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0 0.5 1 1.5 2+ Mortality -9% Improvement Relative Risk Progression 20% primary Hospitalization 17% Aspirin  ACT outpatient  LATE TREATMENT  RCT Is late treatment with aspirin beneficial for COVID-19? RCT 3,881 patients in Canada (August 2020 - February 2022) Lower progression (p=0.21) and hospitalization (p=0.31), not sig. Eikelboom et al., The Lancet Respirato.., Oct 2022 Favors aspirin Favors control

Colchicine and aspirin in community patients with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

Eikelboom et al., The Lancet Respiratory Medicine, doi:10.1016/S2213-2600(22)00299-5, ACT outpatient, NCT04324463
Oct 2022  
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Aspirin for COVID-19
24th treatment shown to reduce risk in August 2021
*, now known with p = 0.000087 from 73 studies, recognized in 2 countries.
Lower risk for mortality and progression.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Late (5.4 days) outpatient RCT showing no significant difference in outcomes with aspirin treatment.
Study covers aspirin and colchicine.
risk of death, 9.0% higher, HR 1.09, p = 0.84, treatment 12 of 1,945 (0.6%), control 11 of 1,936 (0.6%).
risk of progression, 20.0% lower, HR 0.80, p = 0.21, treatment 59 of 1,945 (3.0%), control 73 of 1,936 (3.8%), NNT 136, major thrombosis, hospitalisation, or death, primary outcome.
risk of hospitalization, 17.0% lower, HR 0.83, p = 0.31, treatment 56 of 1,945 (2.9%), control 67 of 1,936 (3.5%), NNT 172.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Eikelboom et al., 10 Oct 2022, Randomized Controlled Trial, Canada, peer-reviewed, mean age 45.0, 31 authors, study period 27 August, 2020 - 10 February, 2022, average treatment delay 5.4 days, trial NCT04324463 (history) (ACT outpatient). Contact:
This PaperAspirinAll
Colchicine and aspirin in community patients with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial
John W Eikelboom, Sanjit S Jolly, Emilie P Belley-Cote, Prof Richard P Whitlock, Sumathy Rangarajan, PhD, S Rangarajan MSc Lizhen Xu, PhD Laura Heenan, Prof S I Shrikant I Bangdiwala, Wadea M Tarhuni, Mohamed Hassany, Anna Kontsevaya, Sanjib William Harper, Sanjib Kumar Sharma, Prof Patricio Lopez-Jaramillo, Antonio L Dans, Prof Lia M Palileo-Villanueva, Alvaro Avezum, Prem Pais, Denis Xavier, Camilo Felix, Afzalhussein Yusufali, Renato D Lopes, Otavio Berwanger, Zeeshan Ali, MD Sean Wasserman, Prof Sonia S Anand, Prof Jackie Bosch, Shurjeel Choudhri, Michael E Farkouh, Mark Loeb, Salim Yusuf
The Lancet Respiratory Medicine, doi:10.1016/s2213-2600(22)00299-5
Background The large number of patients worldwide infected with the SARS-CoV-2 virus has overwhelmed healthcare systems globally. The Anti-Coronavirus Therapies (ACT) outpatient trial aimed to evaluate anti-inflammatory therapy with colchicine and antithrombotic therapy with aspirin for prevention of disease progression in community patients with COVID-19. Methods The ACT outpatient, open-label, 2 × 2 factorial, randomised, controlled trial, was done at 48 clinical sites in 11 countries. Patients in the community aged 30 years and older with symptomatic, laboratory confirmed COVID-19 who were within 7 days of diagnosis and at high risk of disease progression were randomly assigned (1:1) to receive colchicine 0•6 mg twice daily for 3 days and then 0•6 mg once daily for 25 days versus usual care, and in a second (1:1) randomisation to receive aspirin 100 mg once daily for 28 days versus usual care. Investigators and patients were not masked to treatment allocation. The primary outcome was assessed at 45 days in the intention-to-treat population; for the colchicine randomisation it was hospitalisation or death, and for the aspirin randomisation it was major thrombosis, hospitalisation, or death. The ACT outpatient trial is registered at, NCT04324463 and is ongoing.
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Late treatment
is less effective
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