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0 0.5 1 1.5 2+ Mortality, day 56 33% Improvement Relative Risk Mortality, day 30 40% Hospitalization 20% Aspirin for COVID-19  Abul et al.  Prophylaxis Is prophylaxis with aspirin beneficial for COVID-19? Retrospective 1,687 patients in the USA (December 2020 - September 2021) Lower mortality with aspirin (p=0.025) Abul et al., medRxiv, August 2022 Favors aspirin Favors control

Association of mortality and aspirin use for COVID-19 residents at VA Community Living Center Nursing Homes

Abul et al., medRxiv, doi:10.1101/2022.08.03.22278392
Aug 2022  
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Retrospective 1,687 nursing home residents in the USA, showing significantly lower risk of mortality with chronic low-dose aspirin use. Low dose 81mg aspirin users had treatment ≥10 of 14 days prior to the positive COVID date, control patients had no aspirin use in the prior 14 days.
risk of death, 33.0% lower, HR 0.67, p = 0.03, treatment 46 of 511 (9.0%), control 201 of 1,176 (17.1%), Cox proportional hazards, day 56.
risk of death, 40.0% lower, HR 0.60, p = 0.01, treatment 33 of 511 (6.5%), control 154 of 1,176 (13.1%), Cox proportional hazards, day 30.
risk of hospitalization, 20.0% lower, HR 0.80, p = 0.13, treatment 103 of 511 (20.2%), control 352 of 1,176 (29.9%), Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Abul et al., 4 Aug 2022, retrospective, USA, preprint, mean age 72.3, 10 authors, study period 13 December, 2020 - 18 September, 2021.
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Association of mortality and aspirin use for COVID-19 residents at VA Community Living Center Nursing Homes
MD¹, ², ³ Yasin Abul, MS¹ Frank Devone, MD¹, ², ³ Thomas A Bayer, MS¹ Christopher Halladay, PharmD Kevin Mcconeghy, Nadia Mujahid, MD Mriganka Singh, MS¹, ² Ciera Leeder, MD, MS² Stefan Gravenstein, MPH¹, ², ³ James L Rudolph
Background/Objectives: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state and increased thrombotic risk in infected individuals. Several complex and varied coagulation abnormalities were proposed for this association 1 .Acetylsalicylic acid(ASA, aspirin) is known to have inflammatory, antithrombotic properties and its use was reported as having potency to reduce RNA synthesis and replication of some types of coronaviruses including human coronavirus-299E (CoV-229E) and Middle East Respiratory Syndrome (MERS)-CoV 2,3 . We hypothesized that chronic low dose aspirin use may decrease COVID-19 mortality relative to ASA non-users. Methods: This is a retrospective, observational cohort analysis of residents residing at Veterans Affairs Community Living Centers from December 13, 2020, to September 18, 2021, with a positive SARS-CoV-2 PCR test. Low dose aspirin users had low dose (81mg) therapy (10 of 14 days) prior to the positive COVID date and were compared to aspirin non-users (no ASA in prior 14 days). The primary outcome was mortality at 30 and 56 days post positive test and hospitalization. Results: We identified 1.823 residents who had SARS-CoV-2 infection and 1,687 residents were eligible for the study. Aspirin use was independently associated with a reduced risk of 30 days of mortality (adjusted HR, 0.60, 95% CI, 0.40-0.90) and 56 days of mortality (adjusted HR, 0.67, 95% CI, 0.47-0.95) Conclusion: Chronic low dose aspirin use for primary or secondary prevention of cardiovascular events is associated with lower COVID-19 mortality. Although additional randomized controlled trials are required to understand these associations and the potential implications more fully for improving care, aspirin remains a medication with known side effects and clinical practice should not change based on these findings.
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