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A randomised controlled trial of plasma exchange compared to standard of care in the treatment of severe COVID-19 infection (COVIPLEX)
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A randomised controlled trial of plasma exchange compared to standard of care in the treatment of severe COVID-19 infection (COVIPLEX)
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Journal Article
A randomised controlled trial of plasma exchange compared to standard of care in the treatment of severe COVID-19 infection (COVIPLEX)
2024
Overview
COVID-19 disease is associated with a hyperinflammatory, pro-thrombotic state and a high mortality. Our primary objective was to assess the change in inflammatory and thrombotic markers associated with PEX, and secondary objectives were to assess the effects of PEX on progression of respiratory failure and incidence of acute thrombotic events. We conducted a prospective, phase II, non-blinded randomised control trial of plasma exchange compared to standard of care in critically ill adults with severe COVID-19 associated respiratory failure, requiring supplemental oxygen or ventilatory support and elevated thrombo-inflammatory markers (LDH, CRP, ferritin, and D-Dimer). Patients randomised to receive PEX were treated with a daily single volume plasma exchange for a minimum of five days. Twenty-two patients were randomised of who 11 received PEX. Demographic and clinical characteristics were similar between groups at presentation. PEX was associated with a significant reduction in pro-thrombotic markers FVIII, VWF and VWF Ag: ADAMTS 13 ratio (
p
< 0.001). There were no differences in the reduction of inflammatory markers, severity of respiratory failure (
p
= 0.7), thrombotic events (
p
= 0.67), or mortality (
p
> 0.99) at 28 days. PEX successfully reduced pro-thrombotic markers, although was not associated with reduction in inflammatory markers, respiratory failure, or thrombotic events.
Trial registration
: (NCT04623255); first posted on 10/11/2020.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ Adult
/ Aged
/ COVID-19
/ Female
/ Ferritin
/ Fibrin Fibrinogen Degradation Products - analysis
/ Fibrin Fibrinogen Degradation Products - metabolism
/ Humanities and Social Sciences
/ Humans
/ Male
/ Patients
/ Respiratory Insufficiency - blood
/ Respiratory Insufficiency - therapy
/ SARS-CoV-2 - isolation & purification
/ Science
