AntiThrombotic Therapy to Ameliorate Clinical Complications in Community Acquired Pneumonia

Inclusion Criteria:

1. Patients ≥18 years of age

2. Admitted to hospital for a suspected or confirmed diagnosis of CAP defined by:

3. Radiographic evidence of new or worsening infiltrate

4. One or more of the following signs and/or symptoms of lower respiratory tractinfection i. 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 beCAP as per the attending physician

5. Requires supplemental oxygen to treat hypoxemia (or requires an increased level ofsupplemental oxygen if on chronic oxygen therapy)

6. Hospital admission anticipated to last ≥72 hours from randomization

Exclusion Criteria:

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, orextracorporeal life support (ECLS) within an ICU at the time of enrollment

4. Requirement for chronic mechanical ventilation via tracheostomy prior tohospitalization

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:

8. Non-traumatic bleeding that requires medical evaluation or hospitalizationwithin 30 days prior to CAP hospital admission

9. History of an inherited or acquired bleeding disorder

10. Cerebral aneurysm or mass lesions of the central nervous system

11. Ischemic stroke within 3 months of hospital admission

12. Gastrointestinal bleeding within 3 months of hospital admission

13. Platelet count <50 x109/L OR INR >2.0 OR hemoglobin <80 g/L at the time ofscreening

14. Other physician-perceived contraindications to therapeutic anticoagulation

15. History of heparin induced thrombocytopenia (HIT) or other heparin allergy

16. Current or recent (within 7 days of screening) use of dual anti-platelet inhibitors (For example; Aspirin + one of the following; clopidogrel, ticagrelor, prasugrel)

17. Patients in whom imminent death is anticipated

18. Anticipated transfer to another hospital that is not a study site within 72 hours ofrandomization

19. Enrollment in other interventional trials related to anticoagulation or antiplatelettherapy during current hospitalization