The ASCOT Trial for hospitalised patients with acute respiratory tract infections intends to open a new anticoagulation domain in 2025.
This domain evaluates the potential benefits of therapeutic-dose anticoagulation for non-critically ill hospitalised patients with non-COVID-19 community-acquired pneumonia (CAP). Poor clinical outcomes in CAP are driven by maladaptive inflammatory and thrombotic host responses to infection, with resultant micro- and macro-vascular thrombosis and organ dysfunction. In CAP caused by COVID-19, therapeutic-dose heparin has been shown to reduce progression to intensive-care-level organ support and mortality in non-critically ill patients in a multiplatform randomised controlled trial1.
The current study is in collaboration with two other major trials — the Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) and the AntiThrombotic Therapy to Ameliorate Clinical Complications in Community-Acquired Pneumonia (ATTACC-CAP) — led from Australia and Canada respectively.
In this trial, patients with non-COVID-19 CAP, not requiring ICU-level organ support, will be randomised into therapeutic-dose anticoagulation (typically with low molecular-weight heparin) in the intervention arm, and usual-care prophylactic-dose anticoagulation in the control arm.
Both ASCOT and ATTACC-CAP studies have been endorsed by the IMSANZ Research Network.
Expressions of interest are now invited from sites interested in participating in this domain — and potentially in other current or future ASCOT domains. This trial is highly relevant to the general medical patient population due to the frequency of CAP admissions under general medicine. Sites will be reimbursed for recruitment and have the opportunity for authorship in resulting publications. The ultimate aim is to improve care and outcomes for patients with community-acquired pneumonia.
Email ASCOT Trial Team
Prof Zoe McQuilten
Chief Principal Investigator — Haematologist
Alfred Hospital and Monash University
Prof Steven Tong
Associate Investigator — Infectious Diseases Physician
Royal Melbourne Hospital and University of Melbourne
A/Prof Ar Kar Aung
Associate Investigator — General Medicine and Infectious Diseases Physician
Alfred Hospital and Monash University
Reference
1. The ATTACC, ACTIV-4a, and REMAP-CAP Investigators. Therapeutic anticoagulation with heparin in non-critically ill patients with Covid-19.
New England Journal of Medicine 2021; 385: 790–802.