Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study
Shaker Heba Wagih Abdelwahab, Shaker Wagih Shaltout, Hazem A Sayed Ahmed, Ahmed Mahmoud Fouad, Eric Merrell, Jeffrey B Riley, Rasha Salama, Ahmed Gharib Abdelrahman, Edward Darling, Ghada Fadel, Mohamed S A Elfar, Khaled Sabry, Jaffer Shah, Hossam Amin, Gary F Nieman, Adel Mishriky, Hani Aiash
Clinical Drug Investigation, doi:10.1007/s40261-021-01061-2
Background and Objective Low-dose acetylsalicylic acid (ASA, aspirin) is a well-known and frequently studied drug for primary and secondary prevention of disease due to its anti-inflammatory and coagulopathic effects. COVID-19 complications are attributed to the role of thrombo-inflammation. Studies regarding the use of low-dose ASA in COVID-19 are limited. For this reason, we propose that the use of low-dose ASA may have protective effects in COVID-19-related thromboembolism and lung injury. This study was conducted to assess the efficacy of low-dose ASA compared with enoxaparin, an anticoagulant, for the prevention of thrombosis and mechanical ventilation. Methods We conducted a retrospective cohort study on COVID-19-confirmed hospitalized patients at the Mansoura University Quarantine Hospital, outpatients, and home-isolated patients from September to December 2020 in Mansoura governorate, Egypt. Binary logistic regression analysis was used to assess the effect of ASA compared with enoxaparin on thromboembolism, and mechanical ventilation needs. Results This study included 225 COVID-19 patients. Use of ASA-only (81-162 mg orally daily) was significantly associated with reduced thromboembolism (OR 0.163, p = 0.020), but both low-dose ASA and enoxaparin, and enoxaparin-only (0.5 mg/kg subcutaneously (SC) daily as prophylactic dose or 1 mg/kg SC every 12 hours as therapeutic dose) were more protective (odds ratio [OR] 0.010, OR 0.071, respectively, p < 0.001). Neither ASA-only nor enoxaparin-only were associated with a reduction in mechanical ventilation needs. Concomitant use of low-dose ASA and enoxaparin was associated with reduced mechanical ventilation (OR 0.032, 95% CI 0.004-0.226, p = 0.001). Conclusions Low-dose ASA-only use may reduce the incidence of COVID-19-associated thromboembolism, but the reduction may be less than that of enoxaparin-only, and both ASA and enoxaparin. Concomitant use of ASA and enoxaparin demonstrates promising results with regard to the reduction of thrombotic events, and mechanical ventilation needs.
Declarations Funding No financial support was obtained from any individual, institutions, agencies, drug industries or organizations.
Competing interests The authors declare that they have no competing interests.
Ethics approval This study was approved by the Mansoura Institutional Research Board Ethics (code number: R.20.08.971), which waived the need for informed consent.
Consent to participate The Ethics Committee of Mansoura University waived the need for informed consent from the study population for the collection, analysis, and publication of the retrospectively obtained and anonymized data for this non-interventional study.
Consent to publish Not applicable. Author contributions HWA, SWS, and HASA contributed equally to this work and share first authorship. HA put the idea of the research, built the research team, designed the study, revised the manuscript, and approved the final version of manuscript. HWA and SWS participated in designing the study, collected the data, revised the manuscript, and approved the final version of manuscript. HASA participated in designing the study, wrote the manuscript draft, and approved the final version of manuscript. AMF participated in designing the study, analyzed the data, revised the manuscript, and approved the final version of manuscript. AM and AGA participated in designing the study and in statistical analysis, revised the manuscript, and approved the final version. EM, ED, JBR, GF, and GFN participated in designing..
References
Ackermann, Verleden, Kuehnel, Haverich, Welte et al., Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19, N Engl J Med,
doi:10.1056/NEJMoa2015432Ahmed, Merrell, Ismail, Joudeh, Riley et al., Rationales and uncertainties for aspirin use in COVID-19: a narrative review, Fam Med Com Health,
doi:10.1136/fmch-2020-000741Bikdeli, Madhavan, Jimenez, Chuich, Dreyfus et al., COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review, J Am Coll Cardiol,
doi:10.1016/j.jacc.2020.04.031Bilaloglu, Aphinyanaphongs, Jones, Iturrate, Hochman et al., Thrombosis in hospitalized patients with COVID-19 in a New York City health system, JAMA,
doi:10.1001/jama.2020.13372Cheruiyot, Kipkorir, Ngure, Misiani, Munguti et al., Arterial thrombosis in coronavirus disease 2019 patients: a rapid systematic review, Ann Vasc Surg,
doi:10.1016/j.avsg.2020.08.087Chow, Khanna, Kethireddy, Yamane, Levine et al., Aspirin use is associated with decreased mechanical ventilation, ICU admission, and in-hospital mortality in hospitalized patients with COVID-19, Anesth Analg,
doi:10.1213/ANE.0000000000005292Cohen, Harrington, Goldhaber, Hull, Wiens et al., Extended thromboprophylaxis with betrixaban in acutely ill medical patients, N Engl J Med,
doi:10.1056/NEJMoa1601747Cohen, Spiro, Büller, Haskell, Hu et al., Rivaroxaban for thromboprophylaxis in acutely ill medical patients, N Engl J Med,
doi:10.1056/NEJMoa1111096Cook, Meade, Guyatt, Walter, Heels-Ansdell, PROTECT Investigators for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group, N Engl J Med,
doi:10.1056/NEJMoa1014475Diaz, Trachtenberg, Abraham, Kosagisharaf, Aa, Aspirin bioactivity for prevention of cardiovascular injury in COVID-19, Front Cardiovasc Med,
doi:10.3389/fcvm.2020.562708Eikelboom, Hirsh, Spencer, Baglin, Weitz, Antiplatelet drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, Chest,
doi:10.1378/chest.11-2293Glatthaar-Saalmüller, Mair, Saalmüller, Antiviral activity of aspirin against RNA viruses of the respiratory tract-an in vitro study, Influenza Other Respir Viruses,
doi:10.1111/irv.12421Godino, Scotti, Maugeri, Mancini, Fominskiy et al., Antithrombotic therapy in patients with COVID-19?-rationale and evidence, Int J Cardiol,
doi:10.1016/j.ijcard.2020.09.064Goldhaber, Leizorovicz, Kakkar, Haas, Merli et al., Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients, N Engl J Med,
doi:10.1056/NEJMoa1110899Goshua, Pine, Meizlish, Chang, Zhang et al., Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study, Lancet Haematol,
doi:10.1016/S2352-3026(20)30216-7Griffin, Jensen, Khan, Chin, Chin et al., Arterial thromboembolic complications in COVID-19 in low-risk patients despite prophylaxis, Br J Haematol,
doi:10.1111/bjh.16792Klok, Kruip, Van Der Meer, Arbous, Gommers et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19, Thromb Res,
doi:10.1016/j.thromres.2020.04.013Kunutsor, Laukkanen, Incidence of venous and arterial thromboembolic complications in COVID-19: a systematic review and meta-analysis, Thromb Res,
doi:10.1016/j.thromres.2020.08.022Liu, Li, Arnold, Pawlinski, Key, Using heparin molecules to manage COVID-2019, Res Pract Thromb Haemost,
doi:10.1002/rth2.12353Lodigiani, Iapichino, Carenzo, Cecconi, Ferrazzi et al., Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy, Thromb Res,
doi:10.1016/j.thromres.2020.04.024Martha, Pranata, Lim, Wibowo, Akbar, Active prescription of low-dose aspirin during or prior to hospitalization and mortality in COVID-19: a systematic review and meta-analysis of adjusted effect estimates, Int J Infect Dis,
doi:10.1016/j.ijid.2021.05.016Masoud, Elassal, Hassany, Shawky, Hakim et al., Management Protocol for COVID-19 Patients MoHP Protocol for COVID19 November
Meizlish, Goshua, Liu, Fine, Amin et al., Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis, Am J Hematol,
doi:10.1002/ajh.26102Miano, Cuker, Christie, Martin, Smith et al., Comparative effectiveness of enoxaparin vs dalteparin for thromboprophylaxis after traumatic injury, Chest,
doi:10.1016/j.chest.2017.08.008Okoye, Gelbard, Inaba, Esparza, Belzberg et al., Dalteparin versus enoxaparin for the prevention of venous thromboembolic events in trauma patients, Eur J Trauma Emerg Surg,
doi:10.1007/s00068-013-0333-zOran, Topol, Prevalence of asymptomatic SARS-CoV-2 infection: a narrative review, Ann Intern Med,
doi:10.7326/M20-3012Pan, Ye, Sun, Gui, Liang et al., Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19), Radiology,
doi:10.1148/radiol.2020200370Porfidia, Valeriani, Pola, Porreca, Rutjes et al., Venous thromboembolism in patients with COVID-19: systematic review and meta-analysis, Thromb Res,
doi:10.1016/j.thromres.2020.08.020Roomi, Saddique, Ullah, Haq, Ashfaq et al., Anticoagulation in COVID-19: a single-center retrospective study, J Community Hosp Intern Med Perspect,
doi:10.1080/20009666.2020.1835297Sahai, Bhandari, Godwin, Mcintyre, Chung et al., Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19, Vasc Med,
doi:10.1177/1358863X211012754Shawkat, Merrell, Fadel, Amzuta, Amin et al., Multiple thrombotic events in a 67-year-old man 2 weeks after testing positive for SARS-CoV-2: a case report, Am J Case Rep,
doi:10.12659/AJCR.925786Wang, Li, Gu, Wang, Liu et al., Effect of antiplatelet therapy on acute respiratory distress syndrome and mortality in critically ill patients: a meta-analysis, PLoS ONE,
doi:10.1371/journal.pone.0154754Yuan, Chen, Li, Chen, Wang et al., Mortality and pre-hospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease, J Cell Mol Med,
doi:10.1111/jcmm.16198Zeng, Huang, Guo, Yin, Chen et al., Association of inflammatory markers with the severity of COVID-19: a meta-analysis, Int J Infect Dis,
doi:10.1016/j.ijid.2020.05.055Zhou, Li, Yang, Antiplatelet therapy after percutaneous coronary intervention in patients with COVID-19: implications from clinical features to pathologic findings, Circulation,
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'inflammatory markers with the severity of COVID-19: a meta-analysis. Int '
'J Infect Dis. 2020;96:467–74. '
'https://doi.org/10.1016/j.ijid.2020.05.055.',
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'al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in '
'Covid-19. N Engl J Med. 2020;383(2):120–8. '
'https://doi.org/10.1056/NEJMoa2015432.',
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'journal-title': 'Curr Hypertens Rep'},
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'Aspirin use is associated with decreased mechanical ventilation, ICU '
'admission, and in-hospital mortality in hospitalized patients with '
'COVID-19. Anesth Analg. 2021;132(4):930–41. '
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