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. 2022 Mar 4;2022(3):CD013739. doi: 10.1002/14651858.CD013739.pub2

Marietta 2020.

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)

  • Severe pneumonia defined by the presence of at least one of the following criteria:

    • respiratory rate ≥ 25 breaths/min

    • arterial oxygen saturation ≤ 93% at rest on ambient air

    • PaO2/FiO2 ≤ 300 mmHg

  • Coagulopathy, defined by the presence of at least one of the following criteria:

    • D‐dimer > 4 times the ULN reference range

    • sepsis‐induced coagulopathy score > 4

  • 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
  • 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

Notes NCT04408235 | EudraCT 2020‐001972‐13 | No data provided