Venous Thromboembolic DiseaseNCT04158973
CHIPs-VTE Study in Hospitalized Patients With Lung Cancer
A study testing Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after discharge and Routine VTE prophylaxis in hospital in people with Venous Thromboembolic Disease and Pulmonary Embolism, run by China-Japan Friendship Hospital.
Trial summary
Venous thromboembolism (VTE) is a common complication of malignancies, in particular to lung cancer. Patients with lung cancer in surgical and medical departments are at high risk of VTE development. Prophylaxis is one major way to to prevent it. Currently, VTE prophylaxis is mainly based on VTE-risk assessment. Read more about this study
- Who is it for?
- Ages 40 years and older
- Conditions the study is for
- Venous Thromboembolic Disease, Pulmonary Embolism, Deep Venous Thrombosis
- What is being tested?
- Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after discharge and Routine VTE prophylaxis in hospital
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 3,200 participants
- Where
- No sites listed yet
- Study dates
- 1 Dec 2021to 31 Dec 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
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 40 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Aged ≥40 years
- Have an expected hospital stay ≥72 hours for medical and/or surgical treatment
- Confirmed lung cancer at admission or proven lung cancer within prior 6 months
- Evidence of active lung cancer within 6 prior months
- Written informed consent
Who cannot join
- Pregnancy or breastfeeding
- Inability to be followed-up at until 3 months after randomization
- have participated in similar trials or are undergoing other clinical trials
- refuse or are unable to give informed consent VTE/bleeding-related criteria
- Incidental VTE identified on spiral CT scans which are ordered primarily for staging the malignancy at or any time before enrollment
- Neurosurgery, vascular procedures, orthopedic surgery intended during the admission
Show all 15Show fewer
- Severe renal failure not receiving dialysis (creatinine clearance [CrCl] <30 mL/min), moderate to severe liver dysfunction, severe anemia
- Uncontrolled hypertension (systolic blood pressure [BP] >180 mmHg, diastolic BP >110 mmHg)
- severe platelet dysfunction or inherited bleeding disorder (such as haemophilia and von Willebrand's disease)
- Acute stroke or recent stroke (within 4 weeks)
- Recent major bleeding (within 3 months)
- Requiring a full dose of anticoagulant treatment (e.g., recent VTE, atrial fibrillation)
- Contraindication to heparin or rivaroxaban, e.g., heparin induced thrombocytopenia or history of documented episode of heparin or LMWH induced thrombocytopenia and/or thrombosis (HIT, HAT, or HITTS); recent central nervous system (CNS) bleed, hemorrhagic CNS metastases; active major bleeding with more than 2 units transfused in 24 hours.
- Contraindication to mechanical prophylaxis, e.g., acute deep vein thrombosis, severe arterial insufficiency (pertains to graduated compression stockings only)
- Concurrent use of anticoagulants known to increase the risk of bleeding (such as warfarin with INR>2).
Trial locations and contacts
No sites are listed yet.
About this study
Official title: Bleeding Risk Guided VTE Prophylaxis Strategy for Hospitalized Patients With Lung Cancer: Rationale and Design for a Multicenter, Adjudicator-blinded, Parallel, Randomized Clinical Trial in China
Venous thromboembolism (VTE) is a common complication of malignancies, in particular to lung cancer. Patients with lung cancer in surgical and medical departments are at high risk of VTE development. Prophylaxis is one major way to to prevent it. Currently, VTE prophylaxis is mainly based on VTE-risk assessment. However, all patients hospitalized for cancer are at intermediate or high risk of VTE but their bleeding risk vary. To improve effect of VTE prophylaxis and reduce bleeding events in patients with lung cancer, we will conduct an open-label parallel randomized clinical tria to assess the effect of bleeding risk based prophylaxis strategy among lung cancer patients. We hypothesize that VTE prophylaxis based on bleeding risk assessment with a short post-discharge treatment course is superior to VTE propohylaxis based on VTE risk assessment among hospitalized patients with lung cancer
A sample of 3200 eligible patients will be randomized into experimental or control group with an allocation rate of 1:1. Stratified by medical/surgical units, block randomization with a varying block size of 4 or 6 will be adopted to randomize patients into experimental or control group. In experimental group, patients will undergo bleeding risk assessment and receive prophylaxis according to bleeding risk during hospitalization, and they will also receive an extended pharmacological prophylaxis of 5mg Rivaroxaban once daily for up to 15 consecutive days after discharge. In control group, patients will receive routine VTE prophylaxis, VTE risk assessment and prophylaxis if indicated during hospitalization according to current policies for hospitals in China but no further treatment prophylaxis after discharge.
Patients in both groups will be followed up for 30 days. The primary outcome is symptomatic and asymptomatic objectively proven VTE (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)) within 30 days after initiation of randomization. Ultrasound and CTPA will be performed to detect DVT and PE, respectively. Clinically relevant bleeding (non-major clinically relevant and major bleeding, HIT) and death are secondary outcomes.
Read the detailed description
Randomization and sequence generation A computerized random-number generator will be used to generate the allocation sequence. In this multicenter trial involving 10 hospitals, randomization procedures will be organized centrally.
Stratified block randomization with a varying block size of 4 or 6 will be used to allocate patients into experimental or control group. Patients with lung cancer will be stratified into those under planned medical or surgical treatments.
In each stratum, patients will be blocked according to their admission sequence. Four or six patients consecutively admitted will be one block depending on the block size. In each block, patients will be randomly allocated into experimental or control group according to sequence generated in advance by software.
Allocation concealment/Blinded randomization Patient assignments will be enclosed in a sequentially numbered, opaque, sealed envelopes (SNOSE). Clinicians in charge of patient enrollment will not know the allocation sequence until eligible patients who meet inclusion and exclusion criteria are enrolled.
An independent statistician will generate the random allocation sequence. Physicians will enroll participants and assign interventions in experimental or control group.
Blinding/Open label This is an open-label trial that patients, clinicians and researchers will know allocation assignments after enrollment. But imaging experts providing the duplex ultrasound and CTPA results will be blinded in order to objectively assess the 30-day CTPA-proven VTE incidence and other outcomes in both groups. An independent data monitoring board will evaluate the trial data and safety.
- Being tested
- Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after discharge, Routine VTE prophylaxis in hospital
- Medical subject headings
- Pulmonary Embolism, Venous Thrombosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after dischargeOther
At admission, patents undergo bleeding risk assessment and receive prophylaxis according to bleeding risk. After discharge, they will undergo an extended treatment of 5mg Rivaroxaban once daily for 15 consecutive days,
Routine VTE prophylaxis in hospitalOther
Patients randomized to the standard treatment (Control) group will receive routine VTE prophylaxis according to current guidelines and clinical practices, VTE risk assessment and prophylaxis if indicated during hospitalization according to current policies for hospitals in China but no further treatment prophylaxis after discharge
| Study group | Role | What they receive |
|---|---|---|
| VTE prophylaxis based on bleeding risk assessment | Experimental | Patients will undergo a bleeding risk assessment to determine their entering VTE prophylaxis. Low bleeding risk patients will have once daily sc LMWH prophylaxis. Intermediate bleeding risk patients will have q 12 h sc low dose unfractionated heparin prophylaxis. High bleeding risk patients will have mechanical prophylaxis. Assigned prophylaxis can be interrupted as clinical judgement requires, e.g., for peri-procedural reasons. When patients are discharged, if they have low risk of bleeding at the time of discharge, whatever their bleeding risk assessment at the time of randomization, will begin 5 mg rivaroxaban prophylaxis (two 2.5 mg tablets) once daily with food, starting on the day of discharge, for 15 days. Receives: Other: Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after discharge |
| Routine VTE prophylaxis in local clinical practice | Active comparator | VTE risk assessment and prophylaxis if indicated during hospitalization according to current policies for hospitals in China but no further treatment prophylaxis after discharge. Receives: Other: Routine VTE prophylaxis in hospital |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of symptomatic and asymptomatic objectively proven VTE
PE incidence detected by CTPA and/or DVT by ultrasound
Measured: 30 days after randomization
Secondary outcomes (3)
All-cause mortality
All-cause deaths that occur during study
Measured: 30 days after randomization
Clinically relevant bleeding
Bleeding that occur in the study
Measured: 30 days after randomization
Adverse events
Safety events related to drug use
Measured: 30 days after randomization
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Nov 2019
- Study start1 Dec 2021 (estimated)
- Primary completion30 Apr 2022 (estimated)
- Study completion31 Dec 2022 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Venous Thromboembolic DiseaseStudies of the same condition, open and under way.
- More trials run by China-Japan Friendship HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 3,200 participants (estimated)
Sponsor and investigators
- Lead sponsor
- China-Japan Friendship Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Zhenguo Zhai,MD,PhD, China-Japan Friendship Hospital
- Investigators
- Zhenguo Zhai, Doctor, Principal investigator, China-Japan Friendship Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04158973
- Sponsor's protocol ID
- CHIPs-VTE in lung cancer
- Status last verified
- Aug 2021
- First submitted
- 4 Sep 2019
- Last updated
- 3 Aug 2021
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Vitale C, D'Amato M, Calabro P, Stanziola AA, Mormile M, Molino A. Venous thromboembolism and lung cancer: a review. Multidiscip Respir Med. 2015 Sep 15;10(1):28. doi: 10.1186/s40248-015-0021-4. eCollection 2015.
PubMed 26380084Connolly GC, Dalal M, Lin J, Khorana AA. Incidence and predictors of venous thromboembolism (VTE) among ambulatory patients with lung cancer. Lung Cancer. 2012 Dec;78(3):253-8. doi: 10.1016/j.lungcan.2012.09.007. Epub 2012 Sep 29.
PubMed 23026639Zhang Y, Yang Y, Chen W, Guo L, Liang L, Zhai Z, Wang C; China Venous Thromboembolism (VTE) Study Group. Prevalence and associations of VTE in patients with newly diagnosed lung cancer. Chest. 2014 Sep;146(3):650-658. doi: 10.1378/chest.13-2379.
PubMed 24676401Song C, Shargall Y, Li H, Tian B, Chen S, Miao J, Fu Y, You B, Hu B. Prevalence of venous thromboembolism after lung surgery in China: a single-centre, prospective cohort study involving patients undergoing lung resections without perioperative venous thromboembolism prophylaxisdagger. Eur J Cardiothorac Surg. 2019 Mar 1;55(3):455-460. doi: 10.1093/ejcts/ezy323.
PubMed 30289479Lyman GH, Kuderer NM; American Society of Clinical Oncology. Prevention and treatment of venous thromboembolism among patients with cancer: the American Society of Clinical Oncology Guidelines. Thromb Res. 2010 Apr;125 Suppl 2:S120-7. doi: 10.1016/S0049-3848(10)70029-3. No abstract available.
PubMed 20433991Zhai Z, Kan Q, Li W, Qin X, Qu J, Shi Y, Xu R, Xu Y, Zhang Z, Wang C; DissolVE-2 investigators. VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study. Chest. 2019 Jan;155(1):114-122. doi: 10.1016/j.chest.2018.09.020. Epub 2018 Oct 6.
PubMed 30300652
Study at a glance
From the registry record, last updated by the sponsor on 3 Aug 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Bleeding Risk Guided VTE Prophylaxis Strategy for Hospitalized Patients With Lung Cancer: Rationale and Design for a Multicenter, Adjudicator-blinded, Parallel, Randomized Clinical Trial in China
- ClinicalTrials.gov ID
- NCT04158973
- Acronym / sponsor ID
- CHIPs-VTE in lung cancer
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 3,200 participants (estimated)
- Lead sponsor
- China-Japan Friendship HospitalUniversity, hospital or other
- Study start
- 1 Dec 2021 (estimated)
- Primary completion
- 30 Apr 2022 (estimated)
- Study completion
- 31 Dec 2022 (estimated)
- First posted
- 12 Nov 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Venous thromboembolism (VTE) is a common complication of malignancies, in particular to lung cancer. Patients with lung cancer in surgical and medical departments are at high risk of VTE development. Prophylaxis is one major way to to prevent it. Currently, VTE prophylaxis is mainly based on VTE-risk assessment. However, all patients hospitalized for cancer are at intermediate or high risk of VTE but their bleeding risk vary. To improve effect of VTE prophylaxis and reduce bleeding events in patients with lung cancer, we will conduct an open-label parallel randomized clinical tria to assess the effect of bleeding risk based prophylaxis strategy among lung cancer patients. We hypothesize that VTE prophylaxis based on bleeding risk assessment with a short post-discharge treatment course is superior to VTE propohylaxis based on VTE risk assessment among hospitalized patients with lung cancer
A sample of 3200 eligible patients will be randomized into experimental or control group with an allocation rate of 1:1. Stratified by medical/surgical units, block randomization with a varying block size of 4 or 6 will be adopted to randomize patients into experimental or control group. In experimental group, patients will undergo bleeding risk assessment and receive prophylaxis according to bleeding risk during hospitalization, and they will also receive an extended pharmacological prophylaxis of 5mg Rivaroxaban once daily for up to 15 consecutive days after discharge. In control group, patients will receive routine VTE prophylaxis, VTE risk assessment and prophylaxis if indicated during hospitalization according to current policies for hospitals in China but no further treatment prophylaxis after discharge.
Patients in both groups will be followed up for 30 days. The primary outcome is symptomatic and asymptomatic objectively proven VTE (deep vein thrombosis (DVT) and/or pulmonary embolism (PE)) within 30 days after initiation of randomization. Ultrasound and CTPA will be performed to detect DVT and PE, respectively. Clinically relevant bleeding (non-major clinically relevant and major bleeding, HIT) and death are secondary outcomes.
Detailed description
Randomization and sequence generation A computerized random-number generator will be used to generate the allocation sequence. In this multicenter trial involving 10 hospitals, randomization procedures will be organized centrally.
Stratified block randomization with a varying block size of 4 or 6 will be used to allocate patients into experimental or control group. Patients with lung cancer will be stratified into those under planned medical or surgical treatments.
In each stratum, patients will be blocked according to their admission sequence. Four or six patients consecutively admitted will be one block depending on the block size. In each block, patients will be randomly allocated into experimental or control group according to sequence generated in advance by software.
Allocation concealment/Blinded randomization Patient assignments will be enclosed in a sequentially numbered, opaque, sealed envelopes (SNOSE). Clinicians in charge of patient enrollment will not know the allocation sequence until eligible patients who meet inclusion and exclusion criteria are enrolled.
An independent statistician will generate the random allocation sequence. Physicians will enroll participants and assign interventions in experimental or control group.
Blinding/Open label This is an open-label trial that patients, clinicians and researchers will know allocation assignments after enrollment. But imaging experts providing the duplex ultrasound and CTPA results will be blinded in order to objectively assess the 30-day CTPA-proven VTE incidence and other outcomes in both groups. An independent data monitoring board will evaluate the trial data and safety.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| VTE prophylaxis based on bleeding risk assessment | Experimental | Other: Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after dischargePatients will undergo a bleeding risk assessment to determine their entering VTE prophylaxis. Low bleeding risk patients will have once daily sc LMWH prophylaxis. Intermediate bleeding risk patients will have q 12 h sc low dose unfractionated heparin prophylaxis. High bleeding risk patients will have mechanical prophylaxis. Assigned prophylaxis can be interrupted as clinical judgement requires, e.g., for peri-procedural reasons. When patients are discharged, if they have low risk of bleeding at the time of discharge, whatever their bleeding risk assessment at the time of randomization, will begin 5 mg rivaroxaban prophylaxis (two 2.5 mg tablets) once daily with food, starting on the day of discharge, for 15 days. |
| Routine VTE prophylaxis in local clinical practice | Active comparator | Other: Routine VTE prophylaxis in hospitalVTE risk assessment and prophylaxis if indicated during hospitalization according to current policies for hospitals in China but no further treatment prophylaxis after discharge. |
Who may qualify
- Ages
- 40 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Aged ≥40 years
- Have an expected hospital stay ≥72 hours for medical and/or surgical treatment
- Confirmed lung cancer at admission or proven lung cancer within prior 6 months
- Evidence of active lung cancer within 6 prior months
- Written informed consent
Key exclusion criteria (15 listed)
- Pregnancy or breastfeeding
- Inability to be followed-up at until 3 months after randomization
- have participated in similar trials or are undergoing other clinical trials
- refuse or are unable to give informed consent VTE/bleeding-related criteria
- Incidental VTE identified on spiral CT scans which are ordered primarily for staging the malignancy at or any time before enrollment
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after dischargeAt admission, patents undergo bleeding risk assessment and receive prophylaxis according to bleeding risk. After discharge, they will undergo an extended treatment of 5mg Rivaroxaban once daily for 15 consecutive days, | Other | VTE prophylaxis based on bleeding risk assessment |
| Routine VTE prophylaxis in hospitalPatients randomized to the standard treatment (Control) group will receive routine VTE prophylaxis according to current guidelines and clinical practices, VTE risk assessment and prophylaxis if indicated during hospitalization according to current policies for hospitals in China but no further treatment prophylaxis after discharge | Other | Routine VTE prophylaxis in local clinical practice |
Primary outcome
Incidence of symptomatic and asymptomatic objectively proven VTE
Time frame: 30 days after randomization
PE incidence detected by CTPA and/or DVT by ultrasound
3 secondary outcomes
All-cause mortality
Time frame: 30 days after randomization
Clinically relevant bleeding
Time frame: 30 days after randomization
Adverse events
Time frame: 30 days after randomization
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Aug 2021.
- Background: PubMed 26380084Vitale C, D'Amato M, Calabro P, Stanziola AA, Mormile M, Molino A. Venous thromboembolism and lung cancer: a review. Multidiscip Respir Med. 2015 Sep 15;10(1):28. doi: 10.1186/s40248-015-0021-4. eCollection 2015.
- Background: PubMed 23026639Connolly GC, Dalal M, Lin J, Khorana AA. Incidence and predictors of venous thromboembolism (VTE) among ambulatory patients with lung cancer. Lung Cancer. 2012 Dec;78(3):253-8. doi: 10.1016/j.lungcan.2012.09.007. Epub 2012 Sep 29.
- Background: PubMed 24676401Zhang Y, Yang Y, Chen W, Guo L, Liang L, Zhai Z, Wang C; China Venous Thromboembolism (VTE) Study Group. Prevalence and associations of VTE in patients with newly diagnosed lung cancer. Chest. 2014 Sep;146(3):650-658. doi: 10.1378/chest.13-2379.
- Background: PubMed 30289479Song C, Shargall Y, Li H, Tian B, Chen S, Miao J, Fu Y, You B, Hu B. Prevalence of venous thromboembolism after lung surgery in China: a single-centre, prospective cohort study involving patients undergoing lung resections without perioperative venous thromboembolism prophylaxisdagger. Eur J Cardiothorac Surg. 2019 Mar 1;55(3):455-460. doi: 10.1093/ejcts/ezy323.
- Background: PubMed 20433991Lyman GH, Kuderer NM; American Society of Clinical Oncology. Prevention and treatment of venous thromboembolism among patients with cancer: the American Society of Clinical Oncology Guidelines. Thromb Res. 2010 Apr;125 Suppl 2:S120-7. doi: 10.1016/S0049-3848(10)70029-3. No abstract available.
- Background: PubMed 30300652Zhai Z, Kan Q, Li W, Qin X, Qu J, Shi Y, Xu R, Xu Y, Zhang Z, Wang C; DissolVE-2 investigators. VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study. Chest. 2019 Jan;155(1):114-122. doi: 10.1016/j.chest.2018.09.020. Epub 2018 Oct 6.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Zhenguo Zhai, Doctor principal investigator
China-Japan Friendship Hospital
Questions about this trial
What is this clinical trial studying?
A study testing Bleeding-risk based prophylaxis strategy during hospitalization and extended pharmacological treatment after discharge and Routine VTE prophylaxis in hospital in people with Venous Thromboembolic Disease and Pulmonary Embolism, run by China-Japan Friendship Hospital.
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 5 inclusion and 15 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: status not confirmed, as of the sponsor's last update on 3 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Zhenguo Zhai, Doctor (86-10-84206265, zhaizhenguo2011@126.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Incidence of symptomatic and asymptomatic objectively proven VTE (time frame: 30 days after randomization). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04158973, which also lists 6 linked publications.
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 3 Aug 2021.