Abstract: Manal Banaser et al, 2022;6(3):526–534. https://doi.org/10.24911/IJMDC.51-1640383699 International Journal of Medicine in Developing Countries REVIEW ARTICLE A systematic review and meta-analysis on efficacy of low dose aspirin on the management of COVID-19 Manal Banaser1* , Mutaman Jarrar2,3, Ayed Alqahtani4, Abdulelah Banaser5, Waleed Albaker6 ABSTRACT 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 COVID19. Aspirin administration significantly reduces mortality risk (RR: 0.51, 95% CI: 0.46-0.57, I2 = 85.05, p-value <0.001, τ2 = 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, I2 = 0%, p-value: 0.41, τ2 = 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. Keywords: Low dose aspirin, mortality, COVID-19, thrombosis, antiplatelet drug.