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Aspirin for COVID-19
79 studies with >180,000 patients
Serious outcome risk
Aspirin
Control
Significantly lower risk for mortality and progression.
8% lower mortality in 68 studies, 16% lower risk in the REMAP-CAP RCT, and 17% for non-LMWH patients in the RECOVERY RCT
Benefit may be more likely without coadministered anticoagulants. May increase major bleeding risk.
COVID-19 Aspirin studies · October 2026
Bunditanukul et al. show increased risk of major bleeding. Benefit may be more likely without coadministered anticoagulants. Aspirin was adopted in 7 countries. Recent:
Bunditanukul.
Covid Analysis Aspirin for COVID-19: real-time meta-analysis of 79 studies (Version 70)
Significantly lower risk is seen for mortality and progression. 28 studies from 26 independent teams in 11 countries show significant benefit. Meta-analysis using the most serious outcome reported shows 8% [2‑13%] lower risk. E..
Sep 1
 Bunditanukul et al., Journal of Pharmacy & Pharmacognosy Research, doi:10.56499/jppres_14.5.2652 Aspirin use and clinical outcomes in coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis
Systematic review and meta-analysis of 33 studies (5 RCTs and 28 observational studies, 187,224 participants). The RCT analysis (n=20,577) shows 5% lower mortality, without reaching statistical significance. Aspirin was associated with a ..
Jan 7
 Perico et al., Frontiers in Immunology, doi:10.3389/fimmu.2025.1706997 Acetylsalicylic acid disrupts SARS-CoV-2 spike protein glycosylation and selectively impairs binding to ACE2
In vitro and mouse study showing that acetylsalicylic acid (ASA/aspirin) inhibits SARS-CoV-2 spike protein S1 subunit binding to ACE2 in a dose-dependent manner.
Jun 18
2025
 Trimarco et al., npj Metabolic Health and Disease, doi:10.1038/s44324-025-00072-3 Aspirin reduces the risk of type 2 diabetes associated with COVID-19
Retrospective 35,525 adults followed from 2018 to 2022, showing that daily low-dose aspirin (100 mg) significantly reduced the risk of new-onset type 2 diabetes (T2D). After propensity score matching, aspirin users had a 52% overall reduc..
Feb 11
2025
 Kurnik et al., Viruses, doi:10.3390/v17020244 Systolic Pulmonary Artery Pressure as Long-Term Mortality Predictor in Elderly Critically Ill with Severe COVID-19 Pneumonia
11% higher mortality (p=0.37). Retrospective 130 elderly (≥70 years) critically ill COVID-19 patients showing no significant difference in long-term mortality with aspirin usage.
Feb 20
2025
 Dinoi et al., Biomedicines, doi:10.3390/biomedicines13030535 (date from preprint) Retrospective Clinical Investigation into the Association Between Abnormal Blood Clotting, Oral Anticoagulant Therapy, and Medium-Term Mortality in a Cohort of COVID-19 Patients
55% higher mortality (p=0.03). Retrospective 247 non-survivors and 247 matched survivors in hospitalized COVID-19 patients in Italy showing results for several treatments.
Dec 8
2024
 Miele et al., medRxiv, doi:10.1101/2024.12.07.24318645 Effect of background therapy with Non-steroidal anti-inflammatory drugs (NSAIDs) and other anti-inflammatory agents on COVID-19 outcomes
32% higher mortality (p=0.02). Retrospective 485,779 osteoarthritis patients in the US showing lower mortality with non-aspirin NSAIDs and celecoxib, and higher mortality with aspirin. Aspirin was associated with higher hospitalization in COVID-positive and COVID-negat..
Nov 28
2024
 Eissa et al., Medicinal Chemistry, doi:10.2174/0115734064318640241112071225 Identification of Potential FDA-Approved Inhibitors of SARS-CoV-2 Helicase Through a Multistep In Silico Approach: A Promising Prospect for COVID-19 Treatment
In silico study showing potential SARS-CoV-2 helicase inhibition by aspirin and eight other compounds. Authors screened 3,009 clinical and FDA-approved drugs for structural similarity to VXG (a known helicase co-crystallized ligand) and i..
Sep 27
2024
 Sakamaki et al., Discover Public Health, doi:10.1186/s12982-024-00225-7 Insights from a multicenter nationwide cohort analysis in Japan on the association of underlying conditions and pharmacological interventions with COVID-19 disease severity
37% higher severe cases (p<0.0001). Retrospective 650,317 COVID-19 patients in Japan showing higher risk of severe COVID-19 with low-dose apirin use. Although cardiovascular disease should have been adjusted for (details of adjustments are not provided), there may be signif..
Aug 13
2024
 Azimi Pirsaraei et al., Cureus, doi:10.7759/cureus.66798 Anticoagulant Use in COVID-19 Patients: A Longitudinal Study From Zanjan, Iran
97% higher mortality (p=0.002). Retrospective 831 hospitalized COVID-19 patients showing higher mortality with aspirin treatment in unadjusted results.
Jun 24
2024
 Vinod et al., Cardiology Research, doi:10.14740/cr1645 Effect of Aspirin Use on the Adverse Outcomes in Patients Hospitalized for COVID-19
14% lower mortality (p=0.61), 30% lower ventilation (p=0.24), 40% lower progression (p=0.05), and 6% worse results (p=0.88). Retrospective 376 hospitalized COVID-19 patients in the United States showing no significant differences with aspirin. Mortality, mechanical ventilation, and hypoxia were lower with treatment, without statistical significance.
May 28
2024
 Ciszewski et al., Cell Communication and Signaling, doi:10.1186/s12964-024-01665-z Diverse roles of SARS-CoV-2 Spike and Nucleocapsid proteins in EndMT stimulation through the TGF-β-MRTF axis inhibited by aspirin
In vitro study showing that SARS-CoV-2 spike and nucleocapsid proteins induce endothelial-mesenchymal transition (EndMT) in endothelial cells, with the nucleocapsid protein having a more potent effect. The spike protein stimulates TGF-β1 ..
Apr 12
2024
 Corral et al., Global Journal of Aging & Geriatric Research, doi:10.33552/GJAGR.2024.03.000557 Early Treatment Outcomes of SARS-Cov-2 with Ivermectin, Nitazoxanide and Acetylsalicylic Acid in 2 Nursing Homes During The COVID-19 Pandemic in Cali, Colombia
Retrospective 475 nursing home residents showing low mortality with early treatment using ivermectin, nitazoxanide, and acetylsalicylic acid. All residents were treated when the first positive cases were identified. 87 residents tested po..
Apr 12
2024
 Ware et al., medRxiv, doi:10.1101/2024.04.10.24305647 Incidence and Risk of Post-COVID-19 Thromboembolic Disease and the Impact of Aspirin Prescription; Nationwide Observational Cohort at the US Department of Veteran Affairs.
46% lower mortality (p=0.001). PSM retrospective 334,374 COVID-19 patients showing decreased risk of venous thromboembolism, including pulmonary embolism and deep vein thrombosis, but increased risk of arterial thromboembolic disorders, including ischemic stroke and ac..
Mar 19
2024
 Inokuchi et al., The Kurume Medical Journal, doi:10.2739/kurumemedj.MS7012003 Oral Colchicine and Low-Dose Aspirin Combination Therapy for Non-elderly, Non-severe, Early Time From Onset, Adult Outpatients with Coronavirus Disease 2019 (COVID-19) during “The Fifth Pandemic Wave” in Japan
67% lower hospitalization (p=0.55) and 24% improved recovery (p=0.72). RCT 38 low risk outpatients in Japan, showing no significant differences for colchicine and low-dose aspirin compared to loxoprofen. Hospitalization was lower, without statistical significance (4.3% vs. 13.3%, p=0.34). There were no criti..
Mar 7
2024
 Lewandowski et al., Biomedicines, doi:10.3390/biomedicines12030605 Insulin and Metformin Administration: Unravelling the Multifaceted Association with Mortality across Various Clinical Settings Considering Type 2 Diabetes Mellitus and COVID-19
70% higher mortality (p=0.02). Retrospective 430 hospitalized COVID-19 patients with type 2 diabetes in Poland showing lower mortality with metformin and higher mortality with remdesivir, convalescent plasma, and aspirin in univariable analysis. These results were not..
Feb 28
2024
 Sokolski et al., Scientific Reports, doi:10.1038/s41598-024-55407-9 Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study
Retrospective 2,170 hospitalized COVID-19 patients showing lower risk of ICU admission, mechanical ventilation use, and lower 3-month mortality with prior antiplatelet (AP) therapy. AP therapy did not increase bleeding risk. Patients with..
Jan 6
2024
 Prieto-Campo et al., Revista Española de Cardiología (English Edition), doi:10.1016/j.rec.2023.12.004 Impact of prior use of antiplatelets on COVID-19 susceptibility, progression, and severity: a population-based study
13% higher mortality (p=0.38), 3% lower hospitalization (p=0.64), no change in progression (p=0.98), and 8% fewer cases (p=0.02). Population-based case-control study of 86,602 people in Spain, shower lower risk of COVID-19 cases with low-dose aspirin, but no significant difference for severity, hospitalization, or mortality.
Dec 18
2023
 Mehrizi et al., Frontiers in Public Health, doi:10.3389/fpubh.2023.1280434 Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data
16% lower mortality (p<0.0001). Retrospective study of 917,198 hospitalized COVID-19 cases covered by the Iran Health Insurance Organization over 26 months showing that antithrombotics, corticosteroids, and antivirals reduced mortality while diuretics, antibiotics, and..
Oct 18
2023
 Marjaneh et al., Journal of Infection, doi:10.1016/j.jinf.2023.10.009 Analysis of blood and nasal epithelial transcriptomes to identify mechanisms associated with control of SARS-CoV-2 viral load in the upper respiratory tract
Blood and nasal epithelial transcriptomic analysis suggesting potential benefits of several treatments including: Vitamin E: transcriptomic analysis revealed that the AIPL1 module, which contains genes connected to vitamin E (α-tocopherol..
Jul 17
2023
 Shamsi et al., Canadian Journal of Infectious Diseases and Medical Microbiology, doi:10.1155/2023/5205188 Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran
96% lower mortality (p=0.22). Retrospective 183 hospitalized pediatric COVID-19 patients in Iran, showing no significant difference in mortality with in unadjusted results.
Jun 2
2023
 Tse et al., Heart, doi:10.1136/heartjnl-2023-BCS.211 Aspirin is associated with lower risks of severe covid-19 disease: a population-based study
67% lower combined mortality/intubation (p=0.0003). PSM retrospective 2,664 COVID-19 hospitalized patients receiving steroids/antiviral therapy in Hong Kong, showing lower risk of combined death/intubation with aspirin use.
Mar 29
2023
 Aweimer et al., Scientific Reports, doi:10.1038/s41598-023-31944-7 Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany
10% higher mortality (p=0.43). Retrospective 149 patients under invasive mechanical ventilation in Germany showing no significant difference in mortality with aspirin prophylaxis in unadjusted results.
Feb 17
2023
 Azizi et al., Journal of Nephropharmacology, doi:10.34172/npj.2023.10506 A study on the effect of aspirin on clinical symptoms, laboratory indices, and outcomes in patients with COVID-19
no change in mortality (p=1). Retrospective 131 COVID-19 patients with aspirin use and 131 matched controls in Iran, showing no significant difference in outcomes, however age matching used only two categories, 40-60 and 60+, therefore matching may be very poor given ..
Jan 30
2023
 Singla et al., PLOS ONE, doi:10.1371/journal.pone.0274243 A randomized controlled trial to evaluate outcomes with Aggrenox in patients with SARS-CoV-2 infection
20% lower ventilation (p=1), 29% lower ICU admission (p=0.76), and 33% lower progression (p=0.74). RCT 98 hospitalized patients in the USA, 49 treated with aspirin and dipyridamole, showing improved results with treatment, but without statistical significance.
Jan 24
2023
 Naghibzadeh et al., Biomedical Journal of Scientific & Technical Research, doi:10.26717/BJSTR.2023.48.007623 Association Study of Aspirin and Atorvastatin with Covid-19 Hospitalization: A Retrospective Longitudinal Study in Tehran
Retrospective 7,696 patients in Iran, showing aspirin use associated with a lower COVID-19 hospitalization rate for non-hypertensive patients. For hypertensive patients, there was no statistically significant association. Authors do not p..
Dec 20
2022
 Zadeh et al., Innovation in Aging, doi:10.1093/geroni/igac059.3047 Effect of aspirin in COVID-19 outcomes of older adults with a history of coronary artery disease
37% lower mortality (p=0.28) and 1% higher ICU admission (p=0.79). Retrospective 4,017 coronary artery disease patients hospitalized for COVID-19 in the USA, showing no significant difference in outcomes with low dose aspirin use.
Nov 30
2022
 Aidouni et al., Research Square, doi:10.21203/rs.3.rs-2313880/v1 The impact of asprin use on the outcome of patients admitted to the intensive care unit with COVID-19 infection
31% lower mortality (p=0.003) and 10% lower ventilation (p=0.33). Prospective study of 1,124 COVID-19 ICU patients, showing lower mortality with aspirin treatment.
Nov 19
2022
 Ali et al., Chest, doi:10.1016/j.chest.2022.11.013 Cardiovascular complications are the primary drivers of mortality in hospitalized patients with SARS-CoV-2 community-acquired pneumonia
28% lower mortality (p=0.07). Retrospective 1,645 hospitalized patients in the USA, showing lower mortality with aspirin use, without statistical significance.
Nov 15
2022
 Zekri-Nechar et al., Medicina, doi:10.3390/medicina58111649 Analysis of Prior Aspirin Treatment on in-Hospital Outcome of Geriatric COVID-19 Infected Patients
16% higher mortality (p=0.57) and 16% higher ICU admission (p=0.57). Retrospective 201 consecutive elderly hospitalized patients in Spain, showing higher mortality with aspirin use in unadjusted results. The aspirin group was older and had higher prevalence of hypertension and dyslipidemia. Table 1 shows t..
Oct 31
2022
 Ali et al., Egyptian Journal of Anaesthesia, doi:10.1080/11101849.2022.2139104 Effect of Aspirin Use on clinical Outcome among Critically Ill Patients with COVID-19
40% lower mortality (p<0.0001) and 37% lower ARDS (p=0.001). Retrospective 1,190 ICU patients in Egypt, showing lower mortality with aspirin treatment. 150mg daily.
Oct 29
2022
 Baral et al., Biology Methods and Protocols, doi:10.1093/biomethods/bpac027 All-cause and In-hospital Mortality after Aspirin Use in Patients Hospitalized with COVID-19: A Systematic Review and Meta-analysis
14% lower mortality (p=0.02). Systematic review and meta analysis of 11 aspirin COVID-19 studies, showing lower in-hospital mortality with treatment.
Oct 18
2022
 Cosentino et al., Journal of Clinical Medicine, doi:10.3390/jcm11206138 Early Outpatient Treatment of COVID-19: A Retrospective Analysis of 392 Cases in Italy
Retrospective 392 outpatients in Italy showing 0.2% mortality with early treatment, compared with >3% in Italy at the time. Treatment varied for individual patients and included HCQ, vitamin D, vitamin C, vitamin A, zinc, quercetin, bromh..
Oct 10
2022
 Eikelboom et al., The Lancet Respiratory Medicine, doi:10.1016/S2213-2600(22)00299-5 Colchicine and aspirin in community patients with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial
9% higher mortality (p=0.84), 20% lower progression (p=0.21), and 17% lower hospitalization (p=0.31). Late (5.4 days) outpatient RCT showing no significant difference in outcomes with aspirin treatment.
Oct 10
2022
 Eikelboom et al., The Lancet Respiratory Medicine, doi:10.1016/S2213-2600(22)00298-3 Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial
5% higher mortality (p=0.66) and 8% lower progression (p=0.32). RCT very late stage (baseline SpO2 77%) patients, showing no significant differences with rivaroxaban and aspirin treatment.
Oct 10
2022
 Morrison et al., PLOS ONE, doi:10.1371/journal.pone.0275787 COVID-19 outcomes in patients taking cardioprotective medications
8% lower mortality (p=0.52), 1% higher ventilation (p=0.96), 12% higher ICU admission (p=0.36), and 18% higher hospitalization (p=0.04). Retrospective 13,585 COVID+ patients in the USA, showing higher hospitalization with aspirin use, and no significant difference for mortality, ventilation, and ICU admission.
Oct 3
2022
 Karimpour-Razkenari et al., Journal of Pharmaceutical Care, doi:10.18502/jpc.v10i3.10790 Evaluating the Effects of Clinical Characteristics and Therapeutic Regimens on Mortality in Hospitalized Patients with Severe COVID-19
123% higher mortality (p=0.008). Retrospective 478 moderate to severe hospitalized patients in Iran, showing higher mortality with aspirin treatment. Authors note confounding by indication for aspirin treatment.
Sep 27
2022
 Geiger et al., Vaccines, doi:10.3390/vaccines10101619 Acetylsalicylic Acid and Salicylic Acid Inhibit SARS-CoV-2 Replication in Precision-Cut Lung Slices
In vitro study showing that aspirin and metabolite salicylic acid inhibit SARS-CoV-2 viral replication in Vero, A549-ACE2, and Huh-7 cells, and in human precision-cut lung slices. Results indicate inhibition of post-entry pathways.
Aug 16
2022
 Loucera et al., Virology Journal, doi:10.1186/s12985-023-02195-9 (date from preprint) Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments
18% lower mortality (p=0.0004). Retrospective 15,968 COVID-19 hospitalized patients in Spain, showing lower mortality with existing use of several medications including metformin, HCQ, azithromycin, aspirin, vitamin D, vitamin C, and budesonide. Since only hospitalized ..
Aug 11
2022
 Srinivasan et al., American Heart Journal Plus: Cardiology Research and Practice, doi:10.1016/j.ahjo.2022.100191 Aspirin use is associated with decreased inpatient mortality in patients with COVID-19: A meta-analysis
29% lower mortality (p=0.0003). Meta analysis of 14 studies with 164,539 patients, showing lower mortality with aspirin.
Aug 4
2022
 Abul et al., medRxiv, doi:10.1101/2022.08.03.22278392 Association of mortality and aspirin use for COVID-19 residents at VA Community Living Center Nursing Homes
33% lower mortality (p=0.03) and 20% lower hospitalization (p=0.13). 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 pat..
Jul 11
2022
 Malik et al., Health Science Reports, doi:10.1002/hsr2.699 Effect of low dose acetylsalicylic acid and anticoagulant on clinical outcomes in COVID-19, analytical cross-sectional study
14% lower mortality (p=0.72), 28% lower ICU admission (p=0.17), 25% lower ARDS (p=0.39), and 2% lower hospitalization (p=0.94). Retrospective 539 patients in the USA, showing lower mortality, ICU admission, and ARDS with aspirin treatment, without statistical significance.
Jul 9
2022
 Ghati et al., BMC Infectious Diseases, doi:10.1186/s12879-022-07570-5 Statin and aspirin as adjuvant therapy in hospitalised patients with SARS-CoV-2 infection: a randomised clinical trial (RESIST trial)
22% lower mortality (p=0.62), 9% lower ventilation (p=0.8), and 30% lower progression (p=0.46). RCT hospitalized patients in India, 224 treated with atorvastatin, 225 with aspirin, and 225 with both, showing lower serum interleukin-6 levels with aspirin, but no statistically significant changes in other outcomes. Low dose aspirin 75..
Jun 22
2022
 Santoro et al., Journal of the American Heart Association, doi:10.1161/JAHA.121.024530 Aspirin Therapy on Prophylactic Anticoagulation for Patients Hospitalized With COVID-19: A Propensity Score-Matched Cohort Analysis of the HOPE-COVID-19 Registry
38% lower mortality (p=0.02). HOPE-COVID-19 PSM retrospective 7,824 patients, comparing prophylactic anticoagulation with and without additional treatment with aspirin in hospitalized patients, showing lower mortality with aspirin treatment.
Jun 22
2022
 Ma et al., European Journal of Clinical Pharmacology, doi:10.1007/s00228-022-03356-5 Does aspirin have an effect on risk of death in patients with COVID-19? A meta-analysis
20% lower mortality (p=0.005). Meta-analysis of 18 studies with 49,041 COVID-19 patients showing significantly lower mortality with aspirin treatment.
Jun 17
2022
 Botton et al., Research and Practice in Thrombosis and Haemostasis, doi:10.1002/rth2.12743 No association of low-dose aspirin with severe COVID-19 in France: A cohort of 31.1 million people without cardiovascular disease
4% higher combined mortality/intubation (p=0.18) and 3% higher hospitalization (p=0.05). Retrospective 31 million people without cardiovascular disease in France, showing no significant difference in hospitalization or combined intubation/death with low dose aspirin prophylaxis.
May 30
2022
 Kumar et al., Cureus, doi:10.7759/cureus.25467 Efficacy and Safety of Aspirin, Promethazine, and Micronutrients for Rapid Clinical Recovery in Mild to Moderate COVID-19 Patients: A Randomized Controlled Clinical Trial
57% improved recovery (p=0.25). RCT 260 patients in India, 130 treated with aspirin, promethazine, vitamin C, D, B3, zinc, and selenium, showing faster recovery with treatment. There was no hospitalization, ICU admission, or supplemental oxygen requirements in either gr..
May 5
2022
 Lal et al., Archivos de Bronconeumología, doi:10.1016/j.arbres.2022.07.017 (date from preprint) Pre-hospital aspirin use and patient outcomes in COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)
11% lower mortality (p=0.01), 22% lower ICU admission (p<0.0001), and 9% lower progression (p=0.02). Retrospective 21,579 hospitalized COVID-19 patients mostly in the USA, showing lower risk of mortality and severity with existing aspirin use.
May 5
2022
 Campbell et al., PLOS ONE, doi:10.1371/journal.pone.0267462 Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen and relationship with mortality among United States Veterans after testing positive for COVID-19
3% lower mortality (p=0.06). Retrospective 28,856 COVID-19 patients in the USA, showing no significant difference in mortality for chronic aspirin use vs. sporadic NSAID use. Since aspirin is available OTC and authors only tracked prescriptions, many patients classif..
Mar 24
2022
 Chow et al., JAMA Network Open, doi:10.1001/jamanetworkopen.2022.3890 Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
13% lower mortality (p<0.0001). Retrospective 112,269 hospitalized COVID-19 patients in the USA, showing lower mortality with aspirin treatment.
Mar 22
2022
 Bradbury et al., JAMA, doi:10.1001/jama.2022.2910 Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial
16% lower mortality (p=0.05), 17% higher hospital discharge (p=0.08), and 21% lower progression (p=0.02). RCT 1,557 critical patients, showing significantly lower mortality with aspirin, with 97.5% posterior probability of efficacy.
Mar 9
2022
 Gogtay et al., World Journal of Critical Care Medicine, doi:10.5492/wjccm.v11.i2.92 Retrospective analysis of aspirin's role in the severity of COVID-19 pneumonia
6% higher mortality (p=0.87), 50% lower ventilation (p=0.16), and 49% lower ICU admission (p=0.41). Retrospective 125 COVID+ hospitalized patients in the USA, showing no significant differences with aspirin prophylaxis.
Feb 28
2022
 Nimer et al., Bosnian Journal of Basic Medical Sciences, doi:10.17305/bjbms.2021.7009 The impact of vitamin and mineral supplements usage prior to COVID-19 infection on disease severity and hospitalization
4% lower hospitalization (p=0.08) and 18% higher severe cases (p=0.28). Retrospective 2,148 COVID-19 recovered patients in Jordan, showing no significant differences in the risk of severity and hospitalization with aspirin prophylaxis.
Jan 31
2022
 Levy et al., Gerontology, doi:10.1159/000521412 Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis
26% lower combined mortality/hospitalization (p=0.13). Retrospective 849 COVID-19+ patients in skilled nursing homes, showing lower risk of combined hospitalization/death with aspirin prophylaxis, not reaching statistical significance.
Jan 24
2022
 de Jesús Ascencio-Montiel et al., Archives of Medical Research, doi:10.1016/j.arcmed.2022.01.002 A Multimodal Strategy to Reduce the Risk of Hospitalization/death in Ambulatory Patients with COVID-19
59% lower combined mortality/hospitalization (p<0.0001), 15% lower mortality (p=0.16), 9% lower ventilation (p=0.51), and 48% lower hospitalization (p<0.0001). Retrospective 28,048 COVID+ patients in Mexico, 7,898 receiving a treatment kit including low dose ivermectin, AZ, aspirin, and acetaminophen, shower lower mortality/hospitalization for those receiving the kit. Delivery of the treatment k..
Jan 8
2022
 Monserrat Villatoro et al., Pharmaceuticals, doi:10.3390/ph15010078 A Case-Control of Patients with COVID-19 to Explore the Association of Previous Hospitalisation Use of Medication on the Mortality of COVID-19 Disease: A Propensity Score Matching Analysis
31% higher mortality (p=0.04). PSM retrospective 3,712 hospitalized patients in Spain, showing lower mortality with existing use of azithromycin, bemiparine, budesonide-formoterol fumarate, cefuroxime, colchicine, enoxaparin, ipratropium bromide, loratadine, mepyramine..
Jan 7
2022
 Sullerot et al., GeroScience, doi:10.1007/s11357-021-00499-8 Premorbid aspirin use is not associated with lower mortality in older inpatients with SARS-CoV-2 pneumonia
10% higher mortality (p=0.52), 110% higher ICU admission (p=0.007), and 10% longer hospitalization (p=0.02). Retrospective 1,047 pneumonia patients in 5 COVID-19 geriatric units in France and Switzerland, significantly higher ICU admission and longer hospital stays with existing aspirin treatment. Numbers in this study appear to be inconsistent,..
Dec 31
2021
 Zhou et al., Computational and Structural Biotechnology Journal, doi:10.1016/j.csbj.2020.12.005 Temperature dependence of the SARS-CoV-2 affinity to human ACE2 determines COVID-19 progression and clinical outcome
In silico and in vitro study showing decreased SARS-CoV-2 binding affinity to the human ACE2 receptor at higher temperature (40°C vs. 37°C). Molecular dynamics simulations, surface plasmon resonance experiments, and pseudovirus cell entry..
Dec 29
2021
 Mustafa et al., Exploratory Research in Clinical and Social Pharmacy, doi:10.1016/j.rcsop.2021.100101 Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan
44% lower mortality (p=0.28). Retrospective 444 hospitalized patients in Pakistan, showing lower mortality with aspirin treatment in unadjusted results, not reaching statistical significance.
Dec 24
2021
 Banaser et al., International Journal of Medicine in Developing Countries, doi:10.24911/IJMDC.51-1640383699 A systematic review and meta-analysis on efficacy of low dose aspirin on the management of COVID-19
49% lower mortality (p<0.0001) and 30% lower ventilation (p=0.006). Meta analysis of 8 studies showing significantly lower mortality and mechanical ventilation with low dose aspirin.
Nov 29
2021
 Formiga et al., Internal and Emergency Medicine, doi:10.1007/s11739-021-02870-1 Does admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry
3% higher mortality (p=0.48), 3% higher ventilation (p=0.75), and 4% higher ICU admission (p=0.65). Retrospective 20,641 hospitalized patients in Spain, showing no significant difference in outcomes with existing aspirin use.
Nov 18
2021
 Horby et al., The Lancet, doi:10.1016/S0140-6736(21)01825-0 Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
4% lower mortality (p=0.35), 5% lower ventilation (p=0.32), 6% higher hospital discharge (p=0.006), and 11% shorter hospitalization. RCT 14,892 late stage patients, 7,351 treated with aspirin, showing slightly improved discharge and hospitalization time, and no significant difference for mortality. Results are limited due to low dose (150mg daily), very late treatment ..
Oct 14
2021
 Santoro et al., European Heart Journal, doi:10.1093/eurheartj/ehab724.3002 Antiplatelet therapy and outcome in patients with COVID-19. Results from a multi-center international prospective registry (HOPE-COVID19)
71% lower mortality (p<0.0001). Retrospective database analysis of 7,824 patients in the HOPE-COVID19 registry, 730 receiving antiplatelet therapy including aspirin, showing lower mortality with treatment. Authors do not provide results restricted to aspirin.
Oct 11
2021
 Connors et al., JAMA, doi:10.1001/jama.2021.1727283 Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19
67% lower hospitalization (p=0.49) and 19% lower progression (p=0.78). Early terminated RCT with 164 aspirin and 164 control patients in the USA with very few events, showing no significant difference with aspirin treatment for the combined endpoint of all-cause mortality, symptomatic venous or arterial thro..
Oct 4
2021
 Pérez-Segura et al., Medicina Clínica, doi:10.1016/j.medcle.2021.02.010 Prognostic factors at admission on patients with cancer and COVID-19: Analysis of HOPE registry data
49% higher mortality (p=0.0001). Retrospective 770 COVID-19 patients with cancer, showing increased mortality with aspirin use in unadjusted results.
Oct 4
2021
 Sisinni et al., International Journal of Cardiology, doi:10.1016/j.ijcard.2021.09.058 Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study
7% higher mortality (p=0.65) and 30% lower combined mortality/intubation (p=0.01). Retrospective 984 COVID-19 patients, 253 taking aspirin prior to admission, showing lower risk of respiratory support upgrade with treatment.
Oct 2
2021
 Basheer et al., Metabolites, doi:10.3390/metabo11100679 Clinical Predictors of Mortality and Critical Illness in Patients with COVID-19 Pneumonia
13% higher mortality (p=0.0003). Retrospective 390 hospitalized patients in Israel, showing higher risk of mortality with prior aspirin use. Details of the analysis are not provided.
Oct 1
2021
 Zhao et al., Anesthesiology, doi:10.1097/ALN.0000000000003999 Treatments Associated with Lower Mortality among Critically Ill COVID-19 Patients: A Retrospective Cohort Study
43% lower mortality (p=0.0006). Retrospective 2,070 hospitalized patients in the USA, showing lower mortality with aspirin treatment.
Sep 4
2021
 Kim et al., Medicina, doi:10.3390/medicina57090931 Aspirin Is Related to Worse Clinical Outcomes of COVID-19
34% lower mortality (p=0.22), 102% higher ventilation (p=0.16), and 91% higher ICU admission (p=0.36). Retrospective database analysis of 22,660 patients tested for COVID-19 in South Korea. There was no significant difference in cases according to aspirin use. Aspirin use before COVID-19 was related to an increased death rate and aspirin u..
Sep 4
2021
 Kim et al., Medicina, doi:10.3390/medicina57090931 Aspirin Is Related to Worse Clinical Outcomes of COVID-19
700% higher mortality (p=0.03), 433% higher ventilation (p=0.14), 433% higher ICU admission (p=0.14), and 33% fewer cases (p=0.29). Retrospective database analysis of 22,660 patients tested for COVID-19 in South Korea. There was no significant difference in cases according to aspirin use. Aspirin use before COVID-19 was related to an increased death rate and aspirin u..
Sep 3
2021
 Al Harthi et al., Journal of Intensive Care Medicine, doi:10.1177/08850666221093229 Evaluation of Low-Dose Aspirin use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study
27% lower mortality (p=0.03) and 5% shorter ICU admission (p=0.54). 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. ..
Sep 1
2021
 Karruli et al., Microbial Drug Resistance, doi:10.1089/mdr.2020.0489 Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience
46% lower mortality (p=0.63). Retrospective 32 ICU patients showing lower mortality with aspirin treatment, without statistical significance.
Aug 29
2021
 Chow et al., Journal of Thrombosis and Haemostasis, doi:10.1111/jth.15517 Association of Pre-Hospital Antiplatelet Therapy with Survival in Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis
19% lower mortality (p=0.005) and 3% lower ventilation (p=0.21). PSM retrospective 6,781 hospitalized patients ≥50 years old in the USA who were on pre-hospital antiplatelet therapy (84% aspirin), and 10,566 matched controls, showing lower mortality with treatment.
Aug 18
2021
 Ma et al., Drugs & Aging, doi:10.1007/s40266-021-00886-y Sex Differences in Association Between Anti-Hypertensive Medications and Risk of COVID-19 in Middle-Aged and Older Adults
9% lower mortality (p=0.12), 2% lower hospitalization (p=0.47), 9% more symptomatic cases (p=0.18), and 7% more cases (p=0.09). UK Biobank retrospective 77,271 patients aged 50-86, showing no significant differences with aspirin use. Matching lead to different results for the gender vs. overall analysis, for example the overall result for cases was OR 1.07, howeve..
Jul 30
2021
 Son et al., Medicine, doi:10.1097/MD.0000000000026670 Effect of aspirin on coronavirus disease 2019
11% lower mortality (p=0.67), 7% higher progression (p=0.8), and 11% more cases (p=0.21). PSM retrospective case control study in South Korea, showing a trend towards lower mortality, but no significant differences with aspirin use.
Jul 30
2021
 Abdelwahab et al., Clinical Drug Investigation, doi:10.1007/s40261-021-01061-2 Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study
8% higher ventilation (p=0.93). Retrospective 225 hospitalized patients in Egypt, showing significantly lower thromboembolic events with aspirin treatment, but no significant difference in the need for mechanical ventilation.
Jul 20
2021
 Vahedian-Azimi et al., Identification of Biomarkers, New Treatments, and Vaccines for COVID-19, doi:10.1007/978-3-030-71697-4_17 Association of In-hospital Use of Statins, Aspirin, and Renin-Angiotensin-Aldosterone Inhibitors with Mortality and ICU Admission Due to COVID-19
22% lower mortality (p=0.56) and 10% higher ICU admission (p=0.67). Retrospective 587 COVID+ hospitalized patients in Iran, showing no significant differences in outcomes with aspirin treatment.
Jun 30
2021
 Kevorkian et al., Journal of Infection, doi:10.1016/j.jinf.2021.02.008 Oral corticoid, aspirin, anticoagulant, colchicine, and furosemide to improve the outcome of hospitalized COVID-19 patients - the COCAA-COLA cohort study
96% lower progression (p=0.0005). Observational study in France with 28 hospitalized patients treated with prednisone/furosemide/colchicine/salicylate/direct anti-Xa inhibitor, and 40 control patients, showing lower combined mortality, ventilation, or high-flow oxygen the..
Jun 17
2021
 Oh et al., Yonsei Medical Journal, doi:10.3349/ymj.2021.62.7.577 Incidence and Mortality Associated with Cardiovascular Medication among Hypertensive COVID-19 Patients in South Korea
1% lower mortality (p=0.95) and 12% fewer cases (p=0.04). Retrospective database analysis of 328,374 adults in South Korea, showing lower risk of COVID-19 cases with aspirin use, but no difference in mortality for COVID-19 patients.
May 26
2021
 Pourhoseingholi et al., Research Square, doi:10.21203/rs.3.rs-365321/v2 Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study
32% higher mortality (p=0.04). Prospective study of 2,468 hospitalized COVID-19 patients in Iran, showing higher mortality with aspirin treatment. IR.MUQ.REC.1399.013.
May 26
2021
 Pan et al., Heart & Lung, doi:10.1016/j.hrtlng.2021.04.010 Pre-hospital antiplatelet medication use on COVID-19 disease severity
13% higher mortality (p=0.63) and 2% higher combined mortality/intubation (p=0.93). Retrospective 762 COVID+ hospitalized patients in the USA, 239 on antiplatelet medication (199 aspirin), showing no significant differences in outcomes. For more discussion see [sciencedirect.com].
May 19
2021
 Sahai et al., Vascular Medicine, doi:10.1177/1358863X211012754 Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19
13% lower mortality (p=0.53). PSM retrospective 1,994 PCR+ patients in the USA, not showing a significant difference in mortality with aspirin treatment.
May 2
2021
 Drew et al., medRxiv, doi:10.1101/2021.04.28.21256261 Aspirin and NSAID use and the risk of COVID-19
22% lower progression (p=0.3) and 3% more cases (p=0.8). Retrospective 2,736,091 individuals in the U.S., U.K., and Sweden, showing lower risk of hospital/clinic visits with aspirin use.
Apr 30
2021
 Elhadi et al., PLOS ONE, doi:10.1371/journal.pone.0251085 Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study
10% lower mortality (p=0.5). Prospective study of 465 COVID-19 ICU patients in Libya showing no significant differences with treatment.
Apr 29
2021
 Haji Aghajani et al., Journal of Medical Virology, doi:10.1002/jmv.27053 Decreased in-hospital mortality associated with aspirin administration in hospitalized patients due to severe COVID-19
25% lower mortality (p=0.04). Retrospective 991 hospitalized patients in Iran, showing lower mortality with aspirin treatment.
Apr 20
2021
 Reese et al., medRxiv, doi:10.1101/2021.04.13.21255438 Cyclooxygenase inhibitor use is associated with increased COVID-19 severity
61% higher mortality (p<0.0001) and 309% higher severe cases (p<0.0001). N3C retrospective 250,533 patients showing significantly higher mortality with aspirin use. Note that aspirin results were not included in the journal version or v2 of this preprint.
Apr 7
2021
 Mulhem et al., BMJ Open, doi:10.1136/bmjopen-2020-042042 3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
14% higher mortality (p=0.21). Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06..
Apr 1
2021
 Chow et al., Anesthesia & Analgesia, doi:10.1213/ANE.0000000000005292 Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019
47% lower mortality (p=0.02), 44% lower ventilation (p=0.007), and 43% lower ICU admission (p=0.007). Retrospective 412 hospitalized patients, 98 treated with aspirin, showing lower mortality, ventilation, and ICU admission with treatment.
Mar 31
2021
 Mura et al., Signal Transduction and Targeted Therapy, doi:10.1038/s41392-021-00689-y (date from preprint) Real-world evidence for improved outcomes with histamine antagonists and aspirin in 22,560 COVID-19 patients
15% lower mortality (p=0.08). PSM retrospective TriNetX database analysis of 1,379 severe COVID-19 patients requiring respiratory support, showing lower mortality with aspirin (not reaching statistical significance) and famotidine, and improved results from the combin..
Feb 28
2021
 Bejan et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2376 (date from preprint) DrugWAS: Drug‐wide Association Studies for COVID‐19 Drug Repurposing
1% lower ventilation (p=0.97). Retrospective 9,748 COVID-19 patients in the USA showing no signficant difference with aspirin use.
Feb 23
2021
 Merzon et al., The FEBS Journal, doi:10.1111/febs.15784 The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection
28% fewer cases (p=0.04) and 10% faster viral clearance (p=0.05). Retrospective 10,477 patients in Israel, showing lower risk of COVID-19 cases with existing aspiring use.
Feb 12
2021
 Liu et al., Medicine, doi:10.1097/MD.0000000000024544 Effect of low-dose aspirin on mortality and viral duration of the hospitalized adults with COVID-19
75% lower mortality (p=0.03) and 2% slower viral clearance (p=0.94). Retrospective PSM analysis of 232 hospitalized patients, 28 treated with aspirin, showing lower mortality with treatment. There was no significant difference in viral clearance.
Feb 11
2021
 Osborne et al., PLOS ONE, doi:10.1371/journal.pone.0246825 Association of mortality and aspirin prescription for COVID-19 patients at the Veterans Health Administration
59% lower mortality (p<0.0001). Retrospective PSM analysis of pre-existing aspirin use in the USA, showing lower mortality with treatment.
Feb 10
2021
 Lima-Morales et al., International Journal of Infectious Diseases, doi:10.1016/j.ijid.2021.02.014 Effectiveness of a multidrug therapy consisting of ivermectin, azithromycin, montelukast and acetylsalicylic acid to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico
78% lower mortality (p=0.001), 52% lower ventilation (p=0.15), 67% lower hospitalization (p=0.001), and 59% improved recovery (p=0.001). Prospective trial of 768 COVID-19 outpatients in Mexico, 481 treated with ivermectin, AZ, montelukast, and aspirin, and 287 control patients with various treatments, showing significantly lower mortality and hospitalization, and significa..
Jan 21
2021
 Meizlish et al., American Journal of Hematology, doi:10.1002/ajh.26102 Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: A propensity score-matched analysis
48% lower mortality (p=0.004). Retrospective 638 matched hospitalized patients in the USA, 319 treated with aspirin, showing lower mortality with treatment.
Dec 28
2020
 Ramos-Rincón et al., Research Square, doi:10.21203/rs.3.rs-133358/v1 Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain
29% higher mortality (p=0.02). Retrospective 790 hospitalized type 2 diabetes patients ≥80 years old in Spain, showing higher mortality with existing aspirin use.
Dec 18
2020
 Yuan et al., Journal of Cellular and Molecular Medicine, doi:10.1111/jcmm.16198 Mortality and pre-hospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease
4% lower mortality (p=0.89). Retrospective 183 hospitalized patients in China, 52 taking low-dose aspirin prior to hospitalization, showing no significant difference with treatment.
Nov 5
2020
 Goshua et al., Blood, doi:10.1182/blood-2020-143349 Admission Rothman Index, Aspirin, and Intermediate Dose Anticoagulation Effects on Outcomes in COVID-19: A Multi-Site Propensity Matched Analysis
35% lower mortality (p=0.04), 49% higher ventilation (p=0.04), and 45% higher ICU admission (p=0.02). PSM retrospective 2,785 hospitalized patients in the USA, showing lower mortality and higher ventilation and ICU admission with aspirin treatment.
Oct 31
2020
 Husain et al., ResearchGate, doi:10.13140/RG.2.2.26038.93762/2 Beneficial effect of low dose aspirin (Acetyl salicylic acid) in adult Covid-19 patients: a retrospective observational study in Bangladesh
96% lower progression (p=0.001). Retrospective 42 patients in Bangladesh, 11 treated with aspirin, showing fewer complications with treatment.
Sep 9
2020
 Alamdari et al., The Tohoku Journal of Experimental Medicine, doi:10.1620/tjem.252.73 Mortality Risk Factors among Hospitalized COVID-19 Patients in a Major Referral Center in Iran
28% higher mortality (p=0.52). Retrospective 459 patients in Iran, 53 treated with aspirin, showing no significant difference with treatment.
Jul 31
2020
 Lodigiani et al., Thrombosis Research, doi:10.1016/j.thromres.2020.04.024 Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy
21% higher ICU admission (p=0.52). Retrospective 388 hospitalized COVID-19 patients in Italy showing higher use of aspirin in ICU patients, without statistical significance.
Jul 14
2020
 Wang et al., Journal of Hematology & Oncology, doi:10.1186/s13045-020-00934-x A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward
58% lower mortality (p=0.43). Retrospective 58 multiple myeloma COVID-19 patients in the USA, showing no significant difference with aspirin treatment.
May 7
2020
 Holt et al., Journal of Hypertension, doi:10.1097/hjh.0000000000002515 Influence of inhibitors of the renin–angiotensin system on risk of acute respiratory distress syndrome in Danish hospitalized COVID-19 patients
34% higher combined mortality/ICU admission (p=0.09). Retrospective 689 hospitalized COVID-19 patients in Denmark, showing higher risk of ICU/death with aspirin use in unadjusted results subject to confounding by indication.
Dec 1
1990
 Graham et al., Journal of Infectious Diseases, doi:10.1093/infdis/162.6.1277 Adverse Effects of Aspirin, Acetaminophen, and Ibuprofen on Immune Function, Viral Shedding, and Clinical Status in Rhinovirus-Infected Volunteers
RCT examining the effects of aspirin, acetaminophen, and ibuprofen on immune function, virus shedding, and clinical symptoms in 60 healthy volunteers experimentally infected with rhinovirus type 2. The study found that aspirin and acetami..
Apr 30
1988
 Downing et al., Journal of Interferon Research, doi:10.1089/jir.1988.8.143 Hyperthermia in Humans Enhances Interferon-γ Synthesis and Alters the Peripheral Lymphocyte Population
Analysis of induced hyperthermia (high body temperature) showing 10 times greater interferon gamma (IFN-γ) production and increased natural killer cells. This response was observed at a core body temperature of ~39°C, highlighting its pot..
References