Study name |
Randomised controlled trial comparing high versus low LMWH dosages in hospitalised patients with severe COVID‐19 pneumonia and coagulopathy not requiring invasive mechanical ventilation |
Starting date |
1 June 2020 |
Contact information |
Marco Marietta, MD Azienda Ospedaliero‐Universitaria di Modena, Italy 0594224640 ext +39 | marco.marietta@unimore.it |
Methods |
Multicentre, open‐label, investigator‐sponsored, 2‐arm, parallel‐assignment RCT |
Participants |
300 participants, 18‐80 years, female and male Inclusion criteria (all required)
Positive SARS‐CoV‐2 diagnostic (on pharyngeal swab of deep airways material)
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Severe pneumonia defined by the presence of at least one of the following criteria:
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Coagulopathy, defined by the presence of at least one of the following criteria:
No need for invasive mechanical ventilation
Exclusion criteria
Invasive mechanical ventilation
Thrombocytopenia (platelet count < 80.000 mm³)
Coagulopathy: INR > 1.5, aPTT ratio > 1.4
Impaired renal function (eGFR calculated by CKD‐EPI creatinine equation < 30 mL/min)
Known hypersensitivity to enoxaparin
History of HIT
Presence of active bleeding or a pathology susceptible of bleeding in presence of anticoagulation (e.g. recent haemorrhagic stroke, peptic ulcer, malignant cancer at high risk of haemorrhage, recent neurosurgery or ophthalmic surgery, vascular aneurysms, arteriovenous malformations)
Concomitant anticoagulant treatment for other indications (e.g. atrial fibrillation, VTE, prosthetic heart valves)
Concomitant double antiplatelet therapy
Administration of therapeutic doses of LMWH, fondaparinux, or UFH for > 72 h before randomisation; prophylactic doses are allowed
Pregnancy or breastfeeding or positive pregnancy test
Presence of other severe diseases impairing life expectancy (e.g. patients are not expected to survive 28 days given their pre‐existing medical condition)
Lack or withdrawal of informed consent
|
Interventions |
Experimental: high‐dose LMWH: 70 IU/kg twice daily, other name: Inhixa Comparator: low‐dose LMWH: enoxaparin 4000 IU daily |
Outcomes |
Primary
Clinical worsening, defined as the occurrence of at least 1 of the following events, whichever comes first: (time frame: through study completion, up to 30 days)
Death
Acute myocardial infarction
Objectively confirmed, symptomatic arterial or VTE
Need for either non‐invasive ‐ CPAP or NIV ‐ or invasive mechanical ventilation for participants, who are in standard oxygen therapy by delivery interfaces at randomisation
Need for invasive mechanical ventilation for participants, who are in non‐invasive mechanical ventilation at randomisation
Secondary
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Any of the following events occurring within the hospital stay (time frame: through study completion, up to 30 days)
Death
Acute myocardial infarction
Objectively confirmed, symptomatic arterial or VTE
Need for either non‐invasive ‐ CPAP or NIV ‐ or invasive mechanical ventilation for participants, who are in standard oxygen therapy by delivery interfaces at randomisation
Need for invasive mechanical ventilation for participants, who are in non‐invasive mechanical ventilation at randomisation
Improvement of laboratory parameters of disease severity, including: D‐dimer level, plasma fibrinogen levels, mean platelet volume, lymphocyte/neutrophil ratio, IL‐6 plasma levels
Mortality at 30 days (time frame: 30 days). Information about participants' status will be sought in those who are discharged before 30 days on day 30 from randomisation
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Notes |
NCT04408235 | EudraCT 2020‐001972‐13 | No data provided |