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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Mortality -5% Improvement Relative Risk Progression 8% Progression (b) 11% Aspirin  ACT inpatient  LATE TREATMENT  RCT Is late treatment with aspirin + rivaroxaban beneficial for COVID-19? RCT 2,119 patients in multiple countries (October 2020 - February 2022) No significant difference in outcomes seen c19early.org Eikelboom et al., The Lancet Respirato.., Oct 2022 Favors aspirin Favors control

Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

Eikelboom et al., The Lancet Respiratory Medicine, doi:10.1016/S2213-2600(22)00298-3, ACT inpatient, 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.
4,100+ studies for 60+ treatments. c19early.org
RCT very late stage (baseline SpO2 77%) patients, showing no significant differences with rivaroxaban and aspirin treatment.
Study covers aspirin and colchicine.
risk of death, 5.0% higher, HR 1.05, p = 0.66, treatment 193 of 1,063 (18.2%), control 186 of 1,056 (17.6%).
risk of progression, 8.0% lower, HR 0.92, p = 0.32, treatment 281 of 1,063 (26.4%), control 300 of 1,056 (28.4%), NNT 51, major thrombosis, high-flow oxygen, ventilation, or death.
risk of progression, 11.0% lower, HR 0.89, p = 0.27, treatment 191 of 1,063 (18.0%), control 210 of 1,056 (19.9%), NNT 52, high-flow oxygen or ventilation.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Eikelboom et al., 10 Oct 2022, Randomized Controlled Trial, multiple countries, peer-reviewed, mean age 56.0, 29 authors, study period 2 October, 2020 - 10 February, 2022, average treatment delay 7.0 days, this trial uses multiple treatments in the treatment arm (combined with rivaroxaban) - results of individual treatments may vary, trial NCT04324463 (history) (ACT inpatient). Contact: eikelbj@mcmaster.ca.
This PaperAspirinAll
Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial
Prof John W Eikelboom, Sanjit S Jolly, Emilie P Belley-Cote, Prof Richard P Whitlock, Sumathy Rangarajan, MD, S Rangarajan MSc Lizhen Xu, PhD Laura Heenan, Prof S I Shrikant I Bangdiwala, Maria Luz Diaz, MD Rafael Diaz, Afzalhussein Yusufali, Sanjib Kumar Sharma, Wadea M Tarhuni, Mohamed Hassany, Alvaro Avezum, William Harper, Sean Wasserman, Aysha Almas, Oxana Drapkina, Camilo Felix, Renato D Lopes, Otavio Berwanger, Patricio Lopez-Jaramillo, Sonia S Anand, Jackie Bosch, Shurjeel Choudhri, Michael E Farkouh, Mark Loeb, Salim Yusuf
The Lancet Respiratory Medicine, doi:10.1016/s2213-2600(22)00298-3
Background COVID-19 disease is accompanied by a dysregulated immune response and hypercoagulability. The Anti-Coronavirus Therapies (ACT) inpatient trial aimed to evaluate anti-inflammatory therapy with colchicine and antithrombotic therapy with the combination of rivaroxaban and aspirin for prevention of disease progression in patients hospitalised with COVID-19. Methods The ACT inpatient, open-label, 2 × 2 factorial, randomised, controlled trial was done at 62 clinical centres in 11 countries. Patients aged at least 18 years with symptomatic, laboratory confirmed COVID-19 who were within 72 h of hospitalisation or worsening clinically if already hospitalised were randomly assigned (1:1) to receive colchicine 1•2 mg followed by 0•6 mg 2 h later and then 0•6 mg twice daily for 28 days versus usual care; and in a second (1:1) randomisation, to the combination of rivaroxaban 2•5 mg twice daily plus aspirin 100 mg once daily for 28 days versus usual care. Investigators and patients were not masked to treatment allocation. The primary outcome, assessed at 45 days in the intention-to-treat population, for the colchicine randomisation was the composite of the need for high-flow oxygen, mechanical ventilation, or death; and for the rivaroxaban plus aspirin randomisation was the composite of major thrombosis (myocardial infarction, stroke, acute limb ischaemia, or pulmonary embolism), the need for high-flow oxygen, mechanical ventilation, or death. The trial is registered at www.clinicaltrials.gov, NCT04324463 and is ongoing. Findings Between Oct 2, 2020, and Feb 10, 2022, at 62 sites in 11 countries, 2749 patients were randomly assigned to colchicine or control and the combination of rivaroxaban and aspirin or to the control. 2611 patients were included in the analysis of colchicine (n=1304) versus control (n=1307); 2119 patients were included in the analysis of rivaroxaban and aspirin (n=1063) versus control (n=1056). Follow-up was more than 98% complete. Overall, 368 (28•2%) of 1304 patients allocated to colchicine and 356 (27•2%) of 1307 allocated to control had a primary outcome (hazard ratio [HR] 1•04, 95% CI 0•90-1•21, p=0•58); and 281 (26•4%) of 1063 patients allocated to the combination of rivaroxaban and aspirin and 300 (28•4%) of 1056 allocated to control had a primary outcome (HR 0•92, 95% CI 0•78-1•09, p=0•32). Results were consistent in subgroups defined by vaccination status, disease severity at baseline, and timing of randomisation in relation to onset of symptoms. There was no increase in the number of patients who had at least one serious adverse event for colchicine versus control groups (87 [6•7%] of 1304 vs 90 [6•9%] of 1307) or with rivaroxaban and aspirin versus control groups (85 [8•0%] vs 91 [8•6%] ). Among patients assigned to colchicine, 8 (0•61%) had adverse events that led to discontinuation of study drug, mostly gastrointestinal in nature. 17 (1•6%) patients assigned to the combination of rivaroxaban and aspirin had..
Declaration of interests JWE reports grant or in-kind support from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Pfizer, Janssen, Sanofi-Aventis and honoraria from Astra-Zeneca, Bayer, Boehringer-Ingelheim, Bristol-Myer-Squibb, Daiichi-Sankyo, Eli-Lilly, Glaxo-Smith-Kline, Merck, Pfizer, Janssen, Sanofi-Aventis, Servier. SSJ reports grant support from Boston Scientific, honoraria from Medtronic, Penumbra. EPB-C reports grant support from Bayer, Roche, BMS-Pfizer. RPW reports grant support from Bayer, Roche, BMS-Pfizer, grant and honorarium from Boehringer-Ingelheim, and consultancy fees from Atricure and Phasebio. MLD reports grant support from the Population Health Research Institute (PHRI) to manage the ACT study in Argentina. RD reports grant support from PHRI to manage the ACT study in Argentina. AA reports institutional grant support from Bayer and EMS, and lecture fees from Bayer and Sanofi-Aventis. SW reports grant support from NIH, honoraria from Pfizer, and safety monitoring committee of an AIDS Clinical Trial Group. RDL reports institutional grant support from Bristol Myers Squibb, Glaxo Smith Kline, Medtronic, Pfizer, and Sanofi, consulting fees from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, Sanofi, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Merck, and Portola, honoraria from Pfizer and meeting travel support from IQVIA. OB reports grant support from Astra Zeneca, Bayer, Amgen, Novartis, Servier, Pfizer. SSA..
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heparin in critically ill patients ' 'with Covid-19', 'author': 'Goligher', 'doi-asserted-by': 'crossref', 'first-page': '777', 'journal-title': 'N Engl J Med', 'key': '10.1016/S2213-2600(22)00298-3_bib22', 'volume': '385', 'year': '2021'}, { 'DOI': '10.1186/s13063-020-04641-3', 'article-title': 'Corticosteroid therapy for critically ill patients with COVID-19: A ' 'structured summary of a study protocol for a prospective meta-analysis ' 'of randomized trials', 'author': 'Sterne', 'doi-asserted-by': 'crossref', 'first-page': '734', 'journal-title': 'Trials', 'key': '10.1016/S2213-2600(22)00298-3_bib24', 'volume': '21', 'year': '2020'}, { 'DOI': '10.1001/jama.2021.11330', 'article-title': 'Association between administration of IL-6 antagonists and mortality ' 'among patients hospitalized for COVID-19: a meta-analysis', 'doi-asserted-by': 'crossref', 'first-page': '499', 'journal-title': 'JAMA', 'key': '10.1016/S2213-2600(22)00298-3_bib25', 'volume': '326', 'year': '2021'}, { 'DOI': '10.1016/S2213-2600(21)00435-5', 'article-title': 'Colchicine in patients admitted to hospital with COVID-19 (RECOVERY): a ' 'randomised, controlled, open-label, platform trial', 'author': 'Group', 'doi-asserted-by': 'crossref', 'first-page': '1419', 'journal-title': 'Lancet Respir Med', 'key': '10.1016/S2213-2600(22)00298-3_bib26', 'volume': '9', 'year': '2021'}, { 'DOI': '10.1001/jamanetworkopen.2021.41328', 'article-title': 'Effect of colchicine vs usual care alone on intubation and 28-day ' 'mortality in patients hospitalized with COVID-19: a randomized clinical ' 'trial', 'author': 'Diaz', 'doi-asserted-by': 'crossref', 'journal-title': 'JAMA Netw Open', 'key': '10.1016/S2213-2600(22)00298-3_bib27', 'volume': '4', 'year': '2021'}, { 'DOI': '10.1016/S2213-2600(21)00222-8', 'article-title': 'Colchicine for community-treated patients with COVID-19 (COLCORONA): a ' 'phase 3, randomised, double-blinded, adaptive, placebo-controlled, ' 'multicentre trial', 'author': 'Tardif', 'doi-asserted-by': 'crossref', 'first-page': '924', 'journal-title': 'Lancet Respir Med', 'key': '10.1016/S2213-2600(22)00298-3_bib28', 'volume': '9', 'year': '2021'}, { 'DOI': '10.1016/S2352-3026(21)00105-8', 'article-title': 'COVID-19-associated coagulopathy and antithrombotic agents-lessons ' 'after 1 year', 'author': 'Leentjens', 'doi-asserted-by': 'crossref', 'first-page': 'e524', 'journal-title': 'Lancet Haematol', 'key': '10.1016/S2213-2600(22)00298-3_bib29', 'volume': '8', 'year': '2021'}, { 'DOI': '10.1007/s12024-020-00310-8', 'article-title': 'Autopsy findings in COVID-19-related deaths: a literature review', 'author': 'Maiese', 'doi-asserted-by': 'crossref', 'first-page': '279', 'journal-title': 'Forensic Sci Med Pathol', 'key': '10.1016/S2213-2600(22)00298-3_bib30', 'volume': '17', 'year': '2021'}, { 'DOI': '10.1001/jama.2022.2910', 'article-title': 'Effect of antiplatelet therapy on survival and organ support-free days ' 'in critically ill patients with COVID-19: a randomized clinical trial', 'author': 'Bradbury', 'doi-asserted-by': 'crossref', 'first-page': '1247', 'journal-title': 'JAMA', 'key': '10.1016/S2213-2600(22)00298-3_bib31', 'volume': '327', 'year': '2022'}, { 'DOI': '10.1016/S0140-6736(21)01825-0', 'article-title': 'Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a ' 'randomised, controlled, open-label, platform trial', 'author': 'Group', 'doi-asserted-by': 'crossref', 'first-page': '143', 'journal-title': 'Lancet', 'key': '10.1016/S2213-2600(22)00298-3_bib32', 'volume': '399', 'year': '2022'}, { 'DOI': '10.1002/jmv.26771', 'article-title': 'Inflammation-associated factors for predicting in-hospital mortality in ' 'patients with COVID-19', 'author': 'Wang', 'doi-asserted-by': 'crossref', 'first-page': '2908', 'journal-title': 'J Med Virol', 'key': '10.1016/S2213-2600(22)00298-3_bib23', 'volume': '93', 'year': '2021'}], 'reference-count': 32, 'references-count': 32, 'relation': {}, 'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S2213260022002983'}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subject': ['Pulmonary and Respiratory Medicine'], 'subtitle': [], 'title': 'Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 ' '(ACT): an open-label, factorial, randomised, controlled trial', 'type': 'journal-article', 'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy'}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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