A systematic review and meta-analysis on efficacy of low dose aspirin on the management of COVID-19
Manal Banaser, Mutaman Jarrar, Ayed Alqahtani, Abdulelah Banaser, Waleed Albaker
International Journal of Medicine in Developing Countries, doi:10.24911/ijmdc.51-1640383699
COVID-19 pandemic has increased thrombotic risk by 35%. This pandemic led to millions of deaths due to various comorbidities and organ failure. Repurposing aspirin usage to manage COVID-19 hospitalized patients is a logical approach for preventing cardiovascular disease and comorbidities that increase mortality risk. However, several earlier investigations found inconsistent outcomes. This study aims to assess primary and secondary effects in COVID-19 patients with or without aspirin. We performed a multi-database electronic search including Cochrane, Embase, Scopus, and PubMed from date of inception to November 2021 using search terms: ("Coronavirus Disease 2019" OR "COVID-19" OR "SARS-CoV-2" OR "2019-nCoV") AND ("Acetylsalicylic acid" OR "acetylsalicylate" OR "aspirin" OR "antiplatelet") AND ("mortality" OR "severe" OR "severity"). Eight retrospective studies met the study criteria comprising 7,171 aspirin users and 8,327 non-aspirin users in COVID-19. Aspirin administration significantly reduces mortality risk (RR: 0.51, 95% CI: 0.46-0.57, I 2 = 85.05, p-value <0.001, τ 2 = 0.028, Z-value: -11.44, p-value <0.001). Aspirin used in COVID-19 patients demonstrated reduced bleeding risk (RR: 0.80, 95 CI%: 0.34-1.9) and reduced risk for the necessity of mechanical ventilation (RR: 0.70; 95% CI: 0.54-0.90, I 2 = 0%, p-value: 0.41, τ 2 = 0%) when compared with COVID-19 patients without aspirin use. The present review found administration of a low dose of aspirin in COVID-19 patients significantly reduced mortality risk.
Conflict of interest The authors declare that there is no conflict of interest regarding the publication of this article.
Funding None.
Consent to participate Not applicable.
Ethical approval Not applicable.
Author details Manal Banaser 1 , Mutaman Jarrar
References
Akbar, Pranata, Wibowo, Lim, Sihite et al., The prognostic value of elevated creatine kinase to predict poor outcome in patients with COVID-19 -a systematic review and meta-analysis, Diabetes Metab Syndr,
doi:10.1016/j.dsx.2021.02.012Alamdari, Afaghi, Rahimi, Tarki, Tavana et al., Mortality risk factors among hospitalized COVID-19 patients in a major referral center in Iran, Tohoku J Exp Med,
doi:10.1620/tjem.252.73Borenstein, Hedges, Higgins, Rothstein, Comprehensive meta-analysis
Chow, Khanna, Kethireddy, Yamane, Levine et al., Aspirin use is associated with decreased mechanical ventilation, intensive care unit admission, and in-hospital mortality in hospitalized patients with coronavirus disease 2019, Anesth Analg,
doi:10.1213/ANE.0000000000005292Du, Jiang, He, Song, Xu, Antiplatelet therapy for critically Ill patients: a pairwise and bayesian network meta-analysis, Shock,
doi:10.1097/SHK.0000000000001057Han, Yang, Liu, Liu, Wu et al., Prominent changes in blood coagulation of patients with SARS-CoV-2 infection, Clin Chem Lab Med,
doi:10.1515/cclm-2020-0188Helms, Tacquard, Severac, Leonard-Lorant, Ohana et al., High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study, Intensive Care Med,
doi:10.1007/s00134-020-06062-xHo, Dusendang, Schmittdiel, Kavecansky, Tavakoli et al., Association of chronic anticoagulant and antiplatelet use on disease severity in SARS-COV-2 infected patients, J Thromb Thrombolysis,
doi:10.1007/s11239-021-02383-wKlok, 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.2020.04.013Liu, Huang, Li, Zhou, Liang et al., Effect of low-dose aspirin on mortality and viral duration of the hospitalized adults with COVID-19, Medicine,
doi:10.1097/MD.0000000000024544Meizlish, Goshua, Liu, Fine, Amin et al., Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity scorematched analysis, Am J Hematol,
doi:10.1002/ajh.26102Merzon, Green, Vinker, Golan-Cohen, Gorohovski et al., The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection, FEBS J,
doi:10.1111/febs.15784Minno, Ambrosino, Calcaterra, Minno, COVID-19 and venous thromboembolism: a meta-analysis of literature studies, Semin Thromb Hemost,
doi:10.1055/s-0040-1715456Moher, Liberati, Tetzlaff, Altman, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, BMJ,
doi:10.1136/bmj.b2535Moher, Liberati, Tetzlaff, Altman, Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement, Int J Surg,
doi:10.1016/j.ijsu.2010.02.007Osborne, Veigulis, Arreola, Mahajan, Röösli et al., Association of mortality and aspirin prescription for COVID-19 patients at the Veterans Health Administration, PLoS One,
doi:10.1371/journal.pone.0246825Pranata, Lim, Yonas, Huang, Nasution et al., Thrombocytopenia as a prognostic marker in COVID-19 patients: diagnostic test accuracy meta-analysis, Epidemiol Infect,
doi:10.1017/S0950268821000236Russell, Moss, Rigg, Van Hemelrijck, COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting? Ecancermedicalscience,
doi:10.3332/ecancer.2020.1023Sahai, Bhandari, Koupenova, Freedman, Godwin et al., SARS-CoV-2 receptors are expressed on human platelets and the effect of aspirin on clinical outcomes in COVID-19 patients, Res Sq,
doi:10.21203/rs.3.rs-119031/v1Trujillo-Murillo, Rincón-Sánchez, Martínez-Rodríguez, Bosques-Padilla, Ramos-Jiménez et al., Acetylsalicylic acid inhibits hepatitis C virus RNA and protein expression through cyclooxygenase 2 signaling pathways, Hepatology,
doi:10.1002/hep.22215Wang, 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.0154754Yang, Han, Nilsson-Payant, Gupta, Wang et al., A human pluripotent stem cell-based platform to study SARS-CoV-2 tropism and model virus infection in human cells and organoids, Cell Stem Cell,
doi:10.1016/j.stem.2020.06.015Yuan, 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.16198DOI record:
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