Published online Mar 9, 2022. doi: 10.5492/wjccm.v11.i2.92
Peer-review started: November 18, 2021
First decision: December 27, 2021
Revised: January 3, 2022
Accepted: January 20, 2022
Article in press: January 20, 2022
Published online: March 9, 2022
In a retrospective study by Chow et al, it was found that aspirin use may be associated with improved outcomes, reduced rates of mechanical ventilation, and decreased intensive care unit (ICU) admissions in hospitalized coronavirus disease 2019 (COVID-19) patients. Given the encouraging findings, the world’s largest randomized controlled open-label trial was performed using approximately 15000 patients in the UK (RECOVERY TRIAL). The patients in the study were allocated to receive aspirin after diagnosis of COVID-19 during in-hospital admission, and the results showed no associated reductions in the 28-d mortality or the progression to mechanical ventilation of such patients. With the above conflicting findings, the present study was designed to evaluate the impact of daily aspirin intake prior to hospitalization on the rate of COVID-19 positive patients’ progression to the ICU.
With the never ending COVID-19 pandemic, it is imperative we find ways to keep patients out of the ICU. We have learnt that COVID-19 illness has major thrombotic and inflammatory effects. Aspirin would seem like an ideal choice to curb these effects. With this in mind, we conducted our study. But surprisingly we found that aspirin has no beneficial effects when it comes to preventing severe COVID-19 illness like ICU admissions. We postulate that patients taking aspirin were also older and had significant comorbidities, putting them at high risk for severe COVID-19. Furthermore, this study was carried out back when the most effective treatment modalities like steroids and remdesivir were not used. Hence, we conclude that aspirin's antiviral, anti-inflammatory and anti-thrombotic properties may not be strong enough to combat the COVID-19 illness.
Present study was designed to evaluate the impact of daily aspirin intake prior to hospitalization on the rate of COVID-19 positive patients’ progression to the ICU.
The idea of using the below methods were modeled after the study by Chow et al and the recovery trial on Aspirin in patients admitted to the hospital with COVID-19. Research methods adopted were the following: (1) Categorical variables, such as demographic information, comorbidities, receipt of investigational therapeutics, type of oxygen support, mechanical ventilation need, and outcomes, were reported as the number and percentage of patients and were compared between groups using the χ2 test. P values < 0.05 were considered statistically significant; and (2) Multinomial logistic regression analysis to control for interplay of confounding from other anti-coagulation agents.
Our study analyzed 125 patients, of which 38 patients were on daily aspirin use, with a minimum dose of 81 mg. The study showed a significant association of aspirin with variables such as age groups, hypertension, hyperlipidemia, and diabetes mellitus. This insinuated that our aspirin patients were older, and most of them had significant comorbidities, putting them at risk of severe COVID-19 illness. At first glance, aspirin showed a possible protective role in progression to ICU on chi-square analysis. It failed to reach significance in multinomial logistic regression analysis. Furthermore, in terms of mortality, patients on aspirin had a higher mortality rate of 32% as compared to only 25% for non-aspirin users. This could be explained by the fact that patients on aspirin were older and had more comorbidities.
We conclude that aspirin shows no protective role for COVID-19 patients in terms of progression to ICU, survival outcome, and use of mechanical ventilation. Our findings concurred with the results of the RECOVERY trial. The advantage of our study is that it was conducted on the cohort of patients that presented at our hospital during the initial phase of the COVID-19 pandemic back in March of 2020. At that time, the use of corticosteroids and remdesivir were not established as the standard of care, and hence our study is not confounded by the effects of these medications.
Given the conflicting results of recent studies on aspirin and COVID-19 illness, it would seem beneficial for future studies to study the effect of chronic daily aspirin use on COVID-19 outcomes. Since our N-126, larger studies with N-1000s may be able to show definitive significance between aspirin and COVID-19. In theory, aspirin is an over the counter, cheap medication with a wide range of properties to battle the ill effects of the virus.