Daily Aspirin Use Appears to Lower Severity of COVID-19 Cases

One medication that appears to help prevent novel coronavirus cases from turning severe is readily available, inexpensive and sitting on drugstore shelves. That’s according to a new study suggesting that daily low-dose aspirin for cardiovascular disease protection also makes it less likely that patients will have more complications or dies of COVID-19. Here are more details.

BALTIMORE, MD – Could something as simple as taking a daily aspirin to protect against cardiovascular disease also help keep COVID-19 cases from becoming severe?

A new study suggests that might be the case. A report in the journal Anesthesia and Analgesia says a study provides “cautious optimism” that novel coronavirus patients who were taking a daily low-dose aspirin to protect against cardiovascular disease had a significantly lower risk of complications and death compared to those who were not taking aspirin.

University of Maryland School of Medicine-led researchers point out that patients on daily aspirin were less likely to be placed in the intensive care unit (ICU) or to require mechanical ventilation. Most significantly, they add, those patients had a lower death rate.

"This is a critical finding that needs to be confirmed through a randomized clinical trial," said study leader Jonathan Chow, MD, Assistant Professor of Anesthesiology at UMSOM. "If our finding is confirmed, it would make aspirin the first widely available, over-the-counter medication to reduce mortality in COVID-19 patients."

Background information in the study explains that COVID-19 is associated with hypercoagulability and increased thrombotic risk in critically ill patients. Yet, the authors write, they were unaware of any studies evaluating whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.

To remedy that, researchers conducted a retrospective, observational cohort study of 412 adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020. Defined as the primary outcome was the need for mechanical ventilation, while secondary outcomes were ICU admission and in-hospital mortality.

The research team controlled for several factors affected patient prognosis, including age, gender, body mass index, race, hypertension and diabetes. Also considered were cardiovascular disease, kidney disease, liver disease and the use of beta blockers to control blood pressure.

Of the patients studied, 314 (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days prior to admission. Results indicate that aspirin use had a crude association with less mechanical ventilation (35.7% aspirin vs. 48.4% non-aspirin, p=0.03) and ICU admission (38.8% aspirin vs. 51.0% non-aspirin, p=0.04), but no crude association with in-hospital mortality (26.5% aspirin vs. 23.2% non-aspirin, p=0.51).

After adjusting for eight confounding variables, however, the authors report that aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR 0.56, 95% CI 0.37-0.85, p=0.007), ICU admission (adjusted HR 0.57, 95% CI 0.38-0.85, p=0.005), and in-hospital mortality (adjusted HR 0.53, 95% CI 0.31-0.90, p=0.02). No differences in major bleeding (p=0.69) or overt thrombosis (p=0.82) were detected between aspirin users and non-aspirin users, however.

Essentially, aspirin use was associated with a 44% reduction in the risk of being put on a mechanical ventilator, a 43% decrease in the risk of ICU admission and a 47% decrease in the risk of dying in the hospital compared to those who were not taking aspirin, researchers calculated.

“Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients,” the authors conclude. “However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.”

"We believe that the blood thinning effects of aspirin provides benefits for COVID-19 patients by preventing microclot formation," explained study co-author Michael A. Mazzeffi, MD, Associate Professor of Anesthesiology at UMSOM. "Patients diagnosed with COVID-19 may want to consider taking a daily aspirin as long as they check with their doctor first." Those at increased bleeding risk due to chronic kidney disease, for example, or because they regularly use certain medications, like steroids or blood thinners, may not be able to safely take aspirin, he added.

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