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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Ventilation -8% Improvement Relative Risk Aspirin  Abdelwahab et al.  LATE TREATMENT Is late treatment with aspirin beneficial for COVID-19? Retrospective 67 patients in Egypt Study underpowered to detect differences c19early.org Abdelwahab et al., Clinical Drug Inves.., Jul 2021 Favors aspirin Favors control

Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study

Abdelwahab et al., Clinical Drug Investigation, doi:10.1007/s40261-021-01061-2
Jul 2021  
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Aspirin for COVID-19
24th treatment shown to reduce risk in August 2021
 
*, now known with p = 0.000087 from 73 studies, recognized in 2 countries.
Lower risk for mortality and progression.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Retrospective 225 hospitalized patients in Egypt, showing significantly lower thromboembolic events with aspirin treatment, but no significant difference in the need for mechanical ventilation.
risk of mechanical ventilation, 7.8% higher, RR 1.08, p = 0.93, treatment 11 of 31 (35.5%), control 6 of 36 (16.7%), adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Abdelwahab et al., 30 Jul 2021, retrospective, Egypt, peer-reviewed, 17 authors.
This PaperAspirinAll
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..
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' 'https://doi.org/10.12659/AJCR.925786.', 'volume': '21', 'year': '2020'}, { 'DOI': '10.1016/j.jacc.2020.04.031', 'author': 'B Bikdeli', 'doi-asserted-by': 'publisher', 'first-page': '2950', 'issue': '23', 'journal-title': 'J Am Coll Cardiol', 'key': '1061_CR12', 'unstructured': 'Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, 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. 2020;75(23):2950–73. ' 'https://doi.org/10.1016/j.jacc.2020.04.031.', 'volume': '75', 'year': '2020'}, { 'DOI': '10.1007/s11906-016-0688-8', 'author': 'MS Dzeshka', 'doi-asserted-by': 'publisher', 'first-page': '83', 'issue': '11', 'journal-title': 'Curr Hypertens Rep', 'key': '1061_CR13', 'unstructured': 'Dzeshka MS, Shantsila A, Lip GY. Effects of aspirin on endothelial ' 'function and hypertension. Curr Hypertens Rep. 2016;18(11):83. 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' 'https://doi.org/10.1111/irv.12421.', 'volume': '11', 'year': '2017'}, { 'key': '1061_CR16', 'unstructured': 'The European Society for Cardiology. ESC Guidance for the Diagnosis and ' 'Management of CV Disease during the COVID-19 Pandemic. ' 'https://www.escardio.org/static-file/Escardio/Education-General/Topic%20pages/Covid-19/ESC%20Guidance%20Document/ESC-Guidance-COVID-19-Pandemic.pdf. ' 'Accessed 5 Mar 2021.'}, { 'key': '1061_CR17', 'unstructured': 'COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) ' 'Treatment Guidelines. National Institutes of Health. ' 'https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf. ' 'Accessed 8 Dec 2020.'}, { 'DOI': '10.1111/bjh.16792', 'author': 'DO Griffin', 'doi-asserted-by': 'publisher', 'first-page': 'e11', 'issue': '1', 'journal-title': 'Br J Haematol', 'key': '1061_CR18', 'unstructured': 'Griffin DO, Jensen A, Khan M, Chin J, Chin K, Parnell R, Awwad C, Patel ' 'D. Arterial thromboembolic complications in COVID-19 in low-risk ' 'patients despite prophylaxis. Br J Haematol. 2020;190(1):e11–3. ' 'https://doi.org/10.1111/bjh.16792.', 'volume': '190', 'year': '2020'}, { 'DOI': '10.1161/CIRCULATIONAHA.120.046988', 'author': 'X Zhou', 'doi-asserted-by': 'publisher', 'first-page': '1736', 'issue': '22', 'journal-title': 'Circulation', 'key': '1061_CR19', 'unstructured': 'Zhou X, Li Y, Yang Q. Antiplatelet therapy after percutaneous coronary ' 'intervention in patients with COVID-19: implications from clinical ' 'features to pathologic findings. Circulation. 2020;141(22):1736–8. ' 'https://doi.org/10.1161/CIRCULATIONAHA.120.046988.', 'volume': '141', 'year': '2020'}, { 'DOI': '10.1371/journal.pone.0154754', 'author': 'L Wang', 'doi-asserted-by': 'publisher', 'issue': '5', 'journal-title': 'PLoS ONE', 'key': '1061_CR20', 'unstructured': 'Wang L, Li H, Gu X, Wang Z, Liu S, Chen L. Effect of antiplatelet ' 'therapy on acute respiratory distress syndrome and mortality in ' 'critically ill patients: a meta-analysis. PLoS ONE. 2016;11(5): ' 'e0154754. https://doi.org/10.1371/journal.pone.0154754.', 'volume': '11', 'year': '2016'}, { 'DOI': '10.1213/ANE.0000000000005292', 'author': 'JH Chow', 'doi-asserted-by': 'publisher', 'first-page': '930', 'issue': '4', 'journal-title': 'Anesth Analg', 'key': '1061_CR21', 'unstructured': 'Chow JH, Khanna AK, Kethireddy S, Yamane D, Levine A, Jackson AM, et al. ' '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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Int J Infect Dis. 2021;108:6–12. ' 'https://doi.org/10.1016/j.ijid.2021.05.016.', 'volume': '108', 'year': '2021'}, { 'DOI': '10.1111/jcmm.16198', 'author': 'S Yuan', 'doi-asserted-by': 'publisher', 'first-page': '1263', 'issue': '2', 'journal-title': 'J Cell Mol Med', 'key': '1061_CR24', 'unstructured': 'Yuan S, Chen P, Li H, Chen C, Wang F, Wang DW. Mortality and ' 'pre-hospitalization use of low-dose aspirin in COVID-19 patients with ' 'coronary artery disease. J Cell Mol Med. 2020;25(2):1263–73. ' 'https://doi.org/10.1111/jcmm.16198.', 'volume': '25', 'year': '2020'}, { 'DOI': '10.1016/j.amjcard.2020.12.073', 'author': 'HM Salah', 'doi-asserted-by': 'publisher', 'first-page': '158', 'journal-title': 'Am J Cardiol', 'key': '1061_CR25', 'unstructured': 'Salah HM, Mehta JL. Meta-analysis of the effect of aspirin on mortality ' 'in COVID-19. Am J Cardiol. 2021;142:158–9. 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' 'https://doi.org/10.1148/radiol.2020200370.', 'volume': '295', 'year': '2020'}, { 'key': '1061_CR28', 'unstructured': 'Masoud HH, Elassal, G, Hassany M, Shawky A, Abdel Hakim M, Zaky, S, et ' 'al. Management Protocol for COVID-19 Patients MoHP Protocol for COVID19 ' 'November 2020. ' 'https://www.researchgate.net/publication/345813633_Management_Protocol_for_COVID-19_Patients_MoHP_Protocol_for_COVID19_November_2020/link/5faeb3df92851cf24cca8643/download. ' 'Accessed 9 Mar 2021.'}, { 'DOI': '10.1378/chest.11-2293', 'author': 'JW Eikelboom', 'doi-asserted-by': 'publisher', 'first-page': 'e89S', 'issue': '2', 'journal-title': 'Chest', 'key': '1061_CR29', 'unstructured': 'Eikelboom JW, Hirsh J, Spencer FA, Baglin TP, Weitz JI. Antiplatelet ' 'drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: ' 'American College of Chest Physicians Evidence-Based Clinical Practice ' 'Guidelines. Chest. 2012;141(2):e89S-e119S. ' 'https://doi.org/10.1378/chest.11-2293.', 'volume': '141', 'year': '2012'}, { 'DOI': '10.1182/blood-2015-04-640649', 'author': 'J Cho', 'doi-asserted-by': 'publisher', 'first-page': '3523', 'issue': '23', 'journal-title': 'Blood', 'key': '1061_CR30', 'unstructured': 'Cho J. A paradigm shift in platelet transfusion therapy. Blood. ' '2015;125(23):3523–5. https://doi.org/10.1182/blood-2015-04-640649.', 'volume': '125', 'year': '2015'}, { 'DOI': '10.1016/j.avsg.2020.08.087', 'author': 'I Cheruiyot', 'doi-asserted-by': 'publisher', 'first-page': '273', 'journal-title': 'Ann Vasc Surg', 'key': '1061_CR31', 'unstructured': 'Cheruiyot I, Kipkorir V, Ngure B, Misiani M, Munguti J, Ogeng’o J. ' 'Arterial thrombosis in coronavirus disease 2019 patients: a rapid ' 'systematic review. Ann Vasc Surg. 2021;70:273–81. ' 'https://doi.org/10.1016/j.avsg.2020.08.087.', 'volume': '70', 'year': '2021'}, { 'DOI': '10.1016/j.thromres.2020.08.022', 'author': 'SK Kunutsor', 'doi-asserted-by': 'publisher', 'first-page': '27', 'journal-title': 'Thromb Res', 'key': '1061_CR32', 'unstructured': 'Kunutsor SK, Laukkanen JA. Incidence of venous and arterial ' 'thromboembolic complications in COVID-19: a systematic review and ' 'meta-analysis. Thromb Res. 2020;196:27–30. ' 'https://doi.org/10.1016/j.thromres.2020.08.022.', 'volume': '196', 'year': '2020'}, { 'DOI': '10.3389/fcvm.2020.562708', 'author': 'T Diaz', 'doi-asserted-by': 'publisher', 'journal-title': 'Front Cardiovasc Med.', 'key': '1061_CR33', 'unstructured': 'Diaz T, Trachtenberg BH, Abraham SJK, KosagiSharaf R, Durant-Archibold ' 'AA. Aspirin bioactivity for prevention of cardiovascular injury in ' 'COVID-19. Front Cardiovasc Med. 2020;7: 562708. 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' 'https://doi.org/10.1016/j.ijcard.2020.09.064.', 'volume': '324', 'year': '2021'}, { 'DOI': '10.1177/1358863X211012754', 'author': 'A Sahai', 'doi-asserted-by': 'publisher', 'journal-title': 'Vasc Med', 'key': '1061_CR36', 'unstructured': 'Sahai A, Bhandari R, Godwin M, McIntyre T, Chung MK, Iskandar JP, et al. ' 'Effect of aspirin on short-term outcomes in hospitalized patients with ' 'COVID-19. Vasc Med. 2021. https://doi.org/10.1177/1358863X211012754.', 'year': '2021'}, { 'DOI': '10.1213/ANE.0000000000005401', 'author': 'M Giorgi-Pierfranceschi', 'doi-asserted-by': 'publisher', 'first-page': 'e89', 'issue': '5', 'journal-title': 'Anesth Analg', 'key': '1061_CR37', 'unstructured': 'Giorgi-Pierfranceschi M. Is aspirin effective in preventing ICU ' 'admission in patients with COVID-19 pneumonia? Anesth Analg. ' '2021;132(5):e89–90. https://doi.org/10.1213/ANE.0000000000005401.', 'volume': '132', 'year': '2021'}, { 'DOI': '10.1080/20009666.2020.1835297', 'author': 'SS Roomi', 'doi-asserted-by': 'publisher', 'first-page': '17', 'issue': '1', 'journal-title': 'J Community Hosp Intern Med Perspect.', 'key': '1061_CR38', 'unstructured': 'Roomi SS, Saddique M, Ullah W, Haq S, Ashfaq A, Madara J, et al. ' 'Anticoagulation in COVID-19: a single-center retrospective study. J ' 'Community Hosp Intern Med Perspect. 2021;11(1):17–22. ' 'https://doi.org/10.1080/20009666.2020.1835297.', 'volume': '11', 'year': '2021'}, { 'DOI': '10.1016/j.chest.2017.08.008', 'author': 'TA Miano', 'doi-asserted-by': 'publisher', 'first-page': '133', 'issue': '1', 'journal-title': 'Chest', 'key': '1061_CR39', 'unstructured': 'Miano TA, Cuker A, Christie JD, Martin N, Smith B, Makley AT, et al. ' 'Comparative effectiveness of enoxaparin vs dalteparin for ' 'thromboprophylaxis after traumatic injury. 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Dalteparin versus enoxaparin for the prevention of venous ' 'thromboembolic events in trauma patients. Eur J Trauma Emerg Surg. ' '2014;40(2):183–9. https://doi.org/10.1007/s00068-013-0333-z.', 'volume': '40', 'year': '2014'}, { 'DOI': '10.1056/NEJMoa1601747', 'author': 'AT Cohen', 'doi-asserted-by': 'publisher', 'first-page': '534', 'issue': '6', 'journal-title': 'N Engl J Med', 'key': '1061_CR42', 'unstructured': 'Cohen AT, Harrington RA, Goldhaber SZ, Hull RD, Wiens BL, Gold A, ' 'Hernandez AF, Gibson CM, APEX Investigators. Extended thromboprophylaxis ' 'with betrixaban in acutely ill medical patients. N Engl J Med. ' '2016;375(6):534–44. https://doi.org/10.1056/NEJMoa1601747.', 'volume': '375', 'year': '2016'}, { 'DOI': '10.1056/NEJMoa1111096', 'author': 'AT Cohen', 'doi-asserted-by': 'publisher', 'first-page': '513', 'issue': '6', 'journal-title': 'N Engl J Med', 'key': '1061_CR43', 'unstructured': 'Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, Mebazaa A, Merli ' 'G, Schellong S, Spyropoulos AC, Tapson V, MAGELLAN Investigators. ' 'Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N ' 'Engl J Med. 2013;368(6):513–23. https://doi.org/10.1056/NEJMoa1111096.', 'volume': '368', 'year': '2013'}, { 'DOI': '10.1056/NEJMoa1110899', 'author': 'SZ Goldhaber', 'doi-asserted-by': 'publisher', 'first-page': '2167', 'issue': '23', 'journal-title': 'N Engl J Med', 'key': '1061_CR44', 'unstructured': 'Goldhaber SZ, Leizorovicz A, Kakkar AK, Haas SK, Merli G, Knabb RM, ' 'Weitz JI, ADOPT Trial Investigators. Apixaban versus enoxaparin for ' 'thromboprophylaxis in medically ill patients. N Engl J Med. ' '2011;365(23):2167–77. https://doi.org/10.1056/NEJMoa1110899.', 'volume': '365', 'year': '2011'}], 'reference-count': 44, 'references-count': 44, 'relation': {}, 'resource': {'primary': {'URL': 'https://link.springer.com/10.1007/s40261-021-01061-2'}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subject': ['Pharmacology (medical)', 'General Medicine'], 'subtitle': [], 'title': 'Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical ' 'Ventilation in COVID-19 Patients: A Retrospective Cohort Study', 'type': 'journal-article', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'volume': '41'}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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