TABLE 2.
High quality clinical evidence displaying negative role for aspirin in COVID-19 disease.
| Author(s) | Country | Date | Study design | Mortality | Mechanical ventilation | Other outcomes |
|---|---|---|---|---|---|---|
| Yuan et al. | China | Jan-21 | Retrospective database review | No difference in mortality between CAD patients taking and not taking aspirin | No difference in need of mechanical ventilation between the 2 groups | No difference in severe disease, inflammatory markers, liver and kidney function and lung imaging between patients taking and not taking aspirin pre-hospitalization |
| Sahai et al. | United States | Dec-20 | Retrospective database review | Neither aspirin nor NSAIDs affected mortality. They were associated with increased risk of MI, CVA, or VTE | ||
| Salah and Mehta | United States, China, Iran | Mar-21 | Meta-analysis | Mortality was not associated with the use of aspirin in patients with COVID-19 (RR 1.12, [0.84, 1.50]) | ||
| Son et al. | South Korea | Jul-21 | Case control | Mortality was not associated with the use of aspirin. Adjusted OR = 0.92 (0.46–1.84) | No correlation between prior aspirin use and COVID-19 complications. Adjusted OR = 1.06 (0.66–1.69) | |
| Abdelwahab et al. | Egypt | Jul-21 | Retrospective cohort | No correlation between prior aspirin use and mechanical ventilation Adjusted OR = 1.095, p-value = 0.932 | Decreased risk of thromboembolic events with prior aspirin use. Adjusted OR = 0.163, p = 0.02 | |
| Pan et al. | United States | May-21 | Retrospective cohort | Mortality was not associated with the prior use of anti-platelets. Adjusted OR = 1.13 (0.70–1.82) | No correlation between prior anti-platelet use and the composite outcome (high oxygen need, invasive ventilation and death). Adjusted OR = 0.98 (0.65–1.46) | |
| Tremblay et al. | United States | Jul-20 | Retrospective cohort | Mortality was not associated with the prior use of anti-platelets. HR = 1.029 (0.723–1.466) | No correlation between prior anti-platelet use and mechanical ventilation. HR = 1.239 (0.807–1.901) | No correlation between prior anti-platelet use and either survival time, time to mechanical ventilation or hospital admission |
| Russo et al. | Italy | May-20 | Retrospective cohort | In-hospital mortality was not associated with the prior use of anti-platelets. Adjusted RR = 0.51 (0.21–1.15) p-value = 0.110 | No correlation between prior anti-platelet use and ARDS upon admission. Adjusted RR = 0.58 (0.38–1.14), p-value = 0.165 | |
| Banik et al. | Germany | Nov-20 | Retrospective cohort | No correlation between prior anti-platelet use and the composite endpoint death or transfer for ECMO. Adjusted OR = 2.25 (0.0456–270) | No correlation between prior anti-platelet use and the need for mechanical ventilation. Adjusted OR = 0.781 (0.0253–17.0) | Prior anti-platelet use correlated with a positive chest CT. Adjusted OR = 12.1 (1.41–167), p-value = 0.0354 prior use of anti-platelet did not correlate with the length of hospital stay |
| Horby et al. | United Kingdom, Indonesia, Nepal | Jun-21 | RCT | 28-day mortality was not associated with aspirin treatment. RR = 0.96 (0.89–1.04) p = 0.35 | Mechanical ventilation need was not associated with aspirin treatment. RR = 0.96 (0.9–1.03) | Rate of discharges before 28 days was slightly higher among patients in aspirin arm. RR = 1.06 (1.02–1.1) p- value = 0.0062 median time until discharge was 8 days in aspirin users versus 9 days in non-users. There was no correlation with successful cessation of mechanical ventilation or need for renal replacement therapy |
| Kim et al. | South Korea | Sep-21 | Retrospective cohort | Increased risk of death among patients who took aspirin within the 2-weeks prior to COVID-19 diagnosis (40%) vs. those who did not (5%) p-value = 0.027; however, groups were not matched for prior CAD No correlation between mortality and aspirin treatment within 2 weeks after diagnosis | Mechanical ventilation need was not associated with aspirin treatment either before (p-value = 0.141) or after (p-value = 0.173) diagnosis | People who received aspirin after diagnosis were at higher risk of needing oxygen therapy (46.7%) vs. those who did not receive aspirin (35.0%), p-value <0.0001. No correlation between oxygen need and aspirin use before diagnosis. No correlation between COVID infection rate and prior aspirin use. No correlation between aspirin use before or after diagnosis and ICU admission |
CAD, coronary artery disease; NSAIDS, non-steroidal anti-inflammatory drugs; MI, myocardial infarction; CVA, cerebrovascular accident; VTE, venous thromboembolism; ARDS, acute respiratory distress syndrome; ECMO, extra-corporeal membrane oxygenation; ICU, intensive care unit.