Hero-19 aims to evaluate if an intensive anticoagulation strategy using Edoxaban on top of standard of care (SOC) of COVID-19 therapy is superior to SOC (in-hospital moderate anticoagulation strategy = low-dose low-molecular weight heparin \[LMWH\], ambulatory no anticoagulation, i.e. placebo within this trial) in reduction of morbidity and mortality endpoints in patients with COVID-19.
Coagulopathy in the context of COVID-19 is a major threat to affected patients due to deep vein thromboses and pulmonary embolisms. Actual data show an unexpectedly high incidence of partially fatal complications without any prior clinical evidence in some cases. Therefore, this prospective, randomized, assessor-blinded, multicenter, placebo-controlled, interventional trial will investigate whether therapeutic anticoagulation on top of SOC compared to prophylactic anticoagulation as part of SOC- can improve objective patient-relative endpoints, relevant for prognosis in patients with COVID-19. 172 eligible patients will be randomized 1:1 to experimental or control group. Patients enrolled to experimental group will receive therapeutic anticoagulation using LMWH body weight-adapted during course of hospital stay and oral anticoagulation using Edoxaban according to SmPC (60mg once a day) after being discharged from hospital / outpatient course. Patients enrolled to control group will receive prophylactic anticoagulation using LMWH as part of SOC whilst inpatient course, and placebo after discharge / outpatient course. Patients will be informed of their allocation to the placebo group, as it has been shown that the effect of placebo is still detectable.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
140
In-hospital (ICU \& normal ward): weight-adapted LMWH, high dose/ therapeutic dose (according to respective SmPC) After discharge and in ambulatory patients: Edoxaban according to SmPC until
In-hospital (ICU \& normal ward): LMWH, prophylactic dose as part of SOC After discharge and in ambulatory patients: Administration of oral pla-cebo according to the dosing rules for Edoxaban
UK Aachen
Aachen, Germany
Universitätsklinikum Augsburg
Augsburg, Germany
Universitätsklinikum Düsseldorf
Düsseldorf, Germany
Universitätsklinikum Freiburg
Freiburg im Breisgau, Germany
Combined endpoint: all-cause mortality and/ or venous thromboem-bolism and/ or arterial thromboembolism
All-cause mortality and/ or venous thromboem-bolism and/ or arterial thromboembolism during follow-up (42 days). Thromboembolisms will be detected by duplex ultrasonography of arms and legs.
Time frame: 42 days
All-cause mortality
All-cause mortality during follow-up (42 days)
Time frame: 42 days
Mortality related to venous thromboembolism
Mortality related to venous thromboembolism during follow-up (42 days)
Time frame: 42 days
Mortality related to arterial thromboembolism
Mortality related to arterial thromboembolism during follow-up (42 days)
Time frame: 42 days
Rate of venous and/ or arterial thromboembolism
Rate of venous and/ or arterial thromboembolism during follow-up (42 days) Thromboembolisms will be detected by duplex ultrasonography of arms and legs
Time frame: 42 days
Rate and length of mechanical ventilation
Rate and length of mechanical Ventilation during follow-up (42 days)
Time frame: 42 days
Length of initial stay at ICU after application of IMP
Length of initial stay at ICU after application of IMP during follow-up (42 days)
Time frame: 42 days
Rehospitalisation
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Asklepios Klinik Altona
Hamburg, Germany
Asklepios Klinik Barmbek
Hamburg, Germany
Asklepios Klinik St. Georg
Hamburg, Germany
Universitärsklinikum Hamburg-Eppendorf
Hamburg, Germany
Medizinische Hochschule Hannover
Hanover, Germany
TU München Klinikum rechts der Isar
München, Germany
Rehospitalisation during follow-up (42 days)
Time frame: 42 days
Rate and length of renal replacement therapy
Rate and length of renal replacement therapy during follow-up (42 days)
Time frame: 42 days
Cardiac arrest/ CPR
Cardiac arrest/ CPR during follow-up (42 days)
Time frame: 42 days