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Hemostasis in COVID-19: an Adaptive Clinical Trial

Primary Purpose

COVID-19

Status
Unknown status
Phase
Phase 2
Locations
Brazil
Study Type
Interventional
Intervention
acetylsalicylic acid
Unfractionated heparin nebulized
Sponsored by
University of Sao Paulo General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for COVID-19 focused on measuring SARS-CoV-2, Thrombosis, Coagulopathy, Anticoagulation, Respiratory failure

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Adult ≥18 years of age at time of enrollment
  • Subjects with a positive COVID-19 diagnosis by RT-PCR or serologic testing
  • Subject (or legally authorized representative) must be willing, understanding and able to provide written informed consent.
  • Only at phase 2:

    • onset of symptoms must not exceed 4 weeks
    • ICU patients
    • PaO2 to FiO2 ratio < 200

Exclusion Criteria:

  1. General

    • Indications for therapeutic anticoagulation
    • History of chronic lung disease oxygen dependent
    • Pregnancy
    • Death considered imminent and inevitable within 24 hours
    • Patients under exclusive palliative care
    • Participation in another trial of investigational drug
    • Body weight < 40 Kg
    • Total bilirubin > 20 mg/dL
    • Severe active bleeding
    • Persistent GI bleeding
    • Known allergy to UFH or LMWH
    • History of heparin-induced thrombocytopenia (HIT) within the past 6 months
  2. Exclusion criteria at phase 1

    • Platelet count < 25,000/mm3
    • Bacterial endocarditis
  3. Exclusion criteria at phase 2

    • Platelet count < 50,000/mm3
    • History of surgery in the last 30 days
    • Intervention A: allergy to ASA and long-term use of antiplatelet drug
    • Intervention B: inhaled nitric oxide use

Sites / Locations

  • Vanderson RochaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

No Intervention

Experimental

Experimental

Placebo Comparator

Arm Label

phase 1

phase 2A

phase 2B

Placebo

Arm Description

Observational arm

Acetylsalicylic acid

inhaled unfractionated heparin

Placebo arm for Phase 2A

Outcomes

Primary Outcome Measures

Hospital discharge - alive / death
Number of COVID-19 positive patients who are alive within 30 days of symptoms onset

Secondary Outcome Measures

Length of mechanical ventilation free days
Comparison of length of mechanical ventilation free days between each treatment arm
Length of renal replacement therapy free days
Comparison of length of renal replacement therapy free days between each treatment arm
Number of documented venous thromboembolism or arterial thrombosis
Comparison of number of thrombosis events between each treatment arm.

Full Information

First Posted
July 8, 2020
Last Updated
June 4, 2021
Sponsor
University of Sao Paulo General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04466670
Brief Title
Hemostasis in COVID-19: an Adaptive Clinical Trial
Official Title
Dynamics of Hemostatic Parameters in COVID-19 and Comparison of Intervention Strategies Through Adaptive Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2021
Overall Recruitment Status
Unknown status
Study Start Date
July 11, 2020 (Actual)
Primary Completion Date
December 30, 2021 (Anticipated)
Study Completion Date
May 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Sao Paulo General Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Hypercoagulability has been demonstrated in COVID-19, leading to respiratory distress and increased mortality. This is an adaptive clinical trial to compare the efficacy and safety of two experimental strategies in patients with COVID-19: ASA or inhaled UFH associated with standard VTE prophylaxis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19
Keywords
SARS-CoV-2, Thrombosis, Coagulopathy, Anticoagulation, Respiratory failure

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
379 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
phase 1
Arm Type
No Intervention
Arm Description
Observational arm
Arm Title
phase 2A
Arm Type
Experimental
Arm Description
Acetylsalicylic acid
Arm Title
phase 2B
Arm Type
Experimental
Arm Description
inhaled unfractionated heparin
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo arm for Phase 2A
Intervention Type
Drug
Intervention Name(s)
acetylsalicylic acid
Other Intervention Name(s)
aspirin
Intervention Description
acetylsalicylic acid (ASA) 100 mg daily PO up to 14 days OR arterial oxygen saturation greater than or equal to 92% on room air OR PaO2 to FiO2 ratio greater than 200 for 2 consecutive days, whichever is first.
Intervention Type
Drug
Intervention Name(s)
Unfractionated heparin nebulized
Intervention Description
unfractionated heparin - 25,000 U/ 5 ml nebulized inhalation every 6 hours up to 14 days OR arterial oxygen saturation greater than or equal to 92% on room air OR PaO2 to FiO2 ratio greater than 200 for 2 consecutive days, whichever is first.
Primary Outcome Measure Information:
Title
Hospital discharge - alive / death
Description
Number of COVID-19 positive patients who are alive within 30 days of symptoms onset
Time Frame
30 days
Secondary Outcome Measure Information:
Title
Length of mechanical ventilation free days
Description
Comparison of length of mechanical ventilation free days between each treatment arm
Time Frame
30 days
Title
Length of renal replacement therapy free days
Description
Comparison of length of renal replacement therapy free days between each treatment arm
Time Frame
30 days
Title
Number of documented venous thromboembolism or arterial thrombosis
Description
Comparison of number of thrombosis events between each treatment arm.
Time Frame
3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult ≥18 years of age at time of enrollment Subjects with a positive COVID-19 diagnosis by RT-PCR or serologic testing Subject (or legally authorized representative) must be willing, understanding and able to provide written informed consent. Only at phase 2: onset of symptoms must not exceed 4 weeks ICU patients PaO2 to FiO2 ratio < 200 Exclusion Criteria: General Indications for therapeutic anticoagulation History of chronic lung disease oxygen dependent Pregnancy Death considered imminent and inevitable within 24 hours Patients under exclusive palliative care Participation in another trial of investigational drug Body weight < 40 Kg Total bilirubin > 20 mg/dL Severe active bleeding Persistent GI bleeding Known allergy to UFH or LMWH History of heparin-induced thrombocytopenia (HIT) within the past 6 months Exclusion criteria at phase 1 Platelet count < 25,000/mm3 Bacterial endocarditis Exclusion criteria at phase 2 Platelet count < 50,000/mm3 History of surgery in the last 30 days Intervention A: allergy to ASA and long-term use of antiplatelet drug Intervention B: inhaled nitric oxide use
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Vanderson Rocha
Organizational Affiliation
University of Sao Paulo General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Vanderson Rocha
City
Sao Paulo
ZIP/Postal Code
05403-000
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Vanderson Rocha, MD.PhD
Phone
+55-11-26617575
Email
vanderson.rocha@hc.fm.usp.br
First Name & Middle Initial & Last Name & Degree
Yeh-Li Ho, MD.PhD
Phone
+55-11-26616045
Email
ho.yeh@hc.fm.usp.br
First Name & Middle Initial & Last Name & Degree
Yeh-Li Ho, MD.PhD
First Name & Middle Initial & Last Name & Degree
Elbio A D'Amico, MD.PhD
First Name & Middle Initial & Last Name & Degree
Paula R Villaca, MD.PhD
First Name & Middle Initial & Last Name & Degree
Cynthia Rotschild, MD
First Name & Middle Initial & Last Name & Degree
Erica Okazaki, MD
First Name & Middle Initial & Last Name & Degree
Tania RF Rocha, MPharm
First Name & Middle Initial & Last Name & Degree
Giancarlo Fatobene, MD

12. IPD Sharing Statement

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Hemostasis in COVID-19: an Adaptive Clinical Trial

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