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Aspirin associated with improved outcomes for patients with COVID-19

Previous work has suggested that the use of systemic anticoagulants reduces mortality in mechanically ventilated COVID-19 patients and now, in a retrospective analysis of hospitalised patients, it seems that use of low-dose aspirin also has beneficial effects.

The study by a team from the University of Maryland, Baltimore, analysed data for 412 patients admitted to hospital in several US states between March 2020 and July 2020. Included patients were 18 years and over with a positive PCR test result for COVID-19. Use was defined as administration within 24 hours of hospital admission or in the previous 7 days and any patients for whom the drug was administered after an outcome, for example, mechanical ventilation, were considered in the non-aspirin group. The study’s primary outcome the need for invasive mechanical ventilation and secondary outcomes were intensive care admission and in-hospital mortality. The rational for the primary outcome was based on aspirin’s ability to irreversibly inhibit platelet aggregation in the lungs and thus reduce pulmonary microthrombi and subsequent lung injury.

For the 412 patients included, the mean age was 55 years and 59% were male. In total, 98 (23.7%) of patients received aspirin with a median dose of 81mg and 75% of these were taking the drug prior to hospital admission and 86% took aspirin 24 hours prior to admission. Admission vital and laboratory values were not significantly different between the aspirin and non-aspirin groups. After adjustment for potential confounders, use of aspirin significantly reduce the need for invasive mechanical ventilation (adjusted hazard ratio, HR = 0.56, 95% CI 0.37–0.85, p = 0.007). For the secondary outcomes, aspirin use reduced the risk for intensive care (HR = 0.57, 95% CI 0.38–0.85, p = 0.005) and in-hospital mortality (HR = 0.53, 95% CI 0.31–0.90, p = 0.02).

Commenting on the results, the authors suggested that aspirin was a potentially useful adjunctive treatment in patients with COVID-19 and called for further studies to confirm these findings.

Chow JHM et al. Aspirin use is associated with decreased mechanical ventilation, ICU admission and in-hospital mortality in hospitalised patients with COVID-19. Anesth Analg 2020 doi: 10.1213/ANE.0000000000005292

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