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Intrahepatic Non Cirrhotic Portal HypertensionPhase 3APISNCT04007289

Apixaban for Intrahepatic Non Cirrhotic Portal Hypertension

A Phase 3 study testing Apixaban in people with Intrahepatic Non Cirrhotic Portal Hypertension, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Intrahepatic non-cirrhotic portal hypertension (INCPH) is a rare disease mostly affecting adults in their forties, characterized by portal hypertension related to alterations of intrahepatic microcirculation in the absence of cirrhosis.The only therapeutic options currently available for patients with INCPH include… Read more about this study

Who is it for?
Ages 18 to 90 years
What is being tested?
Apixaban
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
166 participants
Where
1 siteFrance
Study dates
24 Jun 2019to 31 Dec 2026
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 and ≤ 90 year old male and female patients,
  • For child-bearing aged women, contraception using progestatives, or intrauterine device or mechanical contraception
  • Adequate prophylaxis against variceal bleeding according to EASL (European association for the study of the liver) guidelines
  • Intrahepatic non cirrhotic portal hypertension (INCPH), defined according to the recent VALDIG workshop (Feb. 2017, Ascona, Italy) as having one of the following simultaneous associations:
  • absence of cirrhosis on an adequate liver biopsy, and one or more signs specific for portal hypertension
  • absence of cirrhosis on an adequate liver biopsy, and one or more signs not specific for portal hypertension and one or more histological signs for INCPH
  • in the absence of adequate liver biopsy, 2 reliable liver stiffness values determined using transient elastography (Fibroscan) < 10 kPa and one or more signs specific for portal hypertension

Who cannot join

  • Myeloproliferative disease treated with aspirin to prevent vascular events, paroxysmal nocturnal hemoglobinuria.
  • Ongoing oestroprogestative contraception
  • Pregnant or breastfeeding women
  • Complete thrombosis of superior mesenteric vein and/or inferior mesenteric vein
  • Complete portal vein thrombosis or portal cavernoma
  • Recent (<6 months) partial portal venous system thrombosis
Show all 27Show fewer
  • Mandatory indication or contraindication for anticoagulation according to guidelines of the American college of chest physicians
  • Concomitant treatment with any other anticoagulant agent unless when bridging from one to the other is performed
  • Disease at high risk of bleeding (except for portal hypertension)
  • Active clinically significant bleeding:. This may include current or recent gastrointestinal ulceration, presence of malignant neoplasms at high risk of bleeding, recent brain or spinal injury, recent brain, spinal or ophthalmic surgery, recent intracranial haemorrhage, arteriovenous malformations, vascular aneurysms or major intraspinal or intracerebral vascular abnormalities.
  • Platelet < 40000/mm3, or prothrombin index <40% in the absence of anti-vitamin K or Factor V < 40% or Fibrinogen < 1.0g/L
  • Transjugular intrahepatic portosystemic shunt (TIPSS) or surgical portosystemic shunt
  • Participation in another interventional trial
  • Creatinine clearance < 30 mL/min
  • Hepatitis C with detectable HCV RNA at inclusion
  • Positive HBs Ag, except patients with HBeAg-negative chronic HBV infection, previously termed 'inactive carriers' [characterised by the presence of serum antibodies to HBeAg (anti-HBe), undetectable or low (<2,000 IU/mL) HBV DNA levels and normal serum ALT levels] that can be included
  • Alcohol intake >210 g/week for men and 140 g/week for women
  • Mandatory indication to aspirin or other antiplatelet agents including P2Y12 receptor antagonists according to guidelines of the American Heart Association
  • Patient who underwent liver transplantation less than 3 years before screening
  • Severe hepatic impairment or significant active liver injury (serum ALT level > 5 times the upper limit of normal values)
  • Life expectancy <12 months
  • Specific causes of portal hypertension or specific vascular liver diseases: history of bone marrow transplantation, Budd-Chiari syndrome / hepatic venous outflow obstruction, hepatic schistosomiasis diagnosed on liver biopsy (an isolated positive serology is not an exclusion criterion), cardiac failure, Fontan surgery, Abernethy syndrome, Hereditary hemorrhagic telangiectasia, chronic cholestatic diseases, liver infiltration by tumor cells
  • Concomitant use of potent inhibitors of CYP3A4 or P-gp. In case of moderate interactions with apixaban (for example, immunosuppressive treatment), the dose of CYP3A4 inhibitor will be adapted according to its plasmatic level in the study patient.
  • Hypersensitivity to the active substance or to any of the excipients including lactose.
  • Patients unable to give consent (under guardianship or curatorship)
  • No written informed consent for participation in the study
  • No coverage for medical insurance

Trial locations and contacts

1 site in 1 country.

France1 site
  • Beaujon hospital

    Clichy, France, 92110

Other trials in France

About this study

Intrahepatic non-cirrhotic portal hypertension (INCPH) is a rare disease mostly affecting adults in their forties, characterized by portal hypertension related to alterations of intrahepatic microcirculation in the absence of cirrhosis.The only therapeutic options currently available for patients with INCPH include prophylaxis for variceal bleeding using betablockers and/or endoscopic band ligation and TIPSS (transjugular intrahepatic portosystemic shunt) or liver transplantation for severe cases.

The investigators hypothesize that anticoagulation using Apixaban in patients with INCPH might prevent occurrence or extension of portal, splenic or mesenteric veins thromboses and thus the development of chronic portal vein thrombosis and associated complications, but also avoid intrahepatic thromboses and consequently liver disease progression and variceal bleeding.

Read more

The Primary Objective is to evaluate the effect of 24 months low dosing of apixaban (2.5 mg x 2/day) versus placebo on the occurrence or the extension of portal venous system thrombosis (including splenic, mesenteric veins, portal trunk or left or right portal branches) at 24 months in patients with INCPH.

166 patients will be included in 21 centers in a prospective, national multicentric, phase III, superiority comparative randomized (1:1) double-blinded clinical trial with two parallel arms: apixaban versus placebo.

Read the detailed description

Intrahepatic non-cirrhotic portal hypertension (INCPH) is a rare disease mostly affecting adults in their forties, characterized by portal hypertension related to alterations of intrahepatic microcirculation in the absence of cirrhosis.The only therapeutic options currently available for patients with INCPH include prophylaxis for variceal bleeding using betablockers and/or endoscopic band ligation and TIPSS (transjugular intrahepatic portosystemic shunt) or liver transplantation for severe cases.

The investigators hypothesize that anticoagulation using Apixaban in patients with INCPH might prevent occurrence or extension of portal, splenic or mesenteric veins thromboses and thus the development of chronic portal vein thrombosis and associated complications, but also avoid intrahepatic thromboses and consequently liver disease progression and variceal bleeding.

The Primary Objective is to evaluate the effect of 24 months low dosing of apixaban (2.5 mg x 2/day) versus placebo on the occurrence or the extension of portal venous system thrombosis (including splenic, mesenteric veins, portal trunk or left or right portal branches) at 24 months in patients with INCPH.

The Secondary Objectives are :

  1. To assess the safety of apixaban on: (a) any major bleeding as defined by the ISTH (International Society on Thrombosis and Haemostasis) guidelines; (b) liver toxicity; (c) adverse events and reactions.
  2. To compare the effect of 24 months low dosing of apixaban (2.5 mg x 2/day) versus placebo on the following outcomes, assessed during the 24 months of treatment:
  3. - at least one event among: deep vein thrombosis in any location, arterial thrombosis, major bleeding, death
  4. - the occurrence of deep vein thrombosis in any location or arterial thrombosis
  5. - mortality (global, liver related, non-liver related), and mortality or liver transplantation
  6. - each and any event among: liver decompensation, complications of portal hypertension including portal hypertensive related gastrointestinal bleeding, liver transplantation or death;
  7. - portal hypertension related features (spleen size, platelet count, size of esophageal varices, portal blood flow velocity) and markers of bacterial translocation and inflammation
  8. - liver function
  9. - quality of life
  10. To evaluate the effect of 24 months low dosing of apixaban (2.5 mg x 2/day) versus placebo on the occurrence or the extension of portal venous system thrombosis (including splenic, mesenteric veins, portal trunk or left or right portal branches) at 24 months after randomisation in patients with INCPH according to HIV status
  11. To identify predictors of portal venous system thrombosis and liver related events:
  • in the control group: liver and spleen stiffness; portal blood flow velocity; specific coagulation tests; markers of bacterial translocation and inflammation
  • in the group receiving apixaban: plasma apixaban levels
  1. To assess treatment compliance
  2. To study the occurrence or extension of portal venous system thrombosis or occurrence of deep vein thrombosis in any location or arterial thrombosis in the 6 months after the 24-month treatment with apixaban versus placebo.

166 patients will be included in 21 centers in a prospective, national multicentric, phase III, superiority comparative randomized (1:1) double-blinded clinical trial with two parallel arms: apixaban versus placebo.

Being tested
Apixaban, Placebo

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ApixabanDrug

    Administration of Apixaban ; 2 clinical examinations; blood tests, 3 liver and spleen stiffness measurements, 2 contrast enhanced echocardiographies, 1 hepatic ultrasonography, Biological samples collections to identify predictors of thrombosis and liver related events

  • PlaceboDrug

    Administration of placebo ; 2 clinical examinations; blood tests, 3 liver and spleen stiffness measurements, 2 contrast enhanced echocardiographies, 1 hepatic ultrasonography,

Study groups in NCT04007289
Study groupRoleWhat they receive
APIXABANActive comparatorApixaban, 1 pill of 2.5 mg per os twice a day (one in the morning and one in the evening) for 24 months.
Receives: Drug: Apixaban
PLACEBOPlacebo comparatorPlacebo, 1 pill per os twice a day (one in the morning and one in the evening) for 24 months.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Portal venous system thrombosis

    Occurrence or extension of portal venous system thrombosis (including splenic, mesenteric veins, portal trunk or left or right portal branches) at 24 months in patients with INCPH.

    Measured: 24 months

Secondary outcomes (19)
  1. Occurrence of side effects

    Any major bleeding as defined by the International Society on Thrombosis and Haemostasis guidelines; liver toxicity; adverse events and reactions.

    Measured: 24 months

  2. Composite endpoint including thrombosis and major bleeding

    Cumulative incidence of one event among: deep vein thrombosis in any location, arterial thrombosis, major bleeding, death

    Measured: 24 months

  3. Occurence of vein or arterial thrombosis

    Compare the effect of 24 months low dosing of apixaban (2.5 mg x 2/day) versus placebo on one event among: deep vein thrombosis in any location, arterial thrombosis,

    Measured: 24 months

  4. Mortality or liver transplantation

    cumulative incidence of death (global, liver related, non liver related) or liver transplantation

    Measured: 24 months

  5. Complications of liver disease

    cumulative incidence of liver decompensation, complications of portal hypertension including portal hypertensive related gastrointestinal bleeding, liver transplantation or death;

    Measured: 24 months

  6. Portal hypertension related features

    change in size of oesophageal varices

    Measured: 24 months

  7. Portal hypertension related features

    platelet count

    Measured: 24 months

  8. Markers of bacterial translocation and inflammation

    circulating concentrations of CRP

    Measured: 24 months

  9. Liver function

    change in child pugh score

    Measured: 24 months

  10. Liver function

    change in MELD score

    Measured: 24 months

  11. Measure of Quality of life

    change in quality of life assessed using SF36 questionnaire

    Measured: 24 months

  12. Measure of quality life

    change in quality of life assessed using CLDQ questionnaire

    Measured: 24 months

  13. occurrence or the extension of portal venous system thrombosis at 24 months after randomisation in patients with INCPH according to HIV status

    Compare the effect of 24 months low dosing of apixaban (2.5 mg x 2/day) versus placebo on the occurrence or the extension of portal venous system thrombosis (including splenic, mesenteric veins, portal trunk or left or right portal branches) at 24 months after randomisation in patients with INCPH according to HIV status

    Measured: 24 months

  14. predictors of portal venous system thrombosis and liver related events

    In group receiving Apixaban : plasma Apixaban levels

    Measured: 24 months

  15. predictors of portal venous system thrombosis and liver related events

    in the control group : portal blood flow Velocity

    Measured: 24 months

  16. predictors of portal venous system thrombosis and liver related events

    in the control group : stiffness measured using Fibroscan

    Measured: 24 months

  17. predictors of portal venous system thrombosis and liver related events

    in the control group : levels of specific coagulation tets (D-dimeres)

    Measured: 24 months

  18. treatment compliance

    number of compliant patient

    Measured: 24 months

  19. occurrence or extension of portal venous system thrombosis or occurrence of deep vein thrombosis in any location or arterial thrombosis in the 6 months after the 24-month treatment with apixaban versus placebo

    cumulative incidence of extension of portal venous system thrombosis or deep vein thrombosis in any location or arterial thrombosis in the 6 months after the 24-month treatment with apixaban versus placebo

    Measured: 30 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Jul 2019
  2. Study start24 Jun 2019
  3. Primary completion31 Jul 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study will be a prospective, national multicentric, phase III, superiority comparative randomized (1:1) double-blinded clinical trial with two parallel arms: apixaban versus placebo.
Masking
Single blind
Who is masked
Participant
Enrolment
166 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04007289
Sponsor's protocol ID
P170916J
Acronym
APIS
Status last verified
May 2025
First submitted
24 May 2019
Last updated
25 May 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Apixaban in people with Intrahepatic Non Cirrhotic Portal Hypertension, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 27 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 25 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Portal venous system thrombosis (time frame: 24 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 May 2025.

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