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Vanassche T, Engelen MM, Van Thillo Q, Wauters J, Gunst J, Wouters C, Vandenbriele C, Rex S, Liesenborghs L, Wilmer A, Meersseman P, Van den Berghe G, Dauwe D, Verbeke G, Thomeer M, Fivez T, Mesotten D, Ruttens D, Heytens L, Dapper I, Tuyls S, De Tavernier B, Verhamme P. Correction to: A randomized, open-label, adaptive, proof-of-concept clinical trial of modulation of host thromboinflammatory response in patients with COVID-19: the DAWn-Antico study. Trials 2020; 21:1033. [PMID: 33375932 PMCID: PMC7770739 DOI: 10.1186/s13063-020-04991-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- T Vanassche
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. .,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
| | - M M Engelen
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | - J Wauters
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - J Gunst
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - C Wouters
- Pediatric Rheumatology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Adaptive Immunology & Immunobiology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - C Vandenbriele
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - S Rex
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - L Liesenborghs
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,REGA Institute, KU Leuven, Leuven, Belgium
| | - A Wilmer
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - P Meersseman
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - G Van den Berghe
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - D Dauwe
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - G Verbeke
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), KU Leuven, Leuven, and Hasselt University (UHasselt), Hasselt, Belgium
| | - M Thomeer
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - T Fivez
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Mesotten
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Ruttens
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - L Heytens
- Department of Anesthestiology, GZA hospital group, Antwerp, Belgium
| | - I Dapper
- Emergency Medicine and Intensive Care, GZA hospital group, Antwerp, Belgium
| | - S Tuyls
- Respiratory Medicine, GZA hospital group, Antwerp, Belgium
| | - B De Tavernier
- Emergency Medicine and Intensive Care, GZA hospital group, Antwerp, Belgium
| | - P Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
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Vanassche T, Engelen MM, Van Thillo Q, Wauters J, Gunst J, Wouters C, Vandenbriele C, Rex S, Liesenborghs L, Wilmer A, Meersseman P, Van den Berghe G, Dauwe D, Verbeke G, Thomeer M, Fivez T, Mesotten D, Ruttens D, Heytens L, Dapper I, Tuyls S, De Tavernier B, Verhamme P. A randomized, open-label, adaptive, proof-of-concept clinical trial of modulation of host thromboinflammatory response in patients with COVID-19: the DAWn-Antico study. Trials 2020; 21:1005. [PMID: 33298149 PMCID: PMC7724460 DOI: 10.1186/s13063-020-04878-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/06/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The peak of the global COVID-19 pandemic has not yet been reached, and many countries face the prospect of a second wave of infections before effective vaccinations will be available. After an initial phase of viral replication, some patients develop a second illness phase in which the host thrombotic and inflammatory responses seem to drive complications. Severe COVID-19 disease is linked to high mortality, hyperinflammation, and a remarkably high incidence of thrombotic events. We hypothesize a crucial pathophysiological role for the contact pathway of coagulation and the kallikrein-bradykinin pathway. Therefore, drugs that modulate this excessive thromboinflammatory response should be investigated in severe COVID-19. METHODS In this adaptive, open-label multicenter randomized clinical trial, we compare low molecular weight heparins at 50 IU anti-Xa/kg twice daily-or 75 IU anti-Xa twice daily for intensive care (ICU) patients-in combination with aprotinin to standard thromboprophylaxis in hospitalized COVID-19 patients. In the case of hyperinflammation, the interleukin-1 receptor antagonist anakinra will be added on top of the drugs in the interventional arm. In a pilot phase, the effect of the intervention on thrombotic markers (D-dimer) will be assessed. In the full trial, the primary outcome is defined as the effect of the interventional drugs on clinical status as defined by the WHO ordinal scale for clinical improvement. DISCUSSION In this trial, we target the thromboinflammatory response at multiple levels. We intensify the dose of low molecular weight heparins to reduce thrombotic complications. Aprotinin is a potent kallikrein pathway inhibitor that reduces fibrinolysis, activation of the contact pathway of coagulation, and local inflammatory response. Additionally, aprotinin has shown in vitro inhibitory effects on SARS-CoV-2 cellular entry. Because the excessive thromboinflammatory response is one of the most adverse prognostic factors in COVID-19, we will add anakinra, a recombinant interleukin-1 receptor antagonist, to the regimen in case of severely increased inflammatory parameters. This way, we hope to modulate the systemic response to SARS-CoV-2 and avoid disease progressions with a potentially fatal outcome. TRIAL REGISTRATION The EU Clinical Trials Register 2020-001739-28 . Registered on April 10, 2020.
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Affiliation(s)
- T Vanassche
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. .,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
| | - M M Engelen
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | - J Wauters
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - J Gunst
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - C Wouters
- Pediatric Rheumatology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Adaptive Immunology & Immunobiology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - C Vandenbriele
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - S Rex
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - L Liesenborghs
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,REGA Institute, KU Leuven, Leuven, Belgium
| | - A Wilmer
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - P Meersseman
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - G Van den Berghe
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - D Dauwe
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - G Verbeke
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), KU Leuven, Leuven, and Hasselt University (UHasselt), Hasselt, Belgium
| | - M Thomeer
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - T Fivez
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Mesotten
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Ruttens
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - L Heytens
- Department of Anesthestiology, GZA hospital group, Antwerp, Belgium
| | - I Dapper
- Emergency Medicine and Intensive Care, GZA hospital group, Antwerp, Belgium
| | - S Tuyls
- Respiratory Medicine, GZA hospital group, Antwerp, Belgium
| | - B De Tavernier
- Emergency Medicine and Intensive Care, GZA hospital group, Antwerp, Belgium
| | - P Verhamme
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
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