Supplementary Data — Aspirin for COVID-19: real-time meta-analysis of 79 studies

October 2026

Aspirin COVID-19 outcomes

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk
Connors (DB RCT)67%0.33 · 0.01–7.96hosp.0/1441/136ACTIV-4B Connors (DB RCT)19%0.81 · 0.28–2.35progression6/1447/136ACTIV-4B Connors (DB RCT)6%0.94 · 0.06–14.95progression1/1441/136ACTIV-4B Alamdari−28%1.28 · 0.67–2.43death9/5354/406 Husain80%0.20 · 0.01–3.55death0/113/31 Husain65%0.35 · 0.05–2.51no recov.1/118/31 Husain96%0.04 · 0.00–0.64progression0/1117/31 Goshua (PSM)35%0.65 · 0.42–0.98death319 (n)319 (n) Goshua (PSM)−49%1.49 · 1.03–2.18ventilation319 (n)319 (n) Goshua (PSM)−45%1.45 · 1.06–1.98ICU319 (n)319 (n) Meizlish (PSM)48%0.52 · 0.34–0.81death319 (n)319 (n) Liu (PSM)75%0.25 · 0.07–0.87death2/2811/204 Liu (PSM)81%0.19 · 0.05–0.78death1/289/204 Liu (PSM)−2%1.02 · 0.64–1.61viral time24 (n)24 (n) Mura (PSM)15%0.85 · 0.69–1.01death527 (n)527 (n) Mura (PSM)37%0.63 · 0.47–0.83death305 (n)305 (n) Chow47%0.53 · 0.31–0.90death26/9873/314 Chow44%0.56 · 0.37–0.85ventilation35/98152/314 Chow43%0.57 · 0.38–0.85ICU38/98160/314 Haji Aghajani25%0.75 · 0.57–0.99death336 (n)655 (n) Elhadi (ICU)10%0.90 · 0.67–1.21death22/40259/425ICU patients Sahai (PSM)13%0.87 · 0.56–1.34death33/24838/248 Pourhoseingholi−32%1.32 · 1.02–1.71death71/290268/2,178 Vahedian-Azimi22%0.78 · 0.33–1.74death13/33728/250 Vahedian-Azimi−10%1.10 · 0.68–1.68ICU36/33744/250 Abdelwahab−8%1.08 · 0.15–3.82ventilation11/316/36 Karruli (ICU)46%0.54 · 0.09–3.13death1/522/27ICU patients Al Harthi (ICU)27%0.73 · 0.56–0.97death98/176107/173ICU patients Al Harthi (ICU)14%0.86 · 0.65–1.14death95/17697/175ICU patients Al Harthi (ICU)5%0.95 · 0.80–1.12ICU176 (n)175 (n)ICU patients Kim (PSM)34%0.66 · 0.36–1.23death14/12423/135 Kim (PSM)−102%2.02 · 0.83–4.90ventilation13/1247/135 Kim (PSM)−91%1.91 · 0.57–6.35ICU7/1244/135 Zhao43%0.57 · 0.41–0.78death121/473140/473 Zhao28%0.72 · 0.54–0.96death473 (n)1,597 (n) Horby (RCT)4%0.96 · 0.89–1.04death7,351 (n)7,541 (n)RECOVERY Horby (RCT)17%0.83 · 0.66–1.04death7,351 (n)7,541 (n)RECOVERY Horby (RCT)5%0.95 · 0.87–1.05ventilation7,351 (n)7,541 (n)RECOVERY Horby (RCT)6%0.94 · 0.91–0.98no disch.7,351 (n)7,541 (n)RECOVERY Horby (RCT)16%0.84 · 0.71–0.99no disch.7,351 (n)7,541 (n)RECOVERY Mustafa44%0.56 · 0.21–1.51death4/6641/378 Bradbury (RCT)16%0.84 · 0.70–1.00death165/563170/521REMAP-CAP Bradbury (RCT)17%0.83 · 0.67–1.02no disch.161/563167/521REMAP-CAP Bradbury (RCT)21%0.79 · 0.65–0.96progression204/563212/521REMAP-CAP Bradbury (RCT)5%0.95 · 0.77–1.18progression563 (n)521 (n)REMAP-CAP Chow (PSW)13%0.87 · 0.81–0.93deathpopulation-based cohort Santoro (PSM)38%0.62 · 0.42–0.92death360 (n)2,949 (n) Ghati (RCT)22%0.78 · 0.31–1.98death11/4427/219RESIST Ghati (RCT)58%0.42 · 0.11–1.62death3/2217/219RESIST Ghati (RCT)9%0.91 · 0.34–2.42ventilation11/4426/219RESIST Ghati (RCT)50%0.50 · 0.13–1.96ventilation3/2216/219RESIST Ghati (RCT)30%0.70 · 0.27–1.81progression11/4427/219RESIST Ghati (RCT)60%0.40 · 0.10–1.54progression3/2217/219RESIST Karimpour-Razke..−123%2.23 · 1.26–3.38death39/9064/363 Eikelboom (RCT)−5%1.05 · 0.86–1.28death193/1,063186/1,056ACT inpatientCT1 Eikelboom (RCT)8%0.92 · 0.78–1.09progression281/1,063300/1,056ACT inpatientCT1 Eikelboom (RCT)11%0.89 · 0.73–1.09progression191/1,063210/1,056ACT inpatientCT1 Eikelboom (RCT)−9%1.09 · 0.48–2.46death12/1,94511/1,936ACT outpatient Eikelboom (RCT)20%0.80 · 0.57–1.13progression59/1,94573/1,936ACT outpatient Eikelboom (RCT)17%0.83 · 0.58–1.19hosp.56/1,94567/1,936ACT outpatient Ali (ICU)40%0.60 · 0.51–0.72death152/660202/530ICU patients Ali (ICU)37%0.63 · 0.47–0.83ARDS74/66095/530ICU patients Aidouni (ICU)31%0.69 · 0.54–0.88death202/712165/412ICU patients Aidouni (ICU)10%0.90 · 0.74–1.10ventilation189/712121/412ICU patients Singla (RCT)57%0.43 · 0.04–3.27death3/495/49CT1 Singla (RCT)15%0.85 · 0.11–6.31death49 (n)49 (n)CT1 Singla (RCT)20%0.80 · 0.23–2.80ventilation4/495/49CT1 Singla (RCT)29%0.71 · 0.24–2.10ICU5/497/49CT1 Singla (RCT)33%0.67 · 0.20–2.22progression4/496/49CT1 Singla (RCT)76%0.24 · 0.02–2.10progression4/497/49CT1 Singla (RCT)44%0.56 · 0.20–1.54progression5/499/49CT1 Singla (RCT)86%0.14 · 0.01–2.69progression0/493/49CT1 Singla (RCT)25%0.75 · 0.35–1.62progression9/4912/49CT1 Shamsi96%0.04 · 0.00–0.58death0/1324/170 Mehrizi16%0.84 · 0.82–0.86deathpopulation-based cohort Lewandowski−70%1.70 · 1.08–2.70death430 (all patients) Vinod14%0.86 · 0.48–1.52death128 (n)248 (n) Vinod30%0.70 · 0.38–1.27ventilation128 (n)248 (n) Vinod40%0.60 · 0.36–1.00progression128 (n)248 (n) Vinod−6%1.06 · 0.53–2.13misc.128 (n)248 (n) Vinod18%0.82 · 0.24–2.78progression128 (n)248 (n) Azimi Pirsaraei−97%1.97 · 1.28–3.04death28/18450/647 Dinoi−55%1.55 · 1.05–2.30deathcase-control study Holt−34%1.34 · 0.98–1.84death/ICU35/116129/573 Wang58%0.42 · 0.01–1.98death1/913/49 Lodigiani−21%1.21 · 0.73–2.01ICU17/9444/294 Yuan4%0.96 · 0.47–1.72death11/5229/131 Ramos-Rincón−29%1.29 · 1.05–1.51death132/264253/526 Osborne (PSM)59%0.41 · 0.35–0.48death272/6,300661/6,300 Osborne (PSM)60%0.40 · 0.33–0.48death170/6,814427/6,814 Merzon28%0.72 · 0.53–0.99cases73/1,621589/8,856 Merzon62%0.38 · 0.02–4.94death1/216/91 Merzon10%0.90 · 0.82–1.00viral time73 (n)589 (n) Merzon15%0.85 · 0.76–0.95viral time73 (n)589 (n) Bejan1%0.99 · 0.61–1.63ventilation1,899 (n)7,330 (n) Mulhem−14%1.14 · 0.93–1.40death300/1,354216/1,865 Reese (PSM)−61%1.61 · 1.31–1.99death4,921 (n)4,921 (n) Reese (PSM)−309%4.09 · 3.72–4.50severe case4,921 (n)4,921 (n) Drew22%0.78 · 0.49–1.24progressionn/an/a Drew−3%1.03 · 0.83–1.28casesn/an/a Pan−13%1.13 · 0.70–1.82death239 (n)523 (n) Pan−2%1.02 · 0.66–1.57death/int.239 (n)523 (n) Oh1%0.99 · 0.65–1.50deathn/an/a Oh12%0.88 · 0.79–0.99casesn/an/a Son (PSM)11%0.89 · 0.53–1.47deathcase-control study Son (PSM)24%0.76 · 0.34–1.71deathcase-control study Son (PSM)−7%1.07 · 0.65–1.75progressioncase-control study Son (PSM)9%0.91 · 0.64–1.29progressioncase-control study Son (PSM)−11%1.11 · 0.94–1.30casescase-control study Son (PSM)−1%1.01 · 0.88–1.16casescase-control study Ma (PSM)9%0.91 · 0.82–1.02death Ma (PSM)2%0.98 · 0.92–1.04hosp. Ma (PSM)−9%1.09 · 0.96–1.25symp. case Ma (PSM)−7%1.07 · 0.99–1.16cases Chow (PSM)19%0.81 · 0.76–0.87death1,280/6,7812,271/10,566 Chow (PSM)3%0.97 · 0.93–1.02ventilation2,122/6,7813,403/10,566 Kim (PSM)−700%8.00 · 1.07–59.61death6/151/20 Kim (PSM)−433%5.33 · 0.66–42.97ventilation4/151/20 Kim (PSM)−433%5.33 · 0.66–42.97ICU4/151/20 Kim (PSM)33%0.67 · 0.30–1.36cases15/13620/136 Kim (PSM)34%0.66 · 0.36–1.23death14/12423/135 Kim (PSM)−102%2.02 · 0.83–4.90ventilation13/1247/135 Kim (PSM)−91%1.91 · 0.57–6.35ICU7/1244/135 Basheer−13%1.13 · 1.05–1.21death45/14029/250 Sisinni−7%1.07 · 0.89–1.29death93/253251/731 Sisinni30%0.70 · 0.53–0.92death/int.253 (n)731 (n) Pérez-Segura−49%1.49 · 1.20–1.80death66/155183/608 Formiga (PSM)−3%1.03 · 0.94–1.13death1,000/3,291874/2,885 Formiga (PSM)−3%1.03 · 0.85–1.25ventilation213/3,291181/2,885 Formiga (PSM)−4%1.04 · 0.88–1.23ICU283/3,291238/2,885 Sullerot (PSW)−10%1.10 · 0.81–1.49death101/301224/746 Sullerot (PSW)−110%2.10 · 1.21–3.64ICU22/30126/746 Sullerot (PSW)−10%1.10 · 1.01–1.20hosp. time301 (n)746 (n) Monserrat .. (PSM)−31%1.31 · 1.01–1.71deathn/an/a Levy26%0.74 · 0.49–1.10death/hosp.29/159178/690 Nimer4%0.96 · 0.69–1.33hosp.83/427136/1,721 Nimer−18%1.18 · 0.87–1.56severe case98/427162/1,721 Gogtay−6%1.06 · 0.51–1.89death12/3821/87 Gogtay50%0.50 · 0.18–1.22ventilation5/3821/87 Gogtay49%0.51 · 0.06–1.46ICU9/3838/87 Campbell (PSW)3%0.97 · 0.95–1.00death419 (n)20,311 (n) Campbell (PSW)2%0.98 · 0.95–1.00death419 (n)20,311 (n) Lal11%0.89 · 0.82–0.97death4,691 (n)16,888 (n) Lal22%0.78 · 0.73–0.84ICU4,691 (n)16,888 (n) Lal9%0.91 · 0.84–0.99progression4,691 (n)16,888 (n) Botton−4%1.04 · 0.98–1.10death/int.population-based cohort Botton−3%1.03 · 1.00–1.06hosp.population-based cohort Malik14%0.86 · 0.39–1.80death15/8724/223 Malik28%0.72 · 0.44–1.11ICU28/8777/223 Malik25%0.75 · 0.38–1.39ARDS13/8740/223 Malik2%0.98 · 0.53–1.78hosp.25 (n)176 (n) Abul33%0.67 · 0.47–0.95death46/511201/1,176 Abul40%0.60 · 0.40–0.90death33/511154/1,176 Abul20%0.80 · 0.60–1.07hosp.103/511352/1,176 Loucera18%0.82 · 0.74–0.92death2,127 (n)13,841 (n) Morrison (PSM)8%0.92 · 0.73–1.18death1,667 (n)1,667 (n) Morrison (PSM)−1%1.01 · 0.71–1.43ventilation1,667 (n)1,667 (n) Morrison (PSM)−12%1.12 · 0.88–1.43ICU1,667 (n)1,667 (n) Morrison (PSM)−18%1.18 · 1.00–1.39hosp.1,667 (n)1,667 (n) Ali28%0.72 · 0.51–1.03death481 (n)1,164 (n) Zadeh37%0.63 · 0.30–1.29deathn/an/a Zadeh−1%1.01 · 0.89–1.15ICUn/an/a Azizi0%1.00 · 0.53–1.87death17/13117/131 Aweimer−10%1.10 · 0.90–1.34death34/4474/105Intubated patients Tse (PSM)67%0.33 · 0.18–0.59death/int.2,664 (all patients) Prieto-Campo−13%1.13 · 0.86–1.48deathcase-control study Prieto-Campo3%0.97 · 0.86–1.09hosp.case-control study Prieto-Campo0%1.00 · 0.87–1.15progressioncase-control study Prieto-Campo8%0.92 · 0.86–0.98casescase-control study Ware (PSM)46%0.54 · 0.53–0.56deathpopulation-based cohort Sakamaki−37%1.37 · 1.31–1.44severe casepopulation-based cohort Miele−32%1.32 · 1.04–1.68deathn/an/a Kurnik (ICU)−11%1.11 · 0.92–1.34death33/4067/90ICU patients
00.511.52+
1 CT: study uses combined treatment
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← Aspirin
reduces risk
Aspirin
increases risk →
Fig. S1. All outcomes.
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Fig. S2. Comparison of results for RCTs versus observational studies. For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.