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Community-acquired PneumoniaPhase 3ATTACC-CAPNCT05848713

AntiThrombotic Therapy to Ameliorate Clinical Complications in Community Acquired Pneumonia

A Phase 3 study testing Heparin in people with Community-acquired Pneumonia, run by University of Manitoba at 68 sites in 4 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

This is an international, open-label, stratified randomized controlled trial with Bayesian adaptive stopping rules to compare the effects of therapeutic-dose heparin vs. usual care pharmacological thromboprophylaxis on outcomes in patients admitted to hospital with community acquired pneumonia (CAP). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Community-acquired Pneumonia
What is being tested?
Heparin
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
4,000 participants
Where
68 sitesin 4 countries
Study dates
10 Oct 2023to 31 Mar 2029
Phase
Phase 3
Are there results?
Not yet: the study is under way

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

  • Patients ≥18 years of age
  • Admitted to hospital for a suspected or confirmed diagnosis of CAP defined by:
  • Radiographic evidence of new or worsening infiltrate
  • One or more of the following signs and/or symptoms of lower respiratory tract infection
  • New or increased cough or sputum production ii. Fever of > 37.8C or temperature < 36C iii. WBC > 11 x 109/L or < 4 x 109/L c. The primary diagnosis is believed to be CAP as per the attending physician
  • Requires supplemental oxygen to treat hypoxemia (or requires an increased level of supplemental oxygen if on chronic oxygen therapy)
  • Hospital admission anticipated to last ≥72 hours from randomization

Who cannot join

  • Suspected or confirmed active COVID-19 infection
  • Hospital admission for >72 hours prior to randomization
  • Patients receiving non-invasive or invasive ventilation, vasopressors, or extracorporeal life support (ECLS) within an ICU at the time of enrollment
  • Requirement for chronic mechanical ventilation via tracheostomy prior to hospitalization
  • Patients for whom the intent is to not use pharmacologic thromboprophylaxis
  • Patients with an independent indication for therapeutic-dose anticoagulation
Show all 19Show fewer
  • Patients with a contraindication to therapeutic-dose anticoagulation, including:
  • Non-traumatic bleeding that requires medical evaluation or hospitalization within 30 days prior to CAP hospital admission
  • History of an inherited or acquired bleeding disorder
  • Cerebral aneurysm or mass lesions of the central nervous system
  • Ischemic stroke within 3 months of hospital admission
  • Gastrointestinal bleeding within 3 months of hospital admission
  • Platelet count <50 x109/L OR INR >2.0 OR hemoglobin <80 g/L at the time of screening
  • Other physician-perceived contraindications to therapeutic anticoagulation
  • History of heparin induced thrombocytopenia (HIT) or other heparin allergy
  • Current or recent (within 7 days of screening) use of dual anti-platelet inhibitors (For example; Aspirin + one of the following; clopidogrel, ticagrelor, prasugrel)
  • Patients in whom imminent death is anticipated
  • Anticipated transfer to another hospital that is not a study site within 72 hours of randomization
  • Enrollment in other interventional trials related to anticoagulation or antiplatelet therapy during current hospitalization

Trial locations and contacts

68 sites in 4 countries. Contact the study team or a site near you to ask about taking part.

Chantale Pineau contact

2042353223

attacc.cap@umanitoba.ca

68 sites in 4 countries

Brazil34 sites, 25 recruiting

  • Hospital Felicio Rocho

    Belo Horizonte, Minas Gerais

    Completed

  • NUPEC-Orizonti

    Belo Horizonte, Minas Gerais

    Completed

  • Santa Casa de Misericórdia de Belo Horizonte

    Belo Horizonte, Minas Gerais

    Claudio Dornas, MD

    Recruiting

  • UPECLIN - Unidade de Pesquisa Clínica da Faculdade de Medicina de Botucatu

    Botucatu, São Paulo

    Suzana Erico Tanni, MD

    Suzana Erico Tanni, MD

    Recruiting

  • Hospital Universitario Sao Francisco na Providencia na Deus

    Bragança Paulista, São Paulo

    Gustavo Mamprin, MD

    Gustavo Mamprin, MD

    Recruiting

  • Hospital Brasilia

    Brasília, Federal District

    Completed

  • Instituto de Cardiologia e Transplantes do Distrito Federal

    Brasília, Federal District

    Completed

  • Fundação Centro Médico de Campinas

    Campinas, São Paulo, 13083-190

    Otavio Coelho, MD

    Otavio Coelho, MD

    Recruiting

  • IPECC

    Campinas, São Paulo

    Jose Francisco Kerr Saraiva, MD

    Jose Francisco Kerr Saraiva, MD

    Recruiting

  • Hospital São Julião

    Campo Grande, Mato Grosso do Sul

    Maurício Pompílio Pompílio, MD

    Recruiting

  • Santa Casa de Campo Grande

    Campo Grande, Mato Grosso do Sul

    Eduardo Calvoso, MD

    Recruiting

  • Hospital do Rocio

    Campo Largo, Paraná, 83606-177

    CESAR DUSILEK, MD

    Recruiting

  • Hospital Sao Jose

    Criciúma, Santa Catarina

    Felipe Pizzol, MD

    Felipe Pizzol, MD

    Recruiting

  • Hospital Santa Cruz

    Curitiba, Paraná

    Marcelo Carneiro, MD

    Marcelo Carneiro, MD

    Recruiting

  • PUCPR

    Curitiba, Paraná

    Completed

  • Hospital de Messejana Dr. Carlos Alberto Studart Gomes

    Goiânia, Goiás

    Sandra Nivea dos Reis Saraiva, MD

    Sandra Falcao, MD

    Recruiting

  • Hospital Ruy Azeredo

    Goiânia, Goiás

    Rafael Bastos, MD

    Rafael Bastos, MD

    Recruiting

  • Instituto Goiano de Oncologia e Hematologia - INGOH

    Goiânia, Goiás

    Mayler Santos, MD

    Mayler Santos, MD

    Recruiting

  • Santa Casa de Misericordia de Itabuna

    Itabuna, Estado de Bahia

    Completed

  • Hospital Bruno Born

    Lajeado, Rio Grande do Sul

    Lucas Mallmann, MD

    Lucas Mallmann, MD

    Recruiting

  • CiTen - Centro Hospital Municipal Antonio Giglio

    Osasco, São Paulo

    Enrico Fortunato, MD

    Enrico Fortunato, MD

    Recruiting

  • Hospital Sao Vicente de Paulo

    Passo Fundo, Rio Grande do Sul

    Alexandre Tognon, MD

    Alexandre Tognon

    Recruiting

  • Hospital de Clínicas de Porto Alegre

    Porto Alegre, Rio Grande do Sul

    Paulo Dalcin, MD

    Paulo Dalcin, MD

    Recruiting

  • Hospital Regional de Presidente Prudente

    Presidente Prudente, São Paulo

    Luis Felipe Pires, MD

    Luis Felipe Pires, MD

    Recruiting

  • Hospital Estadual de Serrana

    Ribeirão Preto, São Paulo

    Marcos Borges, MD

    Marcos Borges, MD

    Not yet recruiting

  • Hospital Clementino Fraga Filho - UFRJ

    Rio de Janeiro, Rio de Janeiro

    Fernanda Mello

    Recruiting

  • Hospital Universitario de Santa Maria

    Santa Maria, Rio Grande do Sul

    Completed

  • Hospital Regional Homero Miranda Gomes

    São José, South Carolina

    Completed

  • Hospital Nipo-Brasileiro

    São Paulo, São Paulo, 02189-010

    Jose Victor Krasner Schubsky, MD

    Recruiting

  • HCFMUSP

    São Paulo, São Paulo, 05403-010

    Ludhmila Hajjar, MD

    Ludhmila Hajjar, MD

    Recruiting

  • Santa Casa de Misericordia de Sao Paulo

    São Paulo, São Paulo

    Completed

  • Hospital Estadual Dr. Jayme Santos Neves

    Serra, Espírito Santo, 29166-828

    Marcus Matos, MD

    Marcus Matos, MD

    Recruiting

  • Hospital das Clínicas da Universidade Federal do Triângulo Mineiro

    Uberaba, Minas Gerais

    Recruiting

  • Hospital Evangelico de Vila Velha

    Vila Velha, Espírito Santo

    Joao Moraes Junior, MD

    Joao Moraes Junior, MD

    Recruiting

Other trials in Brazil

Canada27 sites, 27 recruiting

  • Foothills Medical Centre - Alberta Health Services

    Calgary, Alberta, T2N 2T9

    Deepa Suryanarayan, MD, 4039448167, dsuryana@ucalgary.ca

    Deepa Suryanarayan, MD

    Recruiting

  • Grand Prairie Regional Hospital

    Grande Prairie, Alberta, T8V 4B1

    Tafi Madzimure, MD

    Tafi Madzimure, MD

    Not yet recruiting

  • Health Sciences North Research Institute

    Greater Sudbury, Ontario, P3E 2H3

    Pandma Puranam, MD

    Pandma Puranam, MD

    Recruiting

  • Health Sciences North ResearchInstitute (HSNRI)

    Greater Sudbury, Ontario

    Pandma Puranam, MD

    Recruiting

  • Hamilton Health Sciences - Juravinski

    Hamilton, Ontario

    Bram Rochwerg, MD

    Bram Rochwerg, MD

    Recruiting

  • Hamilton Health Sciences

    Hamilton, Ontario

    Alison Fox-Robichaud, MD

    Alison Fox-Robichaud, MD

    Recruiting

  • Markham Stouffville Hospital

    Markham, Ontario, L3P 7P3

    Paul Lee, MD

    Paul Lee, MD

    Recruiting

  • McGill University Health Centre

    Montreal, Quebec, H4A3J1

    Emily Gibson McDonald, MD, MSc

    Recruiting

  • Centre Hospitalier de l'université de Montréal (CHUM)

    Montreal, Quebec

    Emmanuelle Duceppe, MD

    Recruiting

  • Jewish General Hospital

    Montreal, Quebec

    Susan Khan, MD

    Vicky Tagalakis, MD

    Recruiting

  • Nanaimo Regional General Hospital

    Nanaimo, British Columbia

    Alistair Teale, MD

    Alistair Teale, MD

    Recruiting

  • Hôpital Montfort

    Ottawa, Ontario

    Marc Carrier, MD

    Recruiting

  • The Ottawa Hospital

    Ottawa, Ontario

    Lana Castellucci, MD

    Recruiting

  • Penticton Regional Hospital

    Penticton, British Columbia

    Teresa Rodriguez, MD

    Not yet recruiting

  • CHU de Quebec-University Laval

    Québec, Quebec

    Alexis Turgeon, MD, MSc

    Recruiting

  • Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ)

    Québec, Quebec

    Francois Lallouche, MD

    Recruiting

  • Regina General Hospital

    Regina, Saskatchewan, S4P 0W5

    Payam Dehghani, MD

    Payam Dehghani, MD

    Recruiting

  • Niagara Health System - St Catharines Site

    Saint Catherines, Ontario, L2S 0A9

    Aidan Findlater, MD, Aidan.Findlater@niagarahealth.on.ca

    Aidan Findlater, MD

    Recruiting

  • University of Saskatchewan

    Saskatoon, Saskatchewan

    Geroffrey Shumailak, MD

    Not yet recruiting

  • Centre Hospitalier Universitaire de Sherbrooke

    Sherbrooke, Quebec

    Francois Lamontagne, MD

    Francois Lamontagne, MD

    Recruiting

  • Memorial University

    St. John's, Newfoundland and Labrador, A1C 5S7

    Peter Daley, MD

    Peter Daley, MD

    Recruiting

  • Sunnybrook Health Sciences Centre

    Toronto, Ontario, M4N 3M5

    Jonathan Zipursky, MD

    Jonathan Zipursky, MD

    Recruiting

  • St. Michael's Hospital

    Toronto, Ontario

    Michael Colacci, MD

    Not yet recruiting

  • Vancouver General Hospital

    Vancouver, British Columbia, V5Z 1M9

    Ted Steiner, MD

    Ted Steiner, MD

    Recruiting

  • Health Sciences Center Winnipeg

    Winnipeg, Manitoba, R3A 1R9

    Brett Houstin, MD

    Recruiting

  • Grace General Hospital

    Winnipeg, Manitoba

    Sylvain Lother, MD, sylvain.lother@umanitoba.ca

    Sylvain Lother, MD

    Recruiting

  • St. Boniface General Hospital

    Winnipeg, Manitoba

    Vi Dao, MD

    Terry Wuerz, MD

    Recruiting

Other trials in Canada

United States6 sites, 5 recruiting

  • Cooper University Health Care

    Camden, New Jersey, 08103

    Adam Green, MD

    Adam Green, MD

    Recruiting

  • University of Chicago

    Chicago, Illinois, 60637

    Jonathan Paul, MD

    Recruiting

  • Henry Ford Health System

    Dearborn, Michigan, 48128

    Completed

  • Ochsner Clinic

    Jefferson, Louisiana, 70121

    Derek Vondehaar, MD

    Recruiting

  • Medical College of Wisconsin

    Milwaukee, Wisconsin, 53226

    Alisha Sharma, MD

    Alisha Sharma, MD

    Recruiting

  • Maine Medical Centre

    Portland, Maine, 04102

    Daniel Meyer, MD

    Daniel Meyer, MD

    Recruiting

Other trials in United States

Mexico1 site, 1 recruiting

  • Hospital General Regional 1. Carlos MacGregor Sánchez Navarro

    Mexico City, Mexico City

    Recruiting

Other trials in Mexico

About this study

This is an international, open-label, stratified randomized controlled trial with Bayesian adaptive stopping rules to compare the effects of therapeutic-dose heparin vs. usual care pharmacological thromboprophylaxis on outcomes in patients admitted to hospital with community acquired pneumonia (CAP).

Read the detailed description

The global incidence of hospitalization due to CAP is high and associated with substantive morbidity and mortality. Thrombotic complications - including venous, arterial, and possibly microvascular - occur commonly in hospitalized patients across many etiologies of CAP. Poor outcomes may be mediated by both inflammatory and thrombotic processes leading to respiratory, cardiac, and other end organ dysfunction. There are currently no established therapies that modify the potentially maladaptive immunothrombosis pathway in CAP.

Therapeutic-dose anticoagulation with heparin reduces disease progression and mortality in non-critically ill patients hospitalized with COVID-19 with an acceptable safety profile. COVID-19 shares pathogenic features, including activation of the inflammatory and coagulation cascades, with other pneumonias. Whether therapeutic-dose heparin confers similar clinical benefits in non-COVID-19 CAP is unknown.

Being tested
Heparin
Keywords
Pneumonia, Heparin, Anticoagulation, Community acquired pneumonia, Unfractionated Heparin, Low Molecular Weight Heparin, Dalteparin, Enoxaparin, Tinzaparin
Medical subject headings
Community-Acquired Pneumonia, Pneumonia

What participants receive

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

  • HeparinDrug

    Preference is for LMWH given ease of administration and possibility of a more favorable safety profile, if no contraindication is present. Enoxaparin, dalteparin, or tinzaparin are acceptable LMWHs to be used for patients in the investigational arm and dose should be based on measured or estimated weight of the patient.

    Alternatively, intravenous UFH may be used and may be preferred in the presence of significant renal compromise. Intravenous UFH is typically dosed according to total body weight and pragmatically adjusted according to local institutional policy to achieve an activated partial thromboplastin time (aPTT) of 1.5-2.5x the reference value, or a corresponding UFH anti-Xa level. If UFH is used, the availability of a local site policy that specifies an aPTT target in this range or a corresponding anti-Xa value is a requirement.

Study groups in NCT05848713
Study groupRoleWhat they receive
Therapeutic-Dose HeparinExperimentalParticipants randomized to the investigational arm will receive a pragmatic strategy of therapeutic-dose low molecular-weight heparin (LMWH) or unfractionated heparin (UFH) administered daily for up to 14 days or until hospital discharge, whichever occurs first. Participants should start receiving study drug as soon as possible following randomization.
Receives: Drug: Heparin
Usual CareNo interventionParticipants randomized to the control arm will receive usual care thromboprophylactic dose anticoagulation according to local practice. To ensure adequate separation between the study groups, the dose of heparin/LMWH used in the usual care arm should not equal more than half of the approved therapeutic dose for that agent according to local VTE treatment protocols.

What is being measured

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

  1. Ordinal endpoint reflecting survival

    Survival to hospital discharge without ICU-level organ support. Organ support is defined as receipt of high flow nasal oxygen, invasive or non-invasive mechanical ventilation, vasopressor/inotropic therapy, or extracorporeal life support (ECLS) within an ICU. This outcome reflects disease progression to ICU-level organ failure or the worst possible outcome (death). It was chosen because of its importance to patients, clinicians, and other stakeholders. Given the limited number of ICU beds, reducing the burden of critical illness has important health system capacity implications.

    Measured: 30 days

Secondary outcomes (8)

  1. Bleeding events

    Number of participants with major bleeds as defined by the ISTH definition.

    Measured: 14 days

  2. HIT events

    Number of participants with laboratory confirmed heparin induced thrombocytopenia (HIT)

    Measured: 14 days

  3. Thrombotic events

    Number of participants with deep vein thrombosis, pulmonary embolism, systemic arterial thromboembolism, myocardial infarction, or ischemic stroke

    Measured: 30 days and 90 days

  4. Invasive mechanical ventilation

    Ordered categorical endpoint with three possible outcomes based on the worst status of each patient through day 30 following randomization

    Measured: 30 days

  5. All cause mortality

    Measured: 30 days, 90 days, and 180 days

  6. Hospital-free days

    Days alive outside hospital

    Measured: 30 days, 90 days, and 180 days

  7. Health related quality of life

    Using the EQ-5D-5L instrument

    Measured: 30 days, 90 days, and 180 days

  8. Health related quality of life

    Using the Clinical Frailty Scale instrument

    Measured: 30 days, 90 days, and 180 days

Timeline

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

  1. First posted8 May 2023
  2. Study start10 Oct 2023
  3. Primary completion31 Mar 2028 (estimated)
  4. Study completion31 Mar 2029 (estimated)

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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Adaptive stratified randomized clinical trial with Bayesian stopping rules
Masking
None (open label)
Enrolment
4,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05848713
Sponsor's protocol ID
ATTACC-CAP
Other IDs
OZM-129
Acronym
ATTACC-CAP
Status last verified
Sep 2026
First submitted
17 Apr 2023
Last updated
30 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • ATTACC Investigators; ACTIV-4a Investigators; REMAP-CAP Investigators; Lawler PR, Goligher EC, Berger JS, Neal MD, McVerry BJ, Nicolau JC, Gong MN, Carrier M, Rosenson RS, Reynolds HR, Turgeon AF, Escobedo J, Huang DT, Bradbury CA, Houston BL, Kornblith LZ, Kumar A, Kahn SR, Cushman M, McQuilten Z, Slutsky AS, Kim KS, Gordon AC, Kirwan BA, Brooks MM, Higgins AM, Lewis RJ, Lorenzi E, Berry SM, Berry LR, Aday AW, Al-Beidh F, Annane D, Arabi YM, Aryal D, Baumann Kreuziger L, Beane A, Bhimani Z, Bihari S, Billett HH, Bond L, Bonten M, Brunkhorst F, Buxton M, Buzgau A, Castellucci LA, Chekuri S, Chen JT, Cheng AC, Chkhikvadze T, Coiffard B, Costantini TW, de Brouwer S, Derde LPG, Detry MA, Duggal A, Dzavik V, Effron MB, Estcourt LJ, Everett BM, Fergusson DA, Fitzgerald M, Fowler RA, Galanaud JP, Galen BT, Gandotra S, Garcia-Madrona S, Girard TD, Godoy LC, Goodman AL, Goossens H, Green C, Greenstein YY, Gross PL, Hamburg NM, Haniffa R, Hanna G, Hanna N, Hegde SM, Hendrickson CM, Hite RD, Hindenburg AA, Hope AA, Horowitz JM, Horvat CM, Hudock K, Hunt BJ, Husain M, Hyzy RC, Iyer VN, Jacobson JR, Jayakumar D, Keller NM, Khan A, Kim Y, Kindzelski AL, King AJ, Knudson MM, Kornblith AE, Krishnan V, Kutcher ME, Laffan MA, Lamontagne F, Le Gal G, Leeper CM, Leifer ES, Lim G, Lima FG, Linstrum K, Litton E, Lopez-Sendon J, Lopez-Sendon Moreno JL, Lother SA, Malhotra S, Marcos M, Saud Marinez A, Marshall JC, Marten N, Matthay MA, McAuley DF, McDonald EG, McGlothlin A, McGuinness SP, Middeldorp S, Montgomery SK, Moore SC, Morillo Guerrero R, Mouncey PR, Murthy S, Nair GB, Nair R, Nichol AD, Nunez-Garcia B, Pandey A, Park PK, Parke RL, Parker JC, Parnia S, Paul JD, Perez Gonzalez YS, Pompilio M, Prekker ME, Quigley JG, Rost NS, Rowan K, Santos FO, Santos M, Olombrada Santos M, Satterwhite L, Saunders CT, Schutgens REG, Seymour CW, Siegal DM, Silva DG Jr, Shankar-Hari M, Sheehan JP, Singhal AB, Solvason D, Stanworth SJ, Tritschler T, Turner AM, van Bentum-Puijk W, van de Veerdonk FL, van Diepen S, Vazquez-Grande G, Wahid L, Wareham V, Wells BJ, Widmer RJ, Wilson JG, Yuriditsky E, Zampieri FG, Angus DC, McArthur CJ, Webb SA, Farkouh ME, Hochman JS, Zarychanski R. Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. N Engl J Med. 2021 Aug 26;385(9):790-802. doi: 10.1056/NEJMoa2105911. Epub 2021 Aug 4.

    PubMed 34351721

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Heparin in people with Community-acquired Pneumonia, run by University of Manitoba at 68 sites in 4 countries.

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 7 inclusion and 19 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: looking for participants now, as of the sponsor's last update on 30 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 68 sites in Brazil, Canada, United States, Mexico. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Chantale Pineau (2042353223, attacc.cap@umanitoba.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ordinal endpoint reflecting survival (time frame: 30 days). 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 NCT05848713, which also lists 1 linked publication.

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 30 Sep 2026.

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