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Heart FailurePhase 3RATENCT04536272

Reduced Anticoagulation Targets in ECLS (RATE)

A Phase 3 study testing Heparin and LMWH in people with Heart Failure and Respiratory Failure, run by University Medical Center Groningen at 8 sites in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The objective of the RATE-trial is to study if reduced anticoagulation targets during ECLS diminish bleeding complications without an increase in thromboembolic complications or a negative impact on outcome. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Heparin and LMWH
Could I receive a placebo?
No, everyone receives an active treatment
How many people
330 participants
Where
8 sitesNetherlands
Study dates
1 Oct 2020to 7 Mar 2025
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ECMO treatment during the study period in one of the participating centers
  • Age above 18 years
  • Written informed consent

Who cannot join

  • Patients in whom the ECMO is only used to bridge a procedure
  • Vital indication for robust anticoagulation (e.g. mechanic valve, pulmonary embolism)
  • History of heparin induced thrombocytopenia

Trial locations and contacts

8 sites in 1 country.

8 sites in 1 country

Netherlands8 sites
  • OLVG, location East

    Amsterdam, North Holland, 1091AC

  • Amsterdam UMC, location AMC

    Amsterdam, North Holland, 1100DD

  • University Medical Center Groningen

    Groningen, Provincie Groningen, 9700RB

  • Leids Universitair Medisch Centrum

    Leiden, South Holland, 2300RC

  • Maastricht Universitair Medisch Centrum+

    Maastricht, Limburg, 6229HX

  • Radboud UMC

    Nijmegen, Gelderland, 6525GA

  • Erasmus MC

    Rotterdam, South Holland, 3000CA

  • Isala Clinics

    Zwolle, Overijssel, 8025AB

Other trials in Netherlands

About this study

The objective of the RATE-trial is to study if reduced anticoagulation targets during ECLS diminish bleeding complications without an increase in thromboembolic complications or a negative impact on outcome.

Read the detailed description

Rationale: ECMO treatment has a mortality of 38%, for a large part treatment related due to complications. The most feared complication is ischemic stroke for which heparin is administered with an aPTT target 2.0-2.5 times baseline (approximately 60-75 sec).

However, there is no relation between aPTT and the occurrence of stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome.

Objective: Our objective is to study if reduced anticoagulation targets diminish bleeding complications without an increase in thromboembolic complications or a negative impact on outcome.

Study design: Three-arm non-inferiority RCT.

Study population: All adult Dutch patients treated with ECMO during the 30 months of the study.

Intervention: Randomization between heparin administration with a target of 2-2.5 times baseline aPTT (usual care, about 60-75 sec.), 1.5-2.0 times baseline aPTT (45-60 sec.) or low molecular weight heparin (LMWH) guided by weight and renal function.

Main study parameters/endpoints: The primary outcome parameter is a combined endpoint consisting of: 1) major bleeding including hemorrhagic stroke according to the ELSO definitions; 2) severe thromboembolic complication defined as ischemic stroke, limb ischemia (not related with distal perfusion catheter), or acute pump failure with emergency exchange; 3) mortality at 6 months.

Secondary outcome parameters are: 1) blood transfusions; 2) health related quality of life (HR-QoL) at 6 months; 3) exchange of the membrane oxygenator; 4) vessel thrombosis after ECMO removal detected by echography; 5) pulmonary embolism; 6) costs; 7) the individual components of the composite outcome; and 8) all thromboembolic complications combined.

Expected outcomes: We expect that with a target of 1.5-2.0x baseline aPTT or with LMWH the primary composite endpoint will be reached in 60% of patients compared to 70% in usual care. To show non-inferiority with a significance level (alpha) of 5%, power of 80% and a non-inferiority limit (delta) of 7.5% the corresponding sample size is 91 patients per group. In other words, if there is a true difference in favor of the experimental treatment of 10%, then 91 patients per group are required to be 80% sure that the upper limit of a one-sided 95% confidence interval (or equivalently a 90% two-sided confidence interval) will exclude a difference in favor of the standard group of more than 7.5%. To compensate for a lower effect and drop-outs 330 patients will be enrolled. Apart from anticoagulation targets, treatment will be as usual so study participation will not lead to a burden for the patient, e.g. no extra blood sampling, tests or visits. After 6 months the patients will be contacted for a short questionnaire to measure health-related quality of life.

Being tested
Heparin, LMWH
Keywords
Extracorporeal membrane oxygenation, Extracorporeal life support, ECMO, ECLS, Anticoagulation, Complications
Medical subject headings
Heart Failure, Respiratory Insufficiency, Hemorrhage, Thrombosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • HeparinDrug

    Also called Unfractionated heparin

    Administration of heparin with a target of 2-2.5 or 1.5-2.0 times baseline aPTT during ECLS.

  • LMWHDrug

    Also called Dalteparine, Enoxaparine, Nadroparine, Tinzaparine

    Administration of LMWH guided by weight and renal function during ECLS.

Study groups in NCT04536272
Study groupRoleWhat they receive
Target of 2-2.5 times baseline aPTT (usual care, about 60-75)Active comparatorAdministration of heparin during ECLS with an aPTT target of 2-2.5 times baseline.
Receives: Drug: Heparin
Target of 1.5-2.0 times baseline aPTT (45-60 sec.)Active comparatorAdministration of heparin during ECLS with an aPTT target of 1.5-2.0 times baseline.
Receives: Drug: Heparin
LMWH guided by weight and renal function.Active comparatorAdministration of LMWH guided by weight and renal function during ECLS.
Receives: Drug: LMWH

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Hemorrhagic complications

    Severe hemorrhagic complications will be registered according to the Extracorporeal Life Support Organization (ELSO) definitions for major bleeding and is defined as clinically overt bleeding with a decrease in hemoglobin of at least 1,24 mmol/L (2 g/dl)/24 hours, or a transfusion requirement of ≥ 3 EH RBC over that same time period. Bleeding that is retroperitoneal, pulmonary or involves the central nervous system, or bleeding that requires surgical intervention is also considered major bleeding.

    Measured: Through ECLS completion, an average of 14 days

  2. Severe thromboembolic complications

    Severe thromboembolic complication defined as ischemic stroke, limb ischemia, or acute pump failure

    Measured: Through ECLS completion, an average of 14 days

  3. Mortality

    Mortality at 6 months

    Measured: 6 months after ECLS

Secondary outcomes (7)
  1. Number of blood transfusions

    Number of blood transfusions during ECLS

    Measured: Through ECLS completion, an average of 14 days

  2. Quality of life at 6 months

    Quality of life (HR-QoL) measured 6 months after decannulation from ECMO

    Measured: 6 months after ECLS

  3. Exchange of the membrane oxygenator

    Number of echanges of the membrane oxygenator during ECLS

    Measured: Through ECLS completion, an average of 14 days

  4. Vessel thrombosis after ECLS removal

    Vessel thrombosis after ECLS removal detected by echography

    Measured: After ECLS completion, an average of 14 days

  5. Cost- effectiveness

    Cost- effectiveness will be based on reduced costs of blood transfusions and interventions for bleeding (e.g. surgery, interventional radiology) as well as improved outcome. All medical cost items expected to be affected by the ECMO therapy will be measured and valued according to the Dutch standard guidelines for economic evaluations, e.g. blood transfusion, number of ECMO replacements, surgery, and hospital length of stay.

    Measured: 6 months after ECLS

  6. Pulmonary embolism

    The occurrence of Pulmonary embolism during ECLS

    Measured: Through ECLS completion, an average of 14 days

  7. All thromboembolic complications combined

    The occurrence of all thromboembolic complications combined during ECLS

    Measured: Through ECLS completion, an average of 14 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Sep 2020
  2. Study start1 Oct 2020
  3. Primary completion7 Mar 2025
  4. Study completion7 Mar 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomization between anticoagulation targets during ECLS of: 1). 2-2.5 times baseline aPTT (usual care, about 60-75 sec.), 2). 1.5-2.0 times baseline aPTT (45-60 sec.) or 3). LMWH guided by weight and renal function.
Masking
None (open label)
Enrolment
330 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04536272
Sponsor's protocol ID
201900659
Other IDs
848018014, 7969, 2019-004125-24, 2019
Acronym
RATE
Status last verified
May 2025
First submitted
24 Aug 2020
Last updated
2 May 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Anonymized individual patient level data will be provided in a secure access environment upon approval of a research proposal and a signed data sharing agreement.

Publications

  • Minnen OV, Lansink-Hartgring AO, van Amstel RBE, van den Bogaard B, Bunge JJH, Delnoij TSR, Droogh JM, Koppenhagen LV, Kraemer CVE, Kuijpers M, Maas JJ, Metz J, van de Poll MCG, Raasveld SJ, Dos Reis Miranda D, Vart P, Vermeulen KM, Vlaar APJ, van den Bergh WM; Dutch ECLS Study Group. Standard-dose unfractionated heparin versus low-dose unfractionated heparin and low-molecular-weight heparin in extracorporeal life support (RATE): an open-label, randomised, non-inferiority trial. Lancet. 2026 Jul 25;408(10552):357-366. doi: 10.1016/S0140-6736(26)00851-2. Epub 2026 Jul 7.

    PubMed 42413523
  • Vlasma JR, Fan Y, van der Velde P, Metz E, Lansink AO, Hoffmann RF, Nawijn MC, Burgess JK, Pillay J. Myeloid Cell Differentiation Within Extracorporeal Membrane Oxygenators in Patients With Acute Respiratory Distress Syndrome. ASAIO J. 2026 Jun 1;72(6):e89-e91. doi: 10.1097/MAT.0000000000002650. Epub 2026 Jan 13. No abstract available.

    PubMed 41527181
  • van Minnen O, Linde M, Oude Lansink-Hartgring A, van den Boogaard B, Bunge JJH, Delnoij TSR, Elzo Kraemer CV, Kuijpers M, Maas JJ, de Metz J, van de Poll M, Dos Reis Miranda D, Vlaar APJ, van Ravenzwaaij D, van den Bergh WM. Reduced anticoagulation targets in extracorporeal life support (RATE): protocol for a pre-planned secondary Bayesian analysis of the rate trial. Trials. 2025 Mar 15;26(1):90. doi: 10.1186/s13063-025-08737-6.

    PubMed 40087802
  • van Minnen O, Oude Lansink-Hartgring A, van den Boogaard B, van den Brule J, Bulpa P, Bunge JJH, Delnoij TSR, Elzo Kraemer CV, Kuijpers M, Lambermont B, Maas JJ, de Metz J, Michaux I, van de Pol I, van de Poll M, Raasveld SJ, Raes M, Dos Reis Miranda D, Scholten E, Simonet O, Taccone FS, Vallot F, Vlaar APJ, van den Bergh WM. Reduced anticoagulation targets in extracorporeal life support (RATE): study protocol for a randomized controlled trial. Trials. 2022 May 16;23(1):405. doi: 10.1186/s13063-022-06367-w.

    PubMed 35578271

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Heparin and LMWH in people with Heart Failure and Respiratory Failure, run by University Medical Center Groningen at 8 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hemorrhagic complications (time frame: Through ECLS completion, an average of 14 days). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04536272, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 May 2025.

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Reduced Anticoagulation Targets in ECLS (RATE) | AzTrials