Preventing Cardiac Complication of COVID-19 Disease With Early Acute Coronary Syndrome Therapy: A Randomised Controlled Trial.

Summary

The outbreak of a novel coronavirus (SARS-CoV-2) and associated COVID-19 disease in late December 2019 has led to a global pandemic. At the time of writing, there have been 150 000 confirmed cases and 3500 deaths. Apart from the morbidity and mortality directly related to COVID-19 cases, society has had to also cope with complex political and economic repercussions of this disease.

At present, and despite pressing need for therapeutic intervention, management of patients with COVID-19 is entirely supportive. Despite the majority of patients experiencing a mild respiratory illness a subgroup, and in particular those with pre-existing cardiovascular disease, will experience severe illness that requires invasive cardiorespiratory support in the intensive care unit.

Furthermore, the severity of COVID-19 disease (as well as the likelihood of progressing to severe disease) appears to be in part driven by direct injury to the cardiovascular system. Analysis of data from two recent studies confirms a significantly higher likelihood of acute cardiac injury in patients who have to be admitted to intensive care for the management of COVID-19 disease.

The exact type of acute of cardiac injury that COVID-19 patients suffer remains unclear. There is however mounting evidence that heart attack like events are responsible. Tests ordinarily performed to definitely assess for heart attacks will not be possible in very sick COVID-19 patients. Randomising patients to cardioprotective medicines will help us understand the role of the cardiovascular system in COVID-19 disease. It will also help us determine if there is more we can do to treat these patients.

Conditions

• COVID-19

Interventions

DRUG

Aspirin 75mg

• If patient not on aspirin, add aspirin 75mg once daily unless contraindicated.

DRUG

Clopidogrel 75mg

• If patient not on clopidogrel or equivalent, add clopidogrel 75mg once daily unless contraindicated

DRUG

Rivaroxaban 2.5 MG

* If patient not on an anticoagulation, add rivaroxaban 2.5mg bd unless contraindicated * If patient on DOAC then change to rivaroxaban 2.5mg unless contraindicated

DRUG

Atorvastatin 40mg

• If patient not on a statin, add atorvastatin 40mg once daily unless contraindicated

DRUG

Omeprazole 20mg

• If patient not on a proton pump inhibitor, add omeprazole 20mg once daily.

Sponsors & Collaborators

• Imperial College London

  lead OTHER

Principal Investigators

• Prapa Kanagaratnam, FRCP, PhD · Imperial College Healthcare NHS Trust

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

85 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-04-03

Primary Completion

2021-11-30

Completion

2021-11-30

Countries

• United Kingdom

Study Locations