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Aspirin substantially lowers COVID risk — George Washington University study

Aspirin reduced the risk of mechanical ventilation by 44%, ICU admissions by 43%, and overall in-hospital mortality by 47%, found a George Washington University study into more than 400 COVID patients from hospitals across the United States who take aspirin unrelated to their COVID disease.

“As we learned about the connection between blood clots and COVID-19, we knew that aspirin, used to prevent stroke and heart attack, could be important for COVID-19 patients,” said Dr Jonathan Chow of the study team. “Our research found an association between low-dose aspirin and decreased severity of COVID-19 and death.”

Low-dose aspirin is a common treatment for anyone suffering from blood clotting issues or in danger of stroke, including most people who had a heart attack or a myocardial infarction. Although affecting the respiratory system, the coronavirus has been associated with small blood vessel clotting, causing tiny blockages in the pulmonary blood system, leading to ARDS (acute respiratory distress syndrome).

Israeli researchers reached similar results in a preliminary trial at the Barzilai Medical Center in March. In addition to its effect on blood clots, they found that aspirin carried immunological benefits and that the group taking it was 29% less likely to become infected with the virus in the first place.

“Aspirin is low cost, easily accessible and millions are already using it to treat their health conditions,” said Chow. “Finding this association is a huge win for those looking to reduce risk from some of the most devastating effects of COVID-19.”

Study details

The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection

Eugene Merzon, Ilan Green, Shlomo Vinker, Avivit Golan-Cohen, Alessandro Gorohovski, Eva Avramovich, Milana Frenkel-Morgenstern, Eli Magen,

Published in The FEBS Journal 23 February 2021

Abstract
Acetylsalicylic acid (aspirin) is commonly used for primary and secondary prevention of cardiovascular diseases. Aspirin use is associated with better outcomes among COVID-19 positive patients. We hypothesised that the aspirin use for primary cardiovascular disease prevention might have a protective effect on COVID-19 susceptibility and disease duration.

We conducted a retrospective population-based cross-sectional study, utilising data from the Leumit Health Services database. The proportion of patients treated with aspirin was significantly lower among the COVID-19-positive group, as compared to the COVID-19-negative group [73 (11.03%) vs. 1548 (15.77%); P = 0.001]. Aspirin use was associated with lower likelihood of COVID-19 infection, as compared to nonusers (adjusted OR 0.71 (95% CI, 0.52 to 0.99; P = 0.041).

Aspirin users were older (68.06 ± 12.79 vs. 56.63 ± 12.28 years of age; P < 0.001), presented a lower BMI (28.77 ± 5.4 vs. 30.37 ± 4.55; P < 0.0189), and showed higher prevalence of hypertension (56, 76.71%), diabetes (47, 64.38%), and COPD (11, 15.07%) than the aspirin nonusers (151, 25.64%, P < 0.001; 130, 22.07%, P < 0.001; and 43, 7.3%, P = 0.023, respectively).

Moreover, COVID-19 disease duration (considered as the time between the first positive and second negative COVID-19 RT–PCR test results) among aspirin users was significantly shorter, as compared to aspirin nonusers (19.8 ± 7.8 vs. 21.9 ± 7.9 P = 0.045).
Among hospitalised COVID-positive patients, a higher proportion of surviving subjects were treated with aspirin (20, 19.05%), as opposed to one dead subject (14.29%), although this difference was not significant (P = 0.449). In conclusion, we observed an inverse association between the likelihood of COVID-19 infection, disease duration and mortality, and aspirin use for primary prevention.

Currently, aspirin is proposed for use as an antithrombotic drug for treating COVID-19 in patients with established hypercoagulability [[35]]. The RECOVERY II (Randomized Evaluation of COVID-19 Therapy II) trial, a randomized clinical trial, is now being planned to test the effectiveness of low-dose aspirin as an anti-inflammatory and antithrombotic treatment in COVID-19 patients [[37, 38]].

Conclusion
We observed an inverse association between the likelihood of COVID-19 infection and aspirin use for primary prevention. Our data on the possible use of low doses of aspirin for the prevention of COVID-19 infection are preliminary, yet intriguing. We thus need prompt clinical consideration of this safe, low-cost drug with the potential to favorably alter COVID-19 infection outcome. Such an effect would also provide immediate socioeconomical relief by reduction in COVID-19 susceptibility. Therefore, our observations justify efforts to repeat this study using larger samples, including patients from other institutions.

Study details

Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease

Jonathan Chow, Ashish Khanna, Shravan Kethireddy, David Yamane, Andrea Levine, Amanda Jackson, Michael McCurdy, Ali Tabatabai, Gagan Kumar,
Paul Park, Ivy Benjenk, Jay Menaker, Nayab Ahmed, Evan Glidewell, Elizabeth Presutto, Shannon Cain, Naeha Haridasa, Wesly Field, Jacob Fowler, Duy Trinh, Kathleen Johnson, Aman Kaur, Amanda Lee, Kyle Sebastian, Allison Ulrich, Salvador Peña, Ross Carpenter, Shruti Sudhakar, Pushpinder Uppal, Benjamin Fedeles, Aaron Sachs, Layth Dahbour, William Teeter, Kenichi Tanaka, Samuel Galvagno, Daniel Herr, Thomas Scalea, Michael Mazzeffi.

Published in Anesthesia & Analgesia April 2021

Abstract

Background
Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.

Methods
A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions.

Results
Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users.

Conclusions
Aspirin use may be associated with improved outcomes in hospitalised COVID-19 patients. However, a sufficiently powered randomised controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.

 

FEBS article – The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection (Open access)

Anesthesia & Analgesia article – Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019 (Open access)

 

The Jerusalem Post article – Aspirin lowers risk of COVID: New findings support preliminary Israeli trial (Open access)

 

See more from MedicalBrief archives:

 

Aspirin use for CVD may reduce risk of COVID-19 infection – Israeli study

 

Baby Aspirin on par with full-dose for cardiovascular disease

 

Giving up daily aspIrin may increase heart attack and stroke risk by 37%

 

 

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