Grant: Project Grant

Community acquired pneumonia (CAP) is an acute infection of the lungs acquired outside of a hospital setting. CAP is one of the most common causes of mortality in the world and results in critical illness and death in a significant proportion of patients. Poor clinical outcomes are related to excess inflammation and a propensity to form small and large vessel blood clots. Clinical studies in CAP caused by the virus resulting in COVID-19 disease have demonstrated that full-dose blood thinners, specifically heparin, safely reduces death and disease progression to critical illness in patients who are hospitalized but not yet critically ill. The beneficial effects of heparin are thought to come from its ability to thin the blood, reduce inflammation, and possibly prevent pathogens from entering human cells. The goal of this clinical trial is to establish whether full-dose heparin can reduce progression to critical illness and death in patients hospitalized for CAP from any cause (viruses other than the one that causes COVID-19, bacteria, and others). The trial will compare patients who are treated with full-dose heparin to those that receive standard low-dose heparin which is typically given to prevent blood clots in hospital. The trial will measure whether a patient becomes critically ill and requires life support, or dies, within 30 days of the treatment. It will also monitor patients for other important outcomes such as bleeding, heart attacks, and blood clots. This trial uses an innovative design which allows it to learn as it proceeds, observing where blood thinners are working better and where they are not. This knowledge will allow us to make conclusions about the effectiveness of full-dose heparin as quickly as possible. If therapeutic dose heparin is shown to improve clinical outcomes for patients with CAP, the therapy is likely to result in a paradigm shift in the way lung infections are treated and will impact care for patients around the world.