in the experimental group received LEV and pharmacological treatment nadolol alone or combined with MNI or Prazosin (PZ)
A hepatic hemodynamic study will be performed to patients in both groups, at baseline (In which basal values and acute b-blockers response will be assessed), and a second study at the 3 rd -4 th week after the drug therapy start, after the titration of the doses.
In the experimental group, responders to the acute administration of b-blockers will receive LEV + Nadolol alone, and those patients with no response will receive LEV + N + MNI, and another hemodynamic study will be performed 3 rd -4 th week after the drug therapy start, after the titration of the doses, to assess response. The non-responders in this control study will switched to LEV+ N + PZ, and a 3erd hemodynamic study will be performed.
Randomization will be stratified according to the degree of hepatic insufficiency, assessed by the Child-Pugh classification (classes A and B vs C)
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Candid Villanueva, MD
- Phone Number: +34620955006
- Email: cvillanueva@santpau.es
Study Contact Backup
- Name: Jordi Virgili
Study Locations
-
-
-
Barcelona, Spain, 08025
- Recruiting
- HospitalSCSP
-
Contact:
- Candid Villanueva, MD
- Phone Number: +34620955006
- Email: cvillanueva@santpau.es
-
Principal Investigator:
- Candid Villanueva, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All the patients admitted in emergencies in which 1) with gastrointestinal bleeding due to esophageal varices assessed by endoscopy, will be included.
- We define esophagic variceal bleeding as the endoscopic finding of any the following signs: 1) active variceal bleeding 2) clot or platelet cluster or 3 ) esophageal varices associated to red blood in esophagogastric lumen in the absence of other sources of bleeding.
- Clinical criteria and / or analytical, ultrasound and / or liver biopsy consistent with the diagnosis of liver cirrhosis.
- Written informed consent to participate in the study.
- Patients in fertile age should use barrier methods to prevent pregnancy during the entire study. The pregnancy test prior to the study must be negative
Exclusion Criteria:
- Age <18 or> 80 years.
- Patients not eligible for active treatment due to any underlying morbid condition (terminals). Here are included those patients with advanced liver disfunction (Child-Pugh >) or any patient with life expectancy < 6 mo.
- Refuse to participate in the study.
- Bleeding due to causes other than the esophageal varices.
- Prior inclusion in this study.
- Failure in the control of the acute bleeding (index episode).
- Pretreatment through elective LEV program, sclerotherapy or combined β- blockers plus nitrates, or portosystemic shunt (surgical or percutaneous).
- Contraindication for β- blockers and MNI (not exclude patients with contraindication for one of these drugs) or endoscopic procedures.
- Pregnancy.
- Presence multiple hepatocellular carcinoma or only diameter > 5 cm.
- Portal vein thrombosis.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 2
Standard Therapy: Endoscopic ligation (LEV) + Nadolol + Isosorbide mononitrate (MNI)(drugs carefully titrated until achieve maximum tolerated dose)
|
To switch two or more different treatments for the prevention of variceal rebleeding according to the hemodynamic response. All patients in the experimental group will begin by: 1) LEV + Nadolol. HVPG measurement: if response, no changes, if not, switch to 2) LEV + Nadolol + MNI. HVPG measurement: if response, no changes, if not, switch to: 3) LEV + Nadolol + Prazosin. (drugs carefully titrated until achieve maximum tolerated dose) |
Experimental: 1
Hemodynamic guided therapy: 1) LEV + Nadolol. HVPG measurement: if response, no changes, if not, switch to 2) LEV + Nadolol + MNI. HVPG measurement: if response, no changes, if not, switch to: 3) LEV + Nadolol + Prazosin. (drugs carefully titrated until achieve maximum tolerated dose) |
To switch two or more different treatments for the prevention of variceal rebleeding according to the hemodynamic response. All patients in the experimental group will begin by: 1) LEV + Nadolol. HVPG measurement: if response, no changes, if not, switch to 2) LEV + Nadolol + MNI. HVPG measurement: if response, no changes, if not, switch to: 3) LEV + Nadolol + Prazosin. (drugs carefully titrated until achieve maximum tolerated dose) |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Rebleeding
Time Frame: 1-2 Years
|
1-2 Years
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Survival
Time Frame: 1-2 Years
|
1-2 Years
|
Adverse effects
Time Frame: 1-2 Years
|
1-2 Years
|
Collaborators and Investigators
Investigators
- Principal Investigator: Candid Villanueva, MD, Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
Study record dates
Study Major Dates
Study Start
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CONHEMO-2006
- EudraCT 2007-002237-37
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Portal Hypertension
-
Assistance Publique - Hôpitaux de ParisActive, not recruitingIntrahepatic Non Cirrhotic Portal HypertensionFrance
-
Centro Hospitalar De São João, E.P.E.CompletedClinically Significant Portal HypertensionPortugal
-
University Hospital, ToursCompletedCirrhotic Portal HypertensionFrance
-
Icahn School of Medicine at Mount SinaiNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)CompletedPortal Hypertension | Clinically Significant Portal HypertensionUnited States
-
University Hospital, GhentCompletedEvaluation of Efficacy and Safety of Somatostatin Used as Inflow Modulator in Liver Transplantation.Liver Transplant With Clinically Significant Portal HypertensionBelgium
-
Ain Shams UniversityCompleted
-
Universidade Federal do Rio de JaneiroNot yet recruitingPortal Hypertension | Idiopathic Non-Cirrhotic Portal Hypertension | Non-Cirrhotic Portal Hypertension | Vascular Disorder of Liver | Non-Cirrhotic Portal Fibrosis | Regenerative Nodular Hyperplasia | Incomplete Septal Cirrhosis | Obliterative Portal Venopathy | Hepatoportal Sclerosis | Idiopathic Portal...Brazil
-
Assiut UniversityUnknownPredicting Liver Cell Failure & Portal Hypertension in LCEgypt
-
University Hospital, BonnCompleted
-
Tanta UniversityCompleted
Clinical Trials on Hemodynamic guided therapy
-
University Hospital DubravaCompletedHypotension During SurgeryCroatia
-
University of ChicagoCompletedContinous Flow Left Ventricular DeviceUnited States
-
Loma Linda UniversityEdwards LifesciencesTerminatedHemodynamic MonitoringUnited States
-
Istituto Auxologico ItalianoRecruitingObstructive Hypertrophic CardiomyopathyItaly
-
Università Vita-Salute San RaffaeleNot yet recruiting
-
Maria José Clara Colomina SolerCompletedPostoperative Complications | Postoperative Acute Kidney InjurySpain
-
Fundación Pública Andaluza para la gestión de la...CompletedFluid Therapy | Goal Directed TherapySpain
-
Hadassah Medical OrganizationUnknownSepsis | Septic Shock | Myocardial DysfunctionIsrael
-
National Taiwan University HospitalRecruitingOrthopedic Disorder | Hemodynamic InstabilityTaiwan
-
University Health Network, TorontoCompletedIntraoperative Fluid ManagementCanada