A Novel COMBinATorial Therapy with Albumin and Enoxaparin in Patients with Decompensated Cirrhosis At High-risk of Poor Outcome (COMBAT Trial).

Inclusion Criteria:

1. Age between 18 and 80 years.

2. Patients with decompensated cirrhosis admitted to hospital due to AD according tothe EASL-CLIF criteria (rapid onset of ascites, hepatic encephalopathy, portalhypertensive-related gastrointestinal bleeding, bacterial infection, or anycombination of these).

3. CLIF-C AD score ≥ 45 at admission or at any time during hospital stay.

4. Recovery from AD and expected to be discharged within the next 72 hours.

Exclusion Criteria:

1. Diagnosis of acute-on-chronic liver failure (ACLF) grade 3 or higher according tothe EASL-CLIF criteria at admission or at any time during the index hospitalization

2. Admission for planned diagnostic or therapeutic procedures

3. Recent acute bleeding (unless the cause has been effectively treated and there is noevidence of ongoing bleeding for at least 5 days)

4. Chronic bleeding requiring periodic blood transfusions

5. Presence of an ongoing acute complication of the disease (i.e. hepaticencephalopathy [grade III or IV])

6. Conditions with a high risk of haemorrhage, including haemorrhagic diathesis notrelated to liver disease

7. Patients with INR > 3.0

8. Severe thrombocytopenia (<30x10 9 /L)

9. Ongoing chronic anticoagulation therapy or indication for starting anticoagulationdue to hepatic and non-hepatic conditions

10. Ongoing anti-platelets therapy.

11. Active malignancy (except for hepatocellular carcinoma within the Milan criteria ornon-melanocytic skin cancer)

12. Antiviral treatment for hepatitis C, B and delta initiated in the last 6 months orplanned to be initiated in the following 6 months

13. Ongoing alcohol use disorder with an expected low adherence to protocol as judged byphysician

14. Previous liver transplantation

15. Patients with TIPS or other surgical porto-caval shunts

16. Chronic organic renal failure stage IV and V or estimated Glomerular Filtration Rate <30 ml/min according to the MDRD equations

17. Chronic heart failure NYHA class III or IV

18. Pulmonary disease GOLD III or IV

19. Patients with extrahepatic diseases with life expectancy <6 months

20. Severe psychiatric disorders

21. Hypersensitivity to albumin preparations or to any of the excipients.

22. Hypersensitivity to enoxaparin sodium, heparin or its derivatives, including otherlow molecular weight heparins (LMWH) or to any of the excipients

23. History of immune mediated heparin-induced thrombocytopenia (HIT) within the past 100 days or in the presence of circulating antibodies

24. Pregnancy and breast-feeding

25. Expected low adherence to study protocol as judged by physician

26. Patients who can't provide written informed consent or refusal to participate

27. Participation in other concurrent clinical trials and within the prior 3 months frominformed consent signature.