REMAP-CAP, an application in Spiral’s study manifest, has recently been used in a collaborative clinical trial that focused on identifying effective treatments for critically ill Covid-19 patients.

Thrombosis was considered to contribute to morbidity and mortality in Covid-19. It was hypothesized that therapeutic anticoagulation would improve outcomes in critically ill patients with Covid-19.

An open-label, adaptive, multiplatform, randomized, clinical trial was conducted. Patients with severe Covid-19, defined as the requirement for organ support with high flow nasal cannula, non-invasive ventilation, invasive ventilation, vasopressors, or inotropes, were randomized to receive therapeutic anticoagulation with heparin or pharmacological thromboprophylaxis as per local usual care.

Trial data analysis involved 1,074 critically ill and 2,219 moderately ill patients. Physician investigators gauged how long participants were free of organ support up to 21 days after enrolling in the clinical trial. The investigators discovered that in moderately ill patients full-dose heparin reduced the need for organ support compared to those who received lower-dose heparin. By contrast, for critically ill patients, full-dose heparin was associated with a high probability of a worse outcome.

The worldwide multi-platform trial spanned five continents in over 300 hospitals to urgently test blood thinners on both sets of patients, the critically and non-critically ill.

The results have shown that full-dose anticoagulation with the blood thinner heparin improves survival outcomes and reduces the need for vital organ support such as mechanical ventilation in moderately ill COVID-19 patients, but does not yield the same positive outcomes among critically ill patients already requiring life support.

As summarised by Professor Steve Webb, director of REMAP-CAP: “Our conclusions have set a new, accessible and affordable standard of care for moderately ill hospitalised COVID-19 patients around the world using a familiar drug. As such the results of the trial can be immediately applied,”

These results come at a crucial time when Australia is dealing with outbreaks in several states, therefore there is renewed interest in treatment options.

Spiral is proud to be a part of this worldwide multi-platform trial, one that spanned five continents in over 300 hospitals, helping to urgently test blood thinners on both sets of patients who were ill or critically ill with Covid-19.

Dive deeper:

• The New England Journal of Medicine Publication 

• Trial Results Meeting Online at Critical Care Reviews

• The Medrxiv website

The REMAP-CAP Website