TO THE EDITOR:

The COVID-19 pandemic changed how researchers interact and collaborate. Communication moved online to electronic communication and social media platforms. Simultaneously, researchers around the world rapidly studied venous thromboembolism (VTE) in patients with COVID-19.1 More than 20 randomized controlled trials (RCTs) were initiated independently in different countries to evaluate anticoagulants in patients hospitalized with COVID-19, leading to duplication, then later sparking international collaboration.2-4 Similarly, there was an enormous collective effort to rapidly develop COVID-19–related VTE guidelines.5-12 The early COVID-19 pandemic was a unique time in history, and it is not known how VTE researchers collaborated. Social network analysis is a powerful methodology used to evaluate research collaborations through a rigorous description and analysis of connections among individuals.13 With in-depth understanding of how VTE researchers collaborated during the early pandemic, we can better understand and improve collaboration.

After approval by the University of Calgary’s research ethics board, we distributed an online survey to members of 2 VTE research networks, CanVECTOR (the Canadian Venous Thromboembolism Research Network; Canada; n = 59) and INVENT (the International Network of VENous Thromboembolism Clinical Research Networks; international; n = 389), between 16 June 2020 and 25 June 2020, and on Twitter (Qualtrics, Provo, UT). We collected demographic data, and data on how researchers interacted before and during the early COVID-19 pandemic to lead and collaborate on research. We conducted an egocentered network analysis, which maps the connections from the perspective of a single person, because we did not have a list of all VTE researchers in the world for a whole network analysis.14 To assess collaboration for leaders of research projects, we asked 2 questions: (1) for thrombosis-related COVID-19 research projects that you are leading or coleading, please list the researchers who you consulted with to get feedback on your study idea/protocol; and (2) for your 2 largest non–COVID-19 thrombosis research projects that you developed in the last 2 years, please list the researchers who you consulted with to get feedback on your study idea/protocol. To assess researchers’ contributions to others’ projects we asked: (3) please list the lead researcher(s) for any thrombosis-related COVID-19 research projects that you actively contributed to by giving feedback on a study idea/protocol; and (4) please list the lead researcher(s) for any non–COVID-19 thrombosis research project that you actively contributed to in the last 2 years by giving feedback on a study idea/protocol. We then searched publicly available directories to confirm the institution and country of each named researcher. We assessed the size of the 4 collaborative research networks for each respondent, and the percentage of their network members who were from the same institution and the same country. We assessed whether individuals who led prior VTE projects were leading COVID-19–related projects.

There were 49 respondents based in 12 countries who reported 157 unique individuals as collaborators, from 22 countries. The majority of respondents were men (60% [30 of 50]) and physician researchers (74% [37 of 50]), with (78% [38 of 49]) reporting membership in at least 1 formal research network (Table 1).

Table 1.

Characteristics of survey respondents and research network membership

Sex  
Male 30/50 (60%) 
Female 20/50 (40%) 
Self-identified as other 0/50 (0%) 
Research position 
Physician researcher 37/50 (74%) 
Nonphysician researcher 4/50 (8%) 
Clinical trainee 5/50 (10%) 
Nonclinical trainee 1/50 (2%) 
Other 3/50 (6%) 
Memberships in formalized research networks 
CanVECTOR (Canada) 24/49 (49%) 
INVENT (International) 9/49 (18%) 
HTRS (North America) 8/49 (16%) 
INViTE (Ireland) 3/49 (6%) 
DTN (The Netherlands) 2/49 (4%) 
THANZ (Australia and New Zealand) 1/49 (2%) 
VENUS (United States) 1/49 (2%) 
INNOVTE (France) 1/49 (2%) 
Other networks  7/49 (14%) 
None 11/49 (22%) 
Number of formalized research network memberships 
None 11/49 (22%) 
26/49 (53%) 
6/49 (12%) 
≥3 6/49 (12%) 
Methods to receive feedback when developing VTE research projects 
Research network or investigator group conference calls 23/30 (77%) 
Research network formal protocol strengthening exercises 5/30 (17%) 
Degrees or course programs 4/30 (13%) 
Other  6/30 (20%) 
Sex  
Male 30/50 (60%) 
Female 20/50 (40%) 
Self-identified as other 0/50 (0%) 
Research position 
Physician researcher 37/50 (74%) 
Nonphysician researcher 4/50 (8%) 
Clinical trainee 5/50 (10%) 
Nonclinical trainee 1/50 (2%) 
Other 3/50 (6%) 
Memberships in formalized research networks 
CanVECTOR (Canada) 24/49 (49%) 
INVENT (International) 9/49 (18%) 
HTRS (North America) 8/49 (16%) 
INViTE (Ireland) 3/49 (6%) 
DTN (The Netherlands) 2/49 (4%) 
THANZ (Australia and New Zealand) 1/49 (2%) 
VENUS (United States) 1/49 (2%) 
INNOVTE (France) 1/49 (2%) 
Other networks  7/49 (14%) 
None 11/49 (22%) 
Number of formalized research network memberships 
None 11/49 (22%) 
26/49 (53%) 
6/49 (12%) 
≥3 6/49 (12%) 
Methods to receive feedback when developing VTE research projects 
Research network or investigator group conference calls 23/30 (77%) 
Research network formal protocol strengthening exercises 5/30 (17%) 
Degrees or course programs 4/30 (13%) 
Other  6/30 (20%) 

DTN, Dutch Thrombosis Network; HTRS, Hemostasis and Thrombosis Research Society; INNOVTE, Investigation Network on Venous Thrombo-Embolism; INViTE, Irish Network for VTE Research; THANZ, Thrombosis & Haemostasis Society of Australia and New Zealand; VENUS, Venous thromboembolism Network US.

Other networks: ISTH, International Society on Thrombosis and Haemostasis; SOMETH, Sociedad Mexicana de Trombosis y Hemostasia; BSH, British Society of Haematology; BSHT, British Society of Haemostasis and Thrombosis; and the NBCA, National Blood Clot Alliance; hospitals, and specific research topics of study (eg, research group in diagnostic studies).

Other for project development feedback: have not gotten feedback already; small group interactions with colleagues. In a related question about social media use, 7 of 37 (19%) used social media to develop research ideas with other researchers, and 2 of 37 (5%) used social media to develop protocols with other researchers.

Of the respondents, close to 50% (23 of 49) led a VTE research project in the 2 years before COVID-19, and 16 were leading COVID-19–related VTE studies. In total, 18 respondents worked on a collaborative research project, which they were not leading, before COVID-19, with 17 working on COVID-19–related research collaborations. The size and composition of the collaboration networks are described in Table 2. COVID-19–related collaborations tended to be more local, both at an institutional level and at a country level, than pre–COVID-19 collaborations. Of the respondents who led COVID-19–related VTE research, 8 of 16 (50%) listed ≥5 collaborators, whereas fewer than half (6/15) of the non–COVID-19 VTE research leaders listed ≥5 collaborators.

Table 2.

Collaborative research networks: size and composition

Thrombosis non–COVID-19 project lead last 2 yThrombosis non–COVID-19 project contributor last 2 yCOVID-19 project leadCOVID-19 project contributor
Participants, n 15 16 17 
Network size, n 
1-2 5 (33.3%) 1 (11.1%) 6 (37.5%) 10 (58.8%) 
3-4 4 (26.7%) 3 (33.3%) 2 (12.5%) 4 (23.5%) 
≥5 6 (40.0%) 5 (55.6%) 8 (50.0%) 3 (17.6%) 
Network composition 
Proportion of network from same institution, mean (SD) 13.6% (17.8%) 5.7% (11.1%) 40.7% (43.8%) 22.2% (39.8%) 
Proportion of network from same country, mean (SD) 25.1% (18.2%) 14.7% (14.8%) 42.3% (42.3%) 41.0% (38.6%) 
Thrombosis non–COVID-19 project lead last 2 yThrombosis non–COVID-19 project contributor last 2 yCOVID-19 project leadCOVID-19 project contributor
Participants, n 15 16 17 
Network size, n 
1-2 5 (33.3%) 1 (11.1%) 6 (37.5%) 10 (58.8%) 
3-4 4 (26.7%) 3 (33.3%) 2 (12.5%) 4 (23.5%) 
≥5 6 (40.0%) 5 (55.6%) 8 (50.0%) 3 (17.6%) 
Network composition 
Proportion of network from same institution, mean (SD) 13.6% (17.8%) 5.7% (11.1%) 40.7% (43.8%) 22.2% (39.8%) 
Proportion of network from same country, mean (SD) 25.1% (18.2%) 14.7% (14.8%) 42.3% (42.3%) 41.0% (38.6%) 

SD, standard deviation.

Research project development primarily occurred through non–social media methods such as investigator group conference calls (23 of 30 [77%]; Table 1). Only 9 (7/37; 19%) and 2 (2 of 37 [5%]) used social media platforms to develop research ideas and protocols, respectively. The respondents also highlighted the importance of collaboration: “should be multinational collaborative research to ensure effective use of limited resources and successful completion of a study,” and “COVID-19 showed us the need for collaborative networks.”

Half of researchers (8 of16) who were leading COVID-19–related VTE research had led VTE research projects not related to COVID-19 over the past 2 years, suggesting that successful leaders continued to lead COVID-19 research. Although COVID-19–related collaborations were more local than those before the COVID-19 pandemic, they still often involved at least ≥5 researchers, mostly from other institutions and countries. It is noticeable that the number of COVID-19–related collaborations, which were no more than 6 months old at the time of the survey, is larger than the number of research collaborations in the past 2 years before the COVID-19 pandemic (21 [47%] with COVID-19 research projects vs 15 [33%] with non–COVID-19 thrombosis research projects). Similarly, when publications before and during the COVID-19 pandemic were compared, international research collaboration was higher early in the pandemic.15 

For respondents who identified as a collaborator on COVID-19 research projects, their collaborative networks were relatively small. For example, 10 of 17 COVID-19 project collaborators had a network of 1 to 2, whereas only 3 of 17 had a network of ≥5. In contrast, for participants who contributed as a collaborator on non–COVID-19 thrombosis research projects in the preceding 2 years, their collaborative networks were larger. Only 1 of 9 thrombosis collaborative networks contained 1 to 2 members, compared with 5 of 9 who had a network of ≥5 members. Although this is a small sample size and hypothesis generating, this may speak to the rapid pace of COVID-19 research. Research collaborations take time to mature, and the differences seen may represent a time bias between the 2 groups.

Researchers compete for limited research funding, and once funding is secured, RCTs may not be completed because of poor recruitment.16 In a review of UK government–funded trials, 45% did not reach their sample size.17 We found that when VTE researchers were faced with the unique demands of the COVID-19 pandemic, they shifted away from prior patterns of collaboration to more local efforts. However, we have since seen examples of successful international RCT and meta-analysis collaboration.2-4,18 The mission of INVENT-VTE is to foster international research collaboration and includes 11 national research networks.19 Collaborating as a global research community may improve trial completion rates, but further study is needed on how to work together successfully.

Study limitations include a small sample size, owing to survey distribution during a busy time in the pandemic. Multiple methods were used to disseminate the survey, so the total number of recipients is not known. However, the comparison of individuals' network data before and during the COVID-19 pandemic still enables us to speculate how social networks changed during the early pandemic. How connections changed later in the pandemic is unknown. There was an overrepresentation of Canadian (51%) respondents, although researchers from 12 countries responded. We changed the number of collaborators a respondent could list from 20 to 5 to improve survey uptake; however, listing a maximum of 5 collaborators may underrepresent collaboration. Our survey may be biased toward those with digital literacy.

By characterizing networks of research collaboration in the VTE community during the pandemic, we can better understand how researchers collaborate. This information is valuable for understanding future collaboration efforts. By developing and evaluating innovative ways to foster collaboration through INVENT-VTE, VTE organizations, or government programs, the VTE research community will be better poised to respond during a future call to action.

Acknowledgments: The authors thank all VTE researchers who completed our survey during the early COVID-19 pandemic. The authors acknowledge the support of CanVECTOR (the Canadian Venous Thromboembolism Research Network), and INVENT.

This was a nonfunded study.

Contribution: L.S. and J.G. designed the study; L.S., J.G., D.M.S., T.M.C., G.L.G., M.C. S.R.K., M.A.R., N.J.L, A.G., and C.M. contributed to the design of the survey; D.K., J.A.K., J.G., and L.S. contributed to data collection and analysis; D.K. and L.S. drafted the first version of the manuscript; and all authors critically revised the manuscript for important intellectual content.

Conflict-of-interest disclosure: D.M.S. has received honoraria from Bristol-Myers Squibb–Pfizer, Servier, AstraZeneca, and Roche. G.L.G. has received grants from Pfizer and Bristol-Myers Squibb; and has received honoraria from Pfizer, Sanofi, and Aspen Pharma. M.C. has received honoraria from Leo Pharma, Bristol-Myers Squibb, and Pfizer; and has received consultancy fees from Sanofi, Leo Pharma, Servier, Valeo, Bayer, Pfizer, Bristol-Myers Squibb, and Anthos. L.S. has received honoraria from Leo Pharma and Sanofi; and has received research funding from CSL Behring. The remaining authors declare no competing financial interests.

Correspondence: Leslie Skeith, University of Calgary, 1403-29th St NW, Calgary, AB T2N 2T9, Canada; email: laskeith@ucalgary.ca.

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Author notes

Data are available on request from the corresponding author, Leslie Skeith (laskeith@ucalgary.ca).