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The randomized clinical study aimed to assess the efficacy and safety of standard anticoagulation with rivaroxaban in combination with diosmin compared to the isolated use of standard rivaroxaban for prolonged therapy of acute femoro-popliteal deep vein thrombosis reflected the speed of deep vein recanalization and incidence of post-thrombotic syndrome.
Deep vein thrombosis is an acute inflammatory disease that affects vein wall and leads to the structural changes in the wall and valves reflected with chronic venous insufficiency that called postthrombotic syndrome (PTS).
Diosmin as a flavonoid agent has properties to reduce leukocyte-endothelial interaction and inflammatory response, that could reduce the damage to venous wall and valves.
The hypothesis of the study is based on assumption that diosmin combined with standard anticoagulation can improve outcomes of femoro-popliteal DVT due to increase speed of veins recanalization, decrease of vein wall inflammation and finally decrease the incidence of PTS at 6 month and 1 year after index DVT.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental: Rivaroxaban + Diosmin + Stockings | Experimental | treatment of deep vein thrombosis with anticoagulation (rivaroxaban), elastic compression stockings and additional prescription of diosmin |
|
| Control: Rivaroxaban + Stockings only | Active Comparator | standard treatment of deep vein thrombosis with anticoagulation (rivaroxaban) and elastic compression stockings |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rivaroxaban | Drug | 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Postthrombotic Syndrome as Determined by Villalta Score | Detection of the postthrombotic syndrome (PTS) was made according to the Villalta score (a combination of 5 subjective symptoms and 6 objective signs of chronic venous disease) ranged from 0 (no signs) to 33 scores (maximal severity). PTS defined as 5 and more scores; mild PTS as 5-9 scores; moderate PTS as 10-14 scores; severe PTS as 15 and more scores. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Recurrent Symptomatic or Asymptomatic DVT | detection of any episode of recurrent DVT with or without clinical signs verified by duplex ultrasound | 12 months |
| Number of Participants With Symptomatic Pulmonary Embolism |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ilya Schastlivtsev, PhD | Pirogov Russian National Research Medical University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Hospital no.1 of the President's Administration of Russian Federation | Moscow | 121352 | Russia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33201130 | Result | Lobastov K, Sautina E, Alencheva E, Bargandzhiya A, Schastlivtsev I, Barinov V, Laberko L, Rodoman G, Boyarintsev V. Intermittent Pneumatic Compression in Addition to Standard Prophylaxis of Postoperative Venous Thromboembolism in Extremely High-risk Patients (IPC SUPER): A Randomized Controlled Trial. Ann Surg. 2021 Jul 1;274(1):63-69. doi: 10.1097/SLA.0000000000004556. |
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Admitted to the hospital with the suspicion for DVT: 202; DVT verified: 158; Eligible DVT: 102; Rejected to participate: 12; Randomized: 90
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| ID | Title | Description |
|---|---|---|
| FG000 | Experimental: Rivaroxaban + Diosmin + Stockings | treatment of DVT with anticoagulation (rivaroxaban), elastic compression stockings and additional prescription of diosmin Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month Diosmin: 600 mg q.d. for 12 month compression stockings: above knee stocking for 12 month |
| FG001 | Control: Rivaroxaban + Stockings Only | standard treatment of DVT with anticoagulation (rivaroxaban) and elastic compression stockings Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month compression stockings: above knee stocking for 12 month |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Experimental: Rivaroxaban + Diosmin + Stocking | treatment of DVT with anticoagulation (rivaroxaban), elastic compression stockings and additional prescription of diosmin Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month Diosmin: 600 mg q.d. for 12 month compression stockings: above knee stocking for 12 month |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With Postthrombotic Syndrome as Determined by Villalta Score | Detection of the postthrombotic syndrome (PTS) was made according to the Villalta score (a combination of 5 subjective symptoms and 6 objective signs of chronic venous disease) ranged from 0 (no signs) to 33 scores (maximal severity). PTS defined as 5 and more scores; mild PTS as 5-9 scores; moderate PTS as 10-14 scores; severe PTS as 15 and more scores. | Posted | Count of Participants | Participants | 12 months |
|
12 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Study Group | treatment of DVT with anticoagulation (rivaroxaban), elastic compression stockings and additional prescription of diosmin Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month Diosmin: 600 mg q.d. for 12 month compression stockings: above knee stocking for 12 month |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Dispesia | Gastrointestinal disorders | Systematic Assessment |
Unsuspected high frequency of PTS in the Control group (standard treatment with rivaroxaban and compression stockings) led to early termination of enrollment (75% of planned sample size).
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Kirill Lobastov | Pirogov Russian National Research Medical University | +7-985-211-63-31 | lobastov_kv@hotmail.com |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 11, 2017 | Dec 30, 2019 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D020246 | Venous Thrombosis |
| D054070 | Postthrombotic Syndrome |
| ID | Term |
|---|---|
| D013927 | Thrombosis |
| D016769 | Embolism and Thrombosis |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D000069552 | Rivaroxaban |
| D004145 | Diosmin |
| D053828 | Stockings, Compression |
| ID | Term |
|---|---|
| D013876 | Thiophenes |
| D013457 | Sulfur Compounds |
| D009930 | Organic Chemicals |
| D009025 | Morpholines |
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Randomized open-labeled clinical trial with a masked outcomes assessor
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Outcomes assessor does not involve in randomisation and treatment process, has no information about the patient's belonging to one of the study groups
|
| Diosmin | Drug | 600 mg q.d. for 12 month |
|
|
| compression stockings | Other | above knee stocking for 12 month |
|
detection of symptomatic pulmonary embolism verified with CT pulmonary angiogram
| 12 months |
| The Value of Venous Clinical Severity Score | Venous Clinical Severity Score (VCSS) is a combination of subjective symptoms and objective signs of CVD aimed to assess the severity of disease and ranges from 0 (no signs and symptoms of CVD) to 30 (severe signs and symptoms of CVD) | 12 months |
| The Value of Chronic Lower Limb Venous Insufficiency Questionnaire - 20 Items | Chronic Lower Limb Venous Insufficiency Questionnaire - 20 items (CIVIQ-20) is a venous specific questionnaire to assess the disease-specific quality of life (QoL). It contains 20 items of 1-5 scores, totally, from 20 (best QoL) to100 (worst QoL) scores. | 12 months |
| Number of Participants With Full Recanalization of the Popliteal Vein | Full recanalization of popliteal vein suggests the residual venous obstruction (RVO) less than 20%. The RVO was assessed by duplex ultrasound and calculated as the vein cross-sectional diameter under the maximal compression divided on the diameter without any compression multiplied by 100%. | 12 months |
| Extension of Residual Venous Obstruction by Marder Score | Residual venous obstruction (RVO) defined as a thrombotic masses occupying 20% and more of the vein cross-sectional diameter was measured by duplex ultrasound and calculated as the vein cross-sectional diameter under the maximal compression divided on the diameter without compression and multiplied by 100%. The extension of RVO was assessed by Marder score, the sum of all affected venous segments, evaluated by different scores (see Appendix of the Protocol), that ranged from 0 (no RVO) to 34 (RVO in all possible venous segments in one limb). | 12 months |
| Adverse Events | any adverse events detected or suspected | 12 months |
| Major Bleeding | according to the International Society of Thrombosis and Hemostasis (ISTH) definition, major bleeding defined as fatal bleeding, and/or symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome, and/or bleeding causing a fall in hemoglobin level of 20 g/L or 1.24 mmol/L or more, or leading to transfusion of two or more units of whole blood or red cells | 12 months |
| Clinically Relevant Non-major Bleeding | any non-major bleeding requiring anticoagulant withdrawal, and/or performing haemostatic measures, and/or hospitalization, and/or an unscheduled medical appointment | 12 months |
| Minor Bleeding | any non-major or non-clinically relevant bleeding does not require the suspension of therapy and changes in the patient's lifestyle | 12 months |
| BG001 |
| Control: Rivaroxaban + Stockings Only |
standard treatment of DVT with anticoagulation (rivaroxaban) and elastic compression stockings Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month compression stockings: above knee stocking for 12 month |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Time to randomization | Number of days from DVT verification to randomization | Mean | Standard Deviation | days |
|
| Unprovoked DVT | DVT without any identified clinical provocation (e.g. major surgery, trauma, immobilization, pregnancy and postpartum, estrogen-containing pills, long-travel, etc) | Count of Participants | Participants |
|
| Preexisting chronic venous disease | Chronic venous disease (CVD) according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) clinical class: C0 - no signs for CVD; C1 - telangiectasia and reticular veins; C2 - varicose veins; C3 - venous edema; C4 - skin pigmentation, induration, venous eczema of skin white atrophy; C5 - healed venous ulcer; C6 - active venous ulcer. Preexisting CVD suggests C2 and higher CEAP clinical class. | Count of Participants | Participants |
|
| Thrombus burden | Extension of DVT assessed with duplex ultrasound by Marder score (see Appendix 1 to the Protocol): ranges from 0 (no thrombus) to 34 (occlusion of all veins in one limb). | Mean | Standard Deviation | Marder score |
|
| OG001 |
| Control: Rivaroxaban + Stockings Only |
standard treatment of DVT with anticoagulation (rivaroxaban) and elastic compression stockings Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month compression stockings: above knee stocking for 12 month |
|
|
|
| Secondary | Number of Participants With Recurrent Symptomatic or Asymptomatic DVT | detection of any episode of recurrent DVT with or without clinical signs verified by duplex ultrasound | Posted | Count of Participants | Participants | 12 months |
|
|
|
|
| Secondary | Number of Participants With Symptomatic Pulmonary Embolism | detection of symptomatic pulmonary embolism verified with CT pulmonary angiogram | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | The Value of Venous Clinical Severity Score | Venous Clinical Severity Score (VCSS) is a combination of subjective symptoms and objective signs of CVD aimed to assess the severity of disease and ranges from 0 (no signs and symptoms of CVD) to 30 (severe signs and symptoms of CVD) | Posted | Mean | Standard Deviation | VCSS score | 12 months |
|
|
|
|
| Secondary | The Value of Chronic Lower Limb Venous Insufficiency Questionnaire - 20 Items | Chronic Lower Limb Venous Insufficiency Questionnaire - 20 items (CIVIQ-20) is a venous specific questionnaire to assess the disease-specific quality of life (QoL). It contains 20 items of 1-5 scores, totally, from 20 (best QoL) to100 (worst QoL) scores. | Posted | Mean | Standard Deviation | CIVIQ-20 scores | 12 months |
|
|
|
|
| Secondary | Number of Participants With Full Recanalization of the Popliteal Vein | Full recanalization of popliteal vein suggests the residual venous obstruction (RVO) less than 20%. The RVO was assessed by duplex ultrasound and calculated as the vein cross-sectional diameter under the maximal compression divided on the diameter without any compression multiplied by 100%. | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | Extension of Residual Venous Obstruction by Marder Score | Residual venous obstruction (RVO) defined as a thrombotic masses occupying 20% and more of the vein cross-sectional diameter was measured by duplex ultrasound and calculated as the vein cross-sectional diameter under the maximal compression divided on the diameter without compression and multiplied by 100%. The extension of RVO was assessed by Marder score, the sum of all affected venous segments, evaluated by different scores (see Appendix of the Protocol), that ranged from 0 (no RVO) to 34 (RVO in all possible venous segments in one limb). | Posted | Mean | Standard Deviation | Marder score | 12 months |
|
|
|
|
| Secondary | Adverse Events | any adverse events detected or suspected | Posted | Count of Participants | Participants | 12 months |
|
|
|
|
| Secondary | Major Bleeding | according to the International Society of Thrombosis and Hemostasis (ISTH) definition, major bleeding defined as fatal bleeding, and/or symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome, and/or bleeding causing a fall in hemoglobin level of 20 g/L or 1.24 mmol/L or more, or leading to transfusion of two or more units of whole blood or red cells | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | Clinically Relevant Non-major Bleeding | any non-major bleeding requiring anticoagulant withdrawal, and/or performing haemostatic measures, and/or hospitalization, and/or an unscheduled medical appointment | Posted | Count of Participants | Participants | 12 months |
|
|
|
| Secondary | Minor Bleeding | any non-major or non-clinically relevant bleeding does not require the suspension of therapy and changes in the patient's lifestyle | Posted | Count of Participants | Participants | 12 months |
|
|
|
| 0 |
| 45 |
| 0 |
| 45 |
| 5 |
| 45 |
| EG001 | Control Group | standard treatment of DVT with anticoagulation (rivaroxaban) and elastic compression stockings Rivaroxaban: 15 mg b.i.d. for 3 weeks and then 20 mg q.d. up to 6 month compression stockings: above knee stocking for 12 month | 0 | 45 | 0 | 45 | 4 | 45 |
| Clinically relevant non-major bleeding | Blood and lymphatic system disorders | Systematic Assessment |
|
| Minor bleeding | Blood and lymphatic system disorders | Systematic Assessment |
|
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| D014689 |
| Venous Insufficiency |
| D010078 |
| Oxazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D047309 | Flavones |
| D005419 | Flavonoids |
| D002867 | Chromones |
| D001578 | Benzopyrans |
| D011714 | Pyrans |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D058128 | Compression Bandages |
| D001458 | Bandages |
| D004864 | Equipment and Supplies |