Therapeutic Anticoagulation Strategy for Acute Chest Syndrome
Status:
Unknown status
Trial end date:
2018-12-01
Target enrollment:
Participant gender:
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).