4000 Participants Needed

Heparin for Community-Acquired Pneumonia

(ATTACC-CAP Trial)

Recruiting at 82 trial locations
CP
Overseen ByChantale Pineau
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Pivotal Trial (Near Approval)This treatment is in the last trial phase before FDA approval
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 3 JurisdictionsThis treatment is already approved in other countries

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether heparin, an anticoagulant used to prevent and treat blood clots, can improve outcomes for patients hospitalized with community-acquired pneumonia. Researchers compare therapeutic doses of heparin to the usual dose given to prevent blood clots. The trial targets patients admitted to the hospital with pneumonia who need extra oxygen. Participants should not have COVID-19 or other serious conditions requiring intensive care. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants a chance to contribute to potentially groundbreaking treatment advancements.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, if you are currently using dual anti-platelet inhibitors, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that heparin is generally safe for humans. Although specific safety data for its use in treating community-acquired pneumonia is lacking, extensive knowledge about its safety comes from other applications. Heparin has been widely used in various medical situations, enhancing understanding of its safety profile.

Past studies have tested heparin at treatment doses in patients with other illnesses, such as COVID-19, who were not critically ill. These studies suggest it can improve patient outcomes without major safety issues. However, all medications can have side effects, which should be considered when deciding to join a trial.

Prospective participants might find reassurance in knowing that heparin is already a well-tolerated treatment for other conditions.12345

Why do researchers think this study treatment might be promising for pneumonia?

Researchers are excited about using therapeutic-dose heparin for community-acquired pneumonia because it offers a new approach to treatment. Unlike standard care, which typically involves lower-dose anticoagulation to prevent blood clots, therapeutic-dose heparin directly targets the blood clotting process more aggressively. This method could potentially reduce inflammation and improve respiratory function more rapidly, as it addresses the underlying coagulation issues that can worsen pneumonia symptoms. By exploring this higher dosing strategy, researchers hope to enhance patient outcomes and speed up recovery times.

What evidence suggests that heparin might be an effective treatment for community-acquired pneumonia?

Research has shown that therapeutic-dose heparin, which participants in this trial may receive, might help people with community-acquired pneumonia. One study found that heparin was associated with more days without the need for organ support, meaning patients either survived without dying in the hospital or required less machine assistance. Another study indicated that heparin could reduce the risk of dying in the hospital, especially for patients with moderate sepsis-induced coagulopathy, a condition where blood clotting is impaired. Heparin may also improve short-term survival for critically ill patients with pneumonia-related sepsis. Overall, these findings suggest that therapeutic-dose heparin could benefit patients with severe pneumonia.12567

Who Is on the Research Team?

Chairholder | Dr. A. F. Turgeon ...

Alexis Turgeon, MD

Principal Investigator

L'Universite Laval

RZ

Ryan Zarychanski, MD

Principal Investigator

University of Manitoba

PL

Patrick Lawler, MD

Principal Investigator

University Health Network and McGill University

SL

Sylvain Lother, MD

Principal Investigator

University of Manitoba

Are You a Good Fit for This Trial?

Adults hospitalized with community-acquired pneumonia (CAP) needing oxygen, expected to stay at least 72 hours post-randomization. They must have a primary diagnosis of CAP with new or worsening lung infiltrates and symptoms of lower respiratory infection. Excluded are those admitted over 72 hours, on chronic ventilation, not using thromboprophylaxis, needing full anticoagulation for other reasons, suspected COVID-19, in ICU on life support measures at enrollment time, or with bleeding risks.

Inclusion Criteria

I am in the hospital with pneumonia confirmed by a lung scan and symptoms.
I need extra oxygen to help me breathe.
My doctor diagnosed me with community-acquired pneumonia.
See 1 more

Exclusion Criteria

I am in the ICU receiving support like ventilation or ECLS.
I need blood thinners for a health condition unrelated to the trial.
I am not planned to be given drugs to prevent blood clots.
See 4 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive therapeutic-dose heparin or usual care thromboprophylaxis for up to 14 days or until hospital discharge

2 weeks
Daily administration in hospital

Follow-up

Participants are monitored for survival, bleeding events, and thrombotic events

30 days

Extended Follow-up

Participants are monitored for thrombotic events and health-related quality of life

90 to 180 days

What Are the Treatments Tested in This Trial?

Interventions

  • Heparin
Trial Overview The trial is testing if therapeutic-dose heparin improves outcomes compared to standard care in hospitalized patients with CAP. It's an international study where participants are randomly assigned to receive either heparin or usual care and the results will be evaluated adaptively as they come in.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Active Control
Group I: Therapeutic-Dose HeparinExperimental Treatment1 Intervention
Group II: Usual CareActive Control1 Intervention

Heparin is already approved in European Union, United States, Canada for the following indications:

🇪🇺
Approved in European Union as Heparin sodium for:
🇺🇸
Approved in United States as Heparin sodium for:
🇨🇦
Approved in Canada as Heparin sodium for:

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Manitoba

Lead Sponsor

Trials
628
Recruited
209,000+

Canadian Critical Care Trials Group

Collaborator

Trials
32
Recruited
227,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials
1,417
Recruited
26,550,000+

Ozmosis Research Inc.

Industry Sponsor

Trials
25
Recruited
5,200+

Canadian Venous Thromboembolism Clinical Trials and Outcomes Research (CanVECTOR) Network

Collaborator

Trials
12
Recruited
17,500+

Research Manitoba

Collaborator

Trials
13
Recruited
17,500+

AVANTI

Collaborator

Trials
1
Recruited
4,000+

Published Research Related to This Trial

Intranasally administered unfractionated heparin (UFH) was found to be safe in both mice and a small group of healthy human subjects, with no significant adverse effects or changes in blood coagulation parameters observed during the study.
The pharmacokinetics showed that UFH remains in the nasal cavity at potentially protective levels for up to 12 hours after administration, suggesting its potential as a prophylactic treatment for COVID-19.
Safety and Pharmacokinetics of Intranasally Administered Heparin.Harris, HM., Boyet, KL., Liu, H., et al.[2022]
Unfractionated heparin is a crucial anticoagulant for treating conditions like myocardial infarction and pulmonary embolism, but it carries a significant risk of bleeding, especially with higher doses.
To enhance safety, it is essential to use weight-based dosing guidelines and ongoing developments in automated testing and titration devices may help reduce the risk of adverse events.
Bleeding complications of unfractionated heparin.Krishnaswamy, A., Lincoff, AM., Cannon, CP.[2013]
In a study of 867 adults with community-acquired pneumonia (CAP) discharged from the emergency department, those with a pneumonia severity index (PSI) score of less than 91 had very low readmission (1.9%) and death rates (0.76%) within 30 days.
Patients with higher PSI scores (>90) had increased readmission (7.14%) and death rates (9.34%), but overall, the findings support that discharging patients with CAP based on clinical guidelines is generally safe.
Patients with community acquired pneumonia discharged from the emergency department according to a clinical practice guideline.Campbell, SG., Patrick, W., Urquhart, DG., et al.[2018]

Citations

Unfractionated heparin may improve near-term survival in ...This study aimed to assess whether heparin administration improves near-term survival in critically ill patients with pneumonia-induced sepsis
Heparin for Community-Acquired PneumoniaThis trial is testing if higher doses of heparin, a blood thinner, can help patients hospitalized with pneumonia. These patients often have blood clot ...
Heparin Dose Intensity and Organ Support-Free Days in ...Heparin, compared with usual care, was associated with improved OSFDs, a combination of in-hospital death and days free of organ support.
Therapeutic Anticoagulation with Heparin in Critically Ill ...We hypothesized that therapeutic-dose anticoagulation would improve outcomes in critically ill patients with Covid-19.
Efficacy of unfractionated heparin in patients with moderate ...Early heparin administration upon admission is associated with lower in-hospital mortality, especially in moderate sepsis-induced coagulopathy.
Therapeutic Anticoagulation with Heparin in Noncritically Ill ...We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically ill patients who are hospitalized with Covid-19.
Steroids and Unfractionated Heparin in Critically Ill Patients ...Despite the biological plausibility, no good evidence is available on the efficacy and safety of heparin on sepsis patients, and many issues have to be ...
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