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.
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.
Administration of either tocilizumab or sarilumab was associated with lower 28-day all-cause mortality compared with usual care or placebo. The association is not dependent on the choice of interleukin-6 receptor antagonist.
BACKGROUND Thrombosis and inflammation may contribute to the risk of death and complications among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically…
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.
Abstract Importance Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect, and harm. Objective To estimate the association between administration…
This article is a preprint and has not been certified by peer review.
The evidence for benefit of convalescent plasma for critically ill patients with Covid-19 is inconsistent. We hypothesized that convalescent plasma would improve outcomes for critically ill adult patients with Covid-19
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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
