Potential Benefits of Aspirin in Hospitalized COVID-19 Patients

Aspirin use may be associated with lung protective effects and reduce the need for mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality in hospitalized patients with coronavirus disease 2019 (COVID-19), according to data published in Anesthesia and Analgesia.

In total, 412 patients admitted to a US hospital between March and July with a laboratory-confirmed COVID-19 test were included in this retrospective, multi-center, observational cohort study. The median age of patients was 55 years (interquartile range [IQR], 41-66) and 59.2% were men. Of the 412 patients, 98 (23.7%) received aspirin and 314 (76.3%) did not. Of the patients receiving aspirin, 74 patients (75.5%) were initiated prior to admission.

Median time to aspirin 81 mg administration in the hospital was 0 days (IQR, 0-1 days) and median treatment duration 6 days (IQR, 3-12 days). Patients receiving aspirin had significantly higher rates of hypertension (P <.001), diabetes mellitus (P <.001), coronary artery (P <.001), renal disease (P <.001), home beta blockers use(P <.001), and liver disease (P =.04) compared to patients not receiving aspirin. The proportions of patients receiving other therapeutics such as azithromycin, convalescent plasma, dexamethasone, therapeutic heparin, hydroxychloroquine, remdesivir, and tocilizumab did not differ between groups.

In the unadjusted analysis, 35.7% of patients (35/98) in the aspirin group were on mechanical ventilation, compared to 48.4% of patients (152/314) in the non-aspirin group (P =.03). In addition, 38.8% of patients (38/98) in the aspirin group were admitted to the ICU, compared to 51.0% of patients (160/314) in the non-aspirin group (P =.04). There were no statistically significant differences in in-hospital mortality (P =.51), rate of major bleeding (P =.69), or overt thrombosis (P =.82).

After adjusting for 8 confounding variables, aspirin use was independently associated with a reduced risk for mechanical ventilation (adjusted hazard ratio [aHR], 0.56; 95% CI, 0.37-0.85; P =.007), reduction in the risk of ICU admission (aHR, 0.57; 95% CI, 0.38-0.85; P =.005), and in-hospital mortality (aHR, 0.53; 95% CI, 0.31-0.90; P =.02).

The study was limited by its modest size, observational design. Aspirin group patients might have received different care due to increased comorbidities, leading to a treatment bias. The presence of other medications associated with hypercoagulability, such as oral contraceptives, were not accounted for. Inflammatory markers were not universally measured, investigators noted.

Data suggests potential beneficial effects from aspirin in COVID-19 patients and provides a basis for a larger study, investigators concluded. However, they stress that until randomized controlled trials are performed, cautious optimism is imperative and the risks and benefits need to be deliberately balanced in patients. 

Reference

Chow JH, Khanna AK, Kethireddy S, et al. Aspirin use is associated with decreased mechanical ventilation, ICU admission, and in-hospital mortality in hospitalized patients with COVID-19. Anesth Analg. Published online October 21, 2020.doi: 10.1213/ANE.0000000000005292