A Pragmatic Randomized Controlled Trial of Therapeutic Anticoagulation Versus Standard Care as a … (NCT04444700) | Clinical Trial Compass
CompletedPhase 3
A Pragmatic Randomized Controlled Trial of Therapeutic Anticoagulation Versus Standard Care as a Rapid Response to (SARS-CoV-2) COVID-19 Pandemic
Brazil465 participantsStarted 2020-07-04
Plain-language summary
Coagulopathy of COVID-19 afflicts approximately 20% of patients with severe COVID-19 and is associated with need for critical care and death. COVID-19 coagulopathy is characterized by elevated D-dimer, an indicator of fibrin formation and clot lysis, and a mildly prolonged prothrombin time, suggestive of coagulation consumption. To date, it seems that COVID-19 coagulopathy manifests with thromboembolism, thus anticoagulation may be of benefit. We propose to conduct a parallel pragmatic multi-centre open-label randomized controlled trial to determine the effect of therapeutic anticoagulation compared to standard care in hospitalized patients admitted for COVID-19 with an elevated D-dimer.
Who can participate
Age range18 Years
SexALL
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Inclusion criteria
✓. laboratory confirmed diagnosis of SARS-CoV-2 via reverse transcriptase polymerase chain reaction as per the World Health Organization protocol or by nucleic acid based isothermal amplification.Positive test prior to hospital admission OR within first 5 days (i.e. 120 hours) after hospital admission;
✓. admitted to hospital for COVID-19;
✓. one D-dimer value above ULN (5 days (i.e. 120 hours) of hospital admission) and either: a) D-Dimer ≥2 times ULN; or b) D-dimer above ULN and oxygen saturation ≤ 93% on room air;
✓. ≥18 years of age;
✓. informed consent from the patient (or legally authorized substitute decision maker).
Exclusion criteria
✕. pregnancy;
✕. hemoglobin \<80 g/L in the last 72 hours;
✕. platelet count \<50 x 10\^9/L in the last 72 hours;
✕. known fibrinogen \<1.5 g/L (if testing deemed clinically indicated by the treating physician prior to the initiation of anticoagulation);
What they're measuring
1
Composite outcome of ICU admission (yes/no), non-invasive positive pressure ventilation (yes/no), invasive mechanical ventilation (yes/no), or all-cause death (yes/no) up to 28 days.
✕. known INR \>1.8 (if testing deemed clinically indicated by the treating physician prior to the initiation of anticoagulation);
✕. patient already on intermediate dosing of LMWH that cannot be changed (determination of what constitutes an intermediate dose is to be at the discretion of the treating clinician taking the local institutional thromboprophylaxis protocol for high risk patients into consideration);
✕. patient already on therapeutic anticoagulation at the time of screening (low or high dose nomogram UFH, LMWH, warfarin, direct oral anticoagulant (any dose of dabigatran, apixaban, rivaroxaban, edoxaban);
✕. patient on dual antiplatelet therapy, when one of the agents cannot be stopped safely;