Published: 05 August 2021
Three international clinical trial platforms, working together to test the effects of anticoagulants (blood thinners) in hospitalised people with COVID-19, have found the treatment improves survival and reduces the need for vital organ support such as mechanical ventilation in moderately ill patients.
The findings, published in the New England Journal of Medicine this week, demonstrated benefit when the treatment was started while patients were less sick on the general ward. In contrast they found that anticoagulation therapy did not improve outcomes if started when patients were already critically ill with the disease.
The three international partners involved in the collaboration include NIHR-funded and supported REMAP-CAP - the Randomised, Embedded, Multi-factorial Adaptive Platform Trial for Community-Acquired Pneumonia trial, Accelerating COVID-19 Therapeutic Interventions and Vaccines-4 (ACTIV-4) and Antithrombotics Inpatient and Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC).
70 % of patients in the critically ill study, and 10% in the moderately ill study, were recruited in the UK through the NIHR’s Clinical Research Network (CRN).
Early in the pandemic, physicians around the world observed increased rates of blood clots and inflammation among COVID-19 patients which affected multiple organs and led to complications such as lung failure, heart attack and stroke. Whether providing increased doses of blood thinners routinely administered to hospitalised patients would be safe and effective was unknown at that time.
Professor Anthony Gordon, Professor of Critical Care at Imperial College London, NIHR Research Professor and UK Chief Investigator for REMAP-CAP, said: “This new evidence from less severely ill patients, when combined with the results in critically ill patients, demonstrates the importance of evaluating treatments in randomised clinical trials. This is the only way to learn what are the right treatments but also ensure we treat the right patients at the right time.”
“We were delighted to be able to play a leading role in these innovative, large scale clinical trials, to provide improved outcomes for patients with severe COVID-19.”
“The research infrastructure we have built into the NHS, combined with the commitment from clinical teams and the patients who agree to take part has helped us tackle the pandemic as part of this international collaboration.”
REMAP-CAP in the UK is funded and supported by the NIHR. It is an adaptive platform study investigating community-acquired pneumonia, a syndrome where people develop an acute infection of the lungs before being admitted to hospital.
REMAP-CAP continues to evaluate multiple other study questions, including vitamin C, simvastatin, multiple drugs in the renin-angiotensin system, macrolides and antibiotics.
You can read our case study to find out more about the REMAP-CAP trial, including results from some of the other treatment domains.