In this letter we show that in patients who became critically ill while receiving therapeutic-dose heparin initiated when non-critically ill, continuation of therapeutic-dose compared with the lower doses confers no clinical benefit and appears harmful.
In this randomized clinical trial that included 779 patients, initiation of an ACE inhibitor or ARB did not improve organ support–free days. Among critically ill patients, there was a 95% probability that treatments worsened this outcome.
Among critically ill patients with COVID-19 randomized to receive one or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with the control group. Treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality.
Callum and Sam Spence are twins, but the way COVID-19 affected them was very different. Callum ended up on a ventilator in the ICU fighting for his life, while Sam was at home with aches and pains. Their dramatic experience, chronicled in the Irish Independent, led them to the REMAP-CAP trial.
In this trial, antiplatelet therapy met the prespecified criterion for futility in critically ill patients based on very similar outcomes for organ support–free days compared with control.
To be better prepared for the next pandemic, leading scientists from the Netherlands, Belgium and the United Kingdom are advocating some radical innovations. They propose the creation of a European authority for clinical research on pandemics to coordinate clinical research in this area thereby avoiding fragmentation of studies.
Among critically ill patients with COVID-19, lopinavirritonavir, hydroxychloroquine and combination therapy reduced organ support-free days and survival compared to no COVID-19 antiviral therapy.
Accessibility
Cookies
Data protection
Help using our website
Terms and conditions
University Medical Center Utrecht
Heidelberglaan 100
3584 CX Utrecht
The Netherlands
Email: EU.remapcap@umcutrecht.nl
Tel: +31 88 75 551 96
REMAP-CAP ClinicalTrials.gov registration NCT02735707
REMAP-CAP EU Clinical Trials Register EudraCT number: 2015-002340-14
UMC Utrecht is the Sponsor for the trial in Europe and some countries outside Europe.
RECoVER (Rapid European SARS-CoV-2 Emergency reasearch Response) EU Horizon 2020 research and innovation programme. Grant number 101003589.
ECRAID-Base consortium EU Horizon 2020 research and innovation programme. Grant number 965313.
Inseparable to the design of this trial, platform conclusions are generated through frequent adaptive analyses as data accrues. To date, REMAP-CAP has contributed to the knowledge about the best treatment of COVID-19 with several results:
ACE2 RAS DOMAIN (27 Feb 2022)
Antiplatelet DOMAIN (23 Jun 2021)
CORTICOSTEROID DOMAIN
COVID-19 IMMUNE MODULATION DOMAIN
COVID-19 ANTI-COAGULATION DOMAIN
COVID-19 IMMUNOGLOBULIN DOMAIN
COVID-19 ANTIVIRAL DOMAIN
