COVID-19 的止血:适应性临床试验
2021年6月4日 更新者:Vanderson Geraldo Rocha、University of Sao Paulo General Hospital
COVID-19 中止血参数的动态变化及适应性临床试验干预策略的比较
高凝状态已在 COVID-19 中得到证实,导致呼吸窘迫和死亡率增加。
这是一项适应性临床试验,旨在比较两种实验策略在 COVID-19 患者中的有效性和安全性:ASA 或与标准 VTE 预防相关的吸入 UFH。
研究概览
研究类型
介入性
注册 (预期的)
379
阶段
- 阶段2
联系人和位置
本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。
学习地点
-
-
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Sao Paulo、巴西、05403-000
- 招聘中
- Vanderson Rocha
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接触:
- Vanderson Rocha, MD.PhD
- 电话号码:+55-11-26617575
- 邮箱:vanderson.rocha@hc.fm.usp.br
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接触:
- Yeh-Li Ho, MD.PhD
- 电话号码:+55-11-26616045
- 邮箱:ho.yeh@hc.fm.usp.br
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副研究员:
- Yeh-Li Ho, MD.PhD
-
副研究员:
- Elbio A D'Amico, MD.PhD
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副研究员:
- Paula R Villaca, MD.PhD
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副研究员:
- Cynthia Rotschild, MD
-
副研究员:
- Erica Okazaki, MD
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副研究员:
- Tania RF Rocha, MPharm
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副研究员:
- Giancarlo Fatobene, MD
-
-
参与标准
研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、OLDER_ADULT)
接受健康志愿者
不
有资格学习的性别
全部
描述
纳入标准:
- 入学时年满 18 岁的成人
- 通过 RT-PCR 或血清学检测诊断为 COVID-19 阳性的受试者
- 受试者(或合法授权代表)必须愿意、理解并能够提供书面知情同意。
仅在第 2 阶段:
- 症状发作不得超过 4 周
- ICU患者
- PaO2 与 FiO2 之比 < 200
排除标准:
一般的
- 抗凝治疗的指征
- 慢性肺部疾病的氧气依赖史
- 怀孕
- 在 24 小时内被认为是迫在眉睫且不可避免的死亡
- 接受独家姑息治疗的患者
- 参与另一项研究药物的试验
- 体重 < 40 公斤
- 总胆红素 > 20 mg/dL
- 严重活动性出血
- 持续性胃肠道出血
- 已知对 UFH 或 LMWH 过敏
- 过去 6 个月内有肝素诱导的血小板减少症 (HIT) 病史
第一阶段的排除标准
- 血小板计数 < 25,000/mm3
- 细菌性心内膜炎
第 2 阶段的排除标准
- 血小板计数 < 50,000/mm3
- 最近30天的手术史
- 干预措施A:ASA过敏和长期使用抗血小板药物
- 干预措施 B:吸入一氧化氮
学习计划
本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:顺序的
- 屏蔽:四人间
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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NO_INTERVENTION:阶段1
观察臂
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实验性的:2A期
乙酰水杨酸
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乙酰水杨酸 (ASA) 100 mg 每日 PO 长达 14 天,或连续 2 天动脉血氧饱和度大于或等于 92%,或 PaO2 与 FiO2 之比大于 200,以先到者为准。
其他名称:
|
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实验性的:2B期
吸入普通肝素
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普通肝素 - 25,000 U/5 ml 雾化吸入,每 6 小时一次,最多 14 天,或连续 2 天动脉血氧饱和度大于或等于 92%,或 PaO2 与 FiO2 之比大于 200,以先到者为准。
|
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PLACEBO_COMPARATOR:安慰剂
2A 期安慰剂组
|
乙酰水杨酸 (ASA) 100 mg 每日 PO 长达 14 天,或连续 2 天动脉血氧饱和度大于或等于 92%,或 PaO2 与 FiO2 之比大于 200,以先到者为准。
其他名称:
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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出院 - 活着/死亡
大体时间:30天
|
症状出现后 30 天内存活的 COVID-19 阳性患者人数
|
30天
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
无机械通气天数
大体时间:30天
|
每个治疗组之间无机械通气天数的比较
|
30天
|
|
肾脏替代治疗免费天数的长度
大体时间:30天
|
比较每个治疗组之间的肾脏替代治疗免费天数
|
30天
|
|
记录的静脉血栓栓塞或动脉血栓形成的数量
大体时间:3个月
|
每个治疗组之间血栓形成事件数量的比较。
|
3个月
|
合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员:Vanderson Rocha、University of Sao Paulo General Hospital
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
一般刊物
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- Schulman S, Kearon C; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005 Apr;3(4):692-4. doi: 10.1111/j.1538-7836.2005.01204.x.
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- Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033-1034. doi: 10.1016/S0140-6736(20)30628-0. Epub 2020 Mar 16. No abstract available.
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- Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J Thromb Haemost. 2020 Apr;18(4):786-787. doi: 10.1111/jth.14781. Epub 2020 Mar 24. No abstract available.
- Lippi G, Favaloro EJ. D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis. Thromb Haemost. 2020 May;120(5):876-878. doi: 10.1055/s-0040-1709650. Epub 2020 Apr 3. No abstract available.
- Feng Y, Ling Y, Bai T, Xie Y, Huang J, Li J, Xiong W, Yang D, Chen R, Lu F, Lu Y, Liu X, Chen Y, Li X, Li Y, Summah HD, Lin H, Yan J, Zhou M, Lu H, Qu J. COVID-19 with Different Severities: A Multicenter Study of Clinical Features. Am J Respir Crit Care Med. 2020 Jun 1;201(11):1380-1388. doi: 10.1164/rccm.202002-0445OC.
- Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020 Jun;18(6):1421-1424. doi: 10.1111/jth.14830. Epub 2020 May 6.
- Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020 Jul;191:145-147. doi: 10.1016/j.thromres.2020.04.013. Epub 2020 Apr 10.
- Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Fagot Gandet F, Fafi-Kremer S, Castelain V, Schneider F, Grunebaum L, Angles-Cano E, Sattler L, Mertes PM, Meziani F; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 Jun;46(6):1089-1098. doi: 10.1007/s00134-020-06062-x. Epub 2020 May 4.
- Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, Studt JD, Sacco C, Bertuzzi A, Sandri MT, Barco S; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020 Jul;191:9-14. doi: 10.1016/j.thromres.2020.04.024. Epub 2020 Apr 23.
- Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Muller MCA, Bouman CCS, Beenen LFM, Kootte RS, Heijmans J, Smits LP, Bonta PI, van Es N. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020 Aug;18(8):1995-2002. doi: 10.1111/jth.14888. Epub 2020 Jul 27.
- Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M, Auvray M, Merouani K. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020 Jul;18(7):1743-1746. doi: 10.1111/jth.14869. Epub 2020 May 27.
- Gralinski LE, Bankhead A 3rd, Jeng S, Menachery VD, Proll S, Belisle SE, Matzke M, Webb-Robertson BJ, Luna ML, Shukla AK, Ferris MT, Bolles M, Chang J, Aicher L, Waters KM, Smith RD, Metz TO, Law GL, Katze MG, McWeeney S, Baric RS. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury. mBio. 2013 Aug 6;4(4):e00271-13. doi: 10.1128/mBio.00271-13.
- Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell. 2020 Apr 16;181(2):281-292.e6. doi: 10.1016/j.cell.2020.02.058. Epub 2020 Mar 9. Erratum In: Cell. 2020 Dec 10;183(6):1735.
- Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Muller MA, Drosten C, Pohlmann S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Apr 16;181(2):271-280.e8. doi: 10.1016/j.cell.2020.02.052. Epub 2020 Mar 5.
- Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004 Jun;203(2):631-7. doi: 10.1002/path.1570.
- Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med. 2020 Apr 23;382(17):1653-1659. doi: 10.1056/NEJMsr2005760. Epub 2020 Mar 30. No abstract available.
- Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020 Jul 9;383(2):120-128. doi: 10.1056/NEJMoa2015432. Epub 2020 May 21.
- Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, da Silva LFF, de Oliveira EP, Saldiva PHN, Mauad T, Negri EM. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. 2020 Jun;18(6):1517-1519. doi: 10.1111/jth.14844. No abstract available.
- Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, Pesenti A, Peyvandi F, Tripodi A. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020 Jul;18(7):1738-1742. doi: 10.1111/jth.14850. Epub 2020 Jun 24.
- Escher R, Breakey N, Lammle B. Severe COVID-19 infection associated with endothelial activation. Thromb Res. 2020 Jun;190:62. doi: 10.1016/j.thromres.2020.04.014. Epub 2020 Apr 15. No abstract available.
- Whyte CS, Morrow GB, Mitchell JL, Chowdary P, Mutch NJ. Fibrinolytic abnormalities in acute respiratory distress syndrome (ARDS) and versatility of thrombolytic drugs to treat COVID-19. J Thromb Haemost. 2020 Jul;18(7):1548-1555. doi: 10.1111/jth.14872. Epub 2020 Jun 3.
- White D, MacDonald S, Bull T, Hayman M, de Monteverde-Robb R, Sapsford D, Lavinio A, Varley J, Johnston A, Besser M, Thomas W. Heparin resistance in COVID-19 patients in the intensive care unit. J Thromb Thrombolysis. 2020 Aug;50(2):287-291. doi: 10.1007/s11239-020-02145-0. Erratum In: J Thromb Thrombolysis. 2020 Jun 22;:
- Garcia DA, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e24S-e43S. doi: 10.1378/chest.11-2291. Erratum In: Chest. 2012 May;141(5):1369. Dosage error in article text. Chest. 2013 Aug;144(2):721. Dosage error in article text.
- Barrett CD, Moore HB, Yaffe MB, Moore EE. ISTH interim guidance on recognition and management of coagulopathy in COVID-19: A comment. J Thromb Haemost. 2020 Aug;18(8):2060-2063. doi: 10.1111/jth.14860. Epub 2020 Jun 14. No abstract available.
- Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian C, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Giri J, Cushman M, Quere I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ, Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973. doi: 10.1016/j.jacc.2020.04.031. Epub 2020 Apr 17.
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研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2020年7月11日
初级完成 (预期的)
2021年12月30日
研究完成 (预期的)
2022年5月30日
研究注册日期
首次提交
2020年7月8日
首先提交符合 QC 标准的
2020年7月8日
首次发布 (实际的)
2020年7月10日
研究记录更新
最后更新发布 (实际的)
2021年6月9日
上次提交的符合 QC 标准的更新
2021年6月4日
最后验证
2021年6月1日
更多信息
与本研究相关的术语
关键字
其他相关的 MeSH 术语
其他研究编号
- 33788820.9.0000.0068
药物和器械信息、研究文件
研究美国 FDA 监管的药品
不
研究美国 FDA 监管的设备产品
不
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.