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0 0.5 1 1.5 2+ Mortality 27% Improvement Relative Risk Mortality (b) 14% Aspirin for COVID-19  Al Harthi et al.  LATE TREATMENT Is late treatment with aspirin beneficial for COVID-19? PSM retrospective 351 patients in Saudi Arabia Lower mortality with aspirin (p=0.03) Al Harthi et al., J. Intensive Care Me.., Sep 2021 Favors aspirin Favors control

Evaluation of Low-Dose Aspirin use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study

Al Harthi et al., Journal of Intensive Care Medicine, doi:10.1177/08850666221093229
Sep 2021  
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Retrospective 1,033 critical condition patients, showing lower in-hospital mortality with aspirin in PSM analysis. Patients receiving aspirin also had a higher risk of significant bleeding, although not reaching statistical significance. Authors note that the use of aspirin during an ICU stay should be tailored to each patient.
risk of death, 27.0% lower, HR 0.73, p = 0.03, treatment 98 of 176 (55.7%), control 107 of 173 (61.8%), adjusted per study, in-hospital mortality, multivariable Cox proportional hazards.
risk of death, 14.0% lower, HR 0.86, p = 0.30, treatment 95 of 176 (54.0%), control 97 of 175 (55.4%), adjusted per study, day 30, multivariable Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Al Harthi et al., 3 Sep 2021, retrospective, propensity score matching, Saudi Arabia, peer-reviewed, 21 authors.
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Evaluation of low-dose aspirin use among COVID-19 critically ill patients: A Multicenter Propensity Score Matched Study
Abdullah Al Harthi, Khalid Al Sulaiman, Ohoud Aljuhani, Ghazwa B Korayem, Ali F Altebainawi, Raghdah S Alenezi, Shmeylan Al Harbi, Jawaher Gramish, Raed Kensara, Awattif Hafidh, Huda Al Enazi, Ahad Alawad, Rand Alotaibi, Abdulaziz Alshehri, Omar Alhuthaili, Ramesh Vishwakarma, Khalid Bin Saleh, Thamer Alsulaiman, Rahaf Ali Alqahtani, Saja Almazrou, Sajid Hussain
Background Multiple medications with anti-in ammatory effects have been used to manage the hyper-in ammatory response associated with COVID-19. Aspirin is used widely as a cardioprotective agent due to its antiplatelet and anti-in ammatory properties. Its role in hospitalized COVID-19 patients has been assessed and evaluated in the literature. However, no data regards its role in COVID-19 critically ill patients. Therefore, this study aims to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in COVID-19 critically ill patients. Method This is a multicenter, retrospective cohort study for all adult critically ill patients with con rmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classi ed into two groups based on aspirin use during ICU stay. The primary outcome is the in-hospital mortality; other outcomes were considered secondary. Propensity score-matched used based on patient's age, SOFA score, MV status within 24 hours of ICU admission, prone position status, ischemic heart disease (IHD), and stroke as co-existing illness. We considered a P value of < 0.05 statistically signi cant. Results A total of 1033 patients were eligible; 352 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality (HR (95%CI): 0.73 (0.56, 0.97), p-value=0.03) were lower in patients who received aspirin during hospital stay. On the other hand, patients who received aspirin have a higher risk of major bleeding compared to the control group (OR (95%CI): 2.92 (0.91, 9.36), p-value=0.07); but was not statistically signi cant. Conclusion Aspirin use in COVID-19 critically ill patients may have a mortality bene t; nevertheless, it may be linked with an increased risk of signi cant bleeding. The bene t-risk evaluation for aspirin usage during an ICU stay should be tailored to each patient.
Author contributions All authors contributed to data collections, analysis, drafted, revised, and approved the nal version of the manuscript. Funding None. Ethics approval and consent to participate The study was approved in March 2021 by King Abdullah International Medical Research Center Institutional Review Board, Riyadh, Saudi Arabia (Ref.# NRC21R/058/02). Participants' con dentiality was strictly observed throughout the study by using anonymous unique serial number for each subject and restricting data only to the investigators. Informed consent was not required due to the research's method as per the policy of the governmental and local research center. Consent for publication Not applicable. Competing interests No author has a con ict of interest in this study.
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Late treatment
is less effective
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