AntiThrombotic Therapy to Ameliorate Clinical Complications in Community Acquired Pneumonia

Eligibility Criteria

• 1. Patients ≥18 years of age
• 2. Admitted to hospital for a suspected or confirmed diagnosis of CAP defined by:
• 1. Radiographic evidence of new or worsening infiltrate
• 2. One or more of the following signs and/or symptoms of lower respiratory tract infection
• 3. Requires supplemental oxygen to treat hypoxemia (or requires an increased level of supplemental oxygen if on chronic oxygen therapy)
• 4. Hospital admission anticipated to last ≥72 hours from randomization
• 1. Suspected or confirmed active COVID-19 infection
• 2. Hospital admission for \>72 hours prior to randomization
• 3. Patients receiving non-invasive or invasive ventilation, vasopressors, or extracorporeal life support (ECLS) within an ICU at the time of enrollment
• 4. Requirement for chronic mechanical ventilation via tracheostomy prior to hospitalization
• 5. Patients for whom the intent is to not use pharmacologic thromboprophylaxis
• 6. Patients with an independent indication for therapeutic-dose anticoagulation
• 7. Patients with a contraindication to therapeutic-dose anticoagulation, including:
• 1. Non-traumatic bleeding that requires medical evaluation or hospitalization within 30 days prior to CAP hospital admission
• 2. History of an inherited or acquired bleeding disorder
• 3. Cerebral aneurysm or mass lesions of the central nervous system
• 4. Ischemic stroke within 3 months of hospital admission
• 5. Gastrointestinal bleeding within 3 months of hospital admission
• 6. Platelet count \<50 x109/L OR INR \>2.0 OR hemoglobin \<80 g/L at the time of screening
• 7. Other physician-perceived contraindications to therapeutic anticoagulation
• 8. History of heparin induced thrombocytopenia (HIT) or other heparin allergy
• 9. Current or recent (within 7 days of screening) use of dual anti-platelet inhibitors (For example; Aspirin + one of the following; clopidogrel, ticagrelor, prasugrel)
• 10. Patients in whom imminent death is anticipated
• 11. Anticipated transfer to another hospital that is not a study site within 72 hours of randomization
• 12. Enrollment in other interventional trials related to anticoagulation or antiplatelet therapy during current hospitalization