American Study Shows That Taking Low Dose Aspirin Decreases Risk Of Severity And Mortality When Infected With COVID-19

A new study led by researchers from George Washington University and also included scientists from the University of Maryland, Wake Forest School of Medicine, Northeast Georgia Health System, Walter Reed National Military Medical Center, University of California-San Francisco and the University of Oklahoma School of Medicine have found that low dose aspirin may reduce the need for mechanical ventilation, ICU admission and in-hospital mortality in hospitalized COVID-19 patients.


 
The study team conducted a retrospective, observational cohort Aspirin-COVID-19 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.
 
A total of 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.
 
The study findings found that 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).
 
Upon 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.
 
The study findings concluded that aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. 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.
 
The study results were published in the peer reviewed journal: Anesthesia & Analgesia. https://journals.lww.com/anesthesia-analgesia/Fulltext/2021/04000/Aspirin_Use_Is_Associated_With_Decreased.2.aspx
 
Lead researcher, Dr Jonathan Chow, MD, Assistant Professor, Anesthesiology and Critical Care Medicine and Director, Critical Care Anesthesiology Fellowship, George Washington School of Medicine and Health Sciences told Thailand Medical News, “As we learned about the connection between blood clots and COVID-19, we knew that aspirin that is often used to prevent stroke and he art attack, could be important for COVID-19 patients. Our research found an association between low dose aspirin and decreased severity of COVID-19 and death."
 
In the study, over 400 patients admitted from March to July 2020 to hospitals around the United States, including those at GW Hospital, the University of Maryland Medical Center, Wake Forest Baptist Medical Center and Northeast Georgia Health System, were included in the study. After adjusting for demographics and comorbidities, aspirin use was associated with a decreased risk of mechanical ventilation (44% reduction), ICU admission (43% reduction), and in-hospital mortality (47% reduction).
 
It should be noted that there were no differences in major bleeding or overt thrombosis between aspirin users and non-aspirin users.
 
It should be noted that preliminary findings were first published as a preprint in fall 2020. Since then, other studies have confirmed the impact aspirin can have on both preventing infection and reducing risk for severe COVID-19 and death. https://www.thailandmedical.news/news/breaking-university-of-maryland-study-shows-that-aspirin-use-reduces-risk-of-both-mortality-and-mechanical-ventilation-in-hospitalized-covid-19-patien
 
Dr Chow hopes that this study leads to more research on whether a causal relationship exists between aspirin use and reduced lung injury in COVID-19 patients.
 
Dr Chow added, "Aspirin is low cost, easily accessible and millions are already using it to treat their health conditions. Finding this association is a huge win for those looking to reduce risk from some of the most devastating effects of COVID-19."
 
The study team said that aspirin’s anti-inflammatory properties may also contribute to its lung-protective effects in COVID-19. Aspirin has been shown to decrease the production of interleukin-6 (IL-6), C-reactive protein (CRP), and macrophage colony-stimulating factor in patients with cardiovascular disease, and in COVID-19, these actions could reduce the incidence of cytokine storm.
 
In the study, patients on aspirin had significantly lower initial plasma fibrinogen concentration, which might be explained by aspirin’s effect on the acetylation of fibrinogen and acceleration of fibrinolysis. Aspirin also has an inhibitory effect on cyclooxygenase-2 (COX-2), which decreases IL-6 and CRP production.
 
There is now substantial evidence that COVID-19 is a systemic disease affecting the vasculature and that SARS-CoV-2 causes vascular endothelialitis involving the pulmonary capillary endothelium. Electron microscopy and histological analyses have demonstrated that SARS-CoV-2 infects endothelial cells in multiple organs, causing endothelialitis, impaired microcirculation, and apoptosis, all of which leads to inflammation and microthrombosis.  Microthrombosis has been well described in autopsies of COVID-19 patients, and excess megakaryocytes have been observed in the heart, lungs, and kidneys of deceased patients. Aspirin, as an irreversible antiplatelet agent, may prevent platelets produced from these megakaryocytes from aggregating and creating microthrombi.
 
In summary, the study team’s analysis suggests that aspirin use may have beneficial effects in patients with COVID-19. Mechanistically, these findings are plausible given aspirin’s irreversible antiplatelet effect and the frequent hypercoagulability observed in COVID-19 patients. 
 
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