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76 aspirin COVID-19 controlled studies, 7 RCTs
67% improvement
for early treatment, RR
0.33
[0.01-7.96]
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
ACTIV-4B
Connors (DB RCT)
67%
0.33 [0.01-7.96]
hosp.
0/144
1/136
Improvement, RR [CI]
Treatment
Control
ACTIV-4B
Connors (DB RCT)
19%
0.81 [0.28-2.35]
progression
6/144
7/136
ACTIV-4B
Connors (DB RCT)
6%
0.94 [0.06-15.0]
progression
1/144
1/136
Alamdari
-28%
1.28 [0.67-2.43]
death
9/53
54/406
Husain
80%
0.20 [0.01-3.55]
death
0/11
3/31
Husain
65%
0.35 [0.05-2.51]
no recov.
1/11
8/31
Husain
96%
0.04 [0.00-0.64]
progression
0/11
17/31
Goshua (PSM)
35%
0.65 [0.42-0.98]
death
319 (n)
319 (n)
Goshua (PSM)
-49%
1.49 [1.03-2.18]
ventilation
319 (n)
319 (n)
Goshua (PSM)
-45%
1.45 [1.06-1.98]
ICU
319 (n)
319 (n)
Meizlish (PSM)
48%
0.52 [0.34-0.81]
death
319 (n)
319 (n)
Liu (PSM)
75%
0.25 [0.07-0.87]
death
2/28
11/204
Liu (PSM)
81%
0.19 [0.05-0.78]
death
1/28
9/204
Liu (PSM)
-2%
1.02 [0.64-1.61]
viral time
24 (n)
24 (n)
Mura (PSM)
15%
0.85 [0.69-1.01]
death
527 (n)
527 (n)
Mura (PSM)
37%
0.63 [0.47-0.83]
death
305 (n)
305 (n)
Chow
47%
0.53 [0.31-0.90]
death
26/98
73/314
Chow
44%
0.56 [0.37-0.85]
ventilation
35/98
152/314
Chow
43%
0.57 [0.38-0.85]
ICU
38/98
160/314
Haji Aghajani
25%
0.75 [0.57-0.99]
death
336 (n)
655 (n)
Elhadi (ICU)
10%
0.90 [0.67-1.21]
death
22/40
259/425
ICU patients
Sahai (PSM)
13%
0.87 [0.56-1.34]
death
33/248
38/248
Pourhoseingholi
-32%
1.32 [1.02-1.71]
death
71/290
268/2,178
Vahedian-Azimi
22%
0.78 [0.33-1.74]
death
13/337
28/250
Vahedian-Azimi
-10%
1.10 [0.68-1.68]
ICU
36/337
44/250
Abdelwahab
-8%
1.08 [0.15-3.82]
ventilation
11/31
6/36
Karruli (ICU)
46%
0.54 [0.09-3.13]
death
1/5
22/27
ICU patients
Al Harthi (ICU)
27%
0.73 [0.56-0.97]
death
98/176
107/173
ICU patients
Al Harthi (ICU)
14%
0.86 [0.65-1.14]
death
95/176
97/175
ICU patients
Al Harthi (ICU)
5%
0.95 [0.80-1.12]
ICU
176 (n)
175 (n)
ICU patients
Kim (PSM)
34%
0.66 [0.36-1.23]
death
14/124
23/135
Kim (PSM)
-102%
2.02 [0.83-4.90]
ventilation
13/124
7/135
Kim (PSM)
-91%
1.91 [0.57-6.35]
ICU
7/124
4/135
Zhao
43%
0.57 [0.41-0.78]
death
121/473
140/473
Zhao
28%
0.72 [0.54-0.96]
death
473 (n)
1,597 (n)
RECOVERY
RECOVERY Co.. (RCT)
4%
0.96 [0.89-1.04]
death
7,351 (n)
7,541 (n)
RECOVERY
RECOVERY Co.. (RCT)
17%
0.83 [0.66-1.04]
death
7,351 (n)
7,541 (n)
RECOVERY
RECOVERY Co.. (RCT)
5%
0.95 [0.87-1.05]
ventilation
7,351 (n)
7,541 (n)
RECOVERY
RECOVERY Co.. (RCT)
6%
0.94 [0.91-0.98]
no disch.
7,351 (n)
7,541 (n)
RECOVERY
RECOVERY Co.. (RCT)
16%
0.84 [0.71-0.99]
no disch.
7,351 (n)
7,541 (n)
Mustafa
44%
0.56 [0.21-1.51]
death
4/66
41/378
REMAP-CAP
Bradbury (RCT)
16%
0.84 [0.70-1.00]
death
165/563
170/521
REMAP-CAP
Bradbury (RCT)
17%
0.83 [0.67-1.02]
no disch.
161/563
167/521
REMAP-CAP
Bradbury (RCT)
21%
0.79 [0.65-0.96]
progression
204/563
212/521
REMAP-CAP
Bradbury (RCT)
5%
0.95 [0.77-1.18]
progression
563 (n)
521 (n)
Chow (PSW)
13%
0.87 [0.81-0.93]
death
population-based cohort
Santoro (PSM)
38%
0.62 [0.42-0.92]
death
360 (n)
2,949 (n)
RESIST
Ghati (RCT)
22%
0.78 [0.31-1.98]
death
11/442
7/219
RESIST
Ghati (RCT)
58%
0.42 [0.11-1.62]
death
3/221
7/219
RESIST
Ghati (RCT)
9%
0.91 [0.34-2.42]
ventilation
11/442
6/219
RESIST
Ghati (RCT)
50%
0.50 [0.13-1.96]
ventilation
3/221
6/219
RESIST
Ghati (RCT)
30%
0.70 [0.27-1.81]
progression
11/442
7/219
RESIST
Ghati (RCT)
60%
0.40 [0.10-1.54]
progression
3/221
7/219
Karimpour-Razke..
-123%
2.23 [1.26-3.38]
death
39/90
64/363
ACT inpatient
Eikelboom (RCT)
-5%
1.05 [0.86-1.28]
death
193/1,063
186/1,056
CT1
ACT inpatient
Eikelboom (RCT)
8%
0.92 [0.78-1.09]
progression
281/1,063
300/1,056
CT1
ACT inpatient
Eikelboom (RCT)
11%
0.89 [0.73-1.09]
progression
191/1,063
210/1,056
CT1
ACT outpatient
Eikelboom (RCT)
-9%
1.09 [0.48-2.46]
death
12/1,945
11/1,936
ACT outpatient
Eikelboom (RCT)
20%
0.80 [0.57-1.13]
progression
59/1,945
73/1,936
ACT outpatient
Eikelboom (RCT)
17%
0.83 [0.58-1.19]
hosp.
56/1,945
67/1,936
Ali (ICU)
40%
0.60 [0.51-0.72]
death
152/660
202/530
ICU patients
Ali (ICU)
37%
0.63 [0.47-0.83]
ARDS
74/660
95/530
ICU patients
Aidouni (ICU)
31%
0.69 [0.54-0.88]
death
202/712
165/412
ICU patients
Aidouni (ICU)
10%
0.90 [0.74-1.10]
ventilation
189/712
121/412
ICU patients
Singla (RCT)
57%
0.43 [0.04-3.27]
death
3/49
5/49
CT1
Singla (RCT)
15%
0.85 [0.11-6.31]
death
49 (n)
49 (n)
CT1
Singla (RCT)
20%
0.80 [0.23-2.80]
ventilation
4/49
5/49
CT1
Singla (RCT)
29%
0.71 [0.24-2.10]
ICU
5/49
7/49
CT1
Singla (RCT)
33%
0.67 [0.20-2.22]
progression
4/49
6/49
CT1
Singla (RCT)
76%
0.24 [0.02-2.10]
progression
4/49
7/49
CT1
Singla (RCT)
44%
0.56 [0.20-1.54]
progression
5/49
9/49
CT1
Singla (RCT)
86%
0.14 [0.01-2.69]
progression
0/49
3/49
CT1
Singla (RCT)
25%
0.75 [0.35-1.62]
progression
9/49
12/49
CT1
Shamsi
96%
0.04 [0.00-7.20]
death
0/13
24/170
Mehrizi
16%
0.84 [0.82-0.86]
death
population-based cohort
Lewandowski
-70%
1.70 [1.08-2.70]
death
430 (all patients)
Vinod
14%
0.86 [0.48-1.52]
death
128 (n)
248 (n)
Vinod
30%
0.70 [0.38-1.27]
ventilation
128 (n)
248 (n)
Vinod
40%
0.60 [0.36-1.00]
progression
128 (n)
248 (n)
Vinod
-6%
1.06 [0.53-2.13]
misc.
128 (n)
248 (n)
Vinod
18%
0.82 [0.24-2.78]
progression
128 (n)
248 (n)
Azimi Pirsaraei
-97%
1.97 [1.28-3.04]
death
28/184
50/647
Holt
-34%
1.34 [0.98-1.84]
death/ICU
35/116
129/573
Wang
58%
0.42 [0.01-1.98]
death
1/9
13/49
Lodigiani
-21%
1.21 [0.73-2.01]
ICU
17/94
44/294
Yuan
4%
0.96 [0.47-1.72]
death
11/52
29/131
Ramos-Rincón
-29%
1.29 [1.05-1.51]
death
132/264
253/526
Osborne (PSM)
59%
0.41 [0.35-0.48]
death
272/6,300
661/6,300
Osborne (PSM)
60%
0.40 [0.33-0.48]
death
170/6,814
427/6,814
Merzon
28%
0.72 [0.53-0.99]
cases
73/1,621
589/8,856
Merzon
62%
0.38 [0.02-4.94]
death
1/21
6/91
Merzon
10%
0.90 [0.82-1.00]
viral time
73 (n)
589 (n)
Merzon
15%
0.85 [0.76-0.95]
viral time
73 (n)
589 (n)
Bejan
1%
0.99 [0.61-1.63]
ventilation
1,899 (n)
7,330 (n)
Mulhem
-14%
1.14 [0.93-1.40]
death
300/1,354
216/1,865
Reese (PSM)
-61%
1.61 [1.31-1.99]
death
4,921 (n)
4,921 (n)
Reese (PSM)
-309%
4.09 [3.72-4.50]
severe case
4,921 (n)
4,921 (n)
Drew
22%
0.78 [0.49-1.24]
progression
n/a
n/a
Drew
-3%
1.03 [0.83-1.28]
cases
n/a
n/a
Pan
-13%
1.13 [0.70-1.82]
death
239 (n)
523 (n)
Pan
-2%
1.02 [0.66-1.57]
death/int.
239 (n)
523 (n)
Oh
1%
0.99 [0.65-1.50]
death
n/a
n/a
Oh
12%
0.88 [0.79-0.99]
cases
n/a
n/a
Son (PSM)
11%
0.89 [0.53-1.47]
death
case control
Son (PSM)
24%
0.76 [0.34-1.71]
death
case control
Son (PSM)
-7%
1.07 [0.65-1.75]
progression
case control
Son (PSM)
9%
0.91 [0.64-1.29]
progression
case control
Son (PSM)
-11%
1.11 [0.94-1.30]
cases
case control
Son (PSM)
-1%
1.01 [0.88-1.16]
cases
case control
Ma (PSM)
9%
0.91 [0.82-1.02]
death
Ma (PSM)
2%
0.98 [0.92-1.04]
hosp.
Ma (PSM)
-9%
1.09 [0.96-1.25]
symp. case
Ma (PSM)
-7%
1.07 [0.99-1.16]
cases
Chow (PSM)
19%
0.81 [0.76-0.87]
death
1,280/6,781
2,271/10,566
Chow (PSM)
3%
0.97 [0.93-1.02]
ventilation
2,122/6,781
3,403/10,566
Kim (PSM)
-700%
8.00 [1.07-59.6]
death
6/15
1/20
Kim (PSM)
-433%
5.33 [0.66-43.0]
ventilation
4/15
1/20
Kim (PSM)
-433%
5.33 [0.66-43.0]
ICU
4/15
1/20
Kim (PSM)
33%
0.67 [0.30-1.36]
cases
15/136
20/136
Kim (PSM)
34%
0.66 [0.36-1.23]
death
14/124
23/135
Kim (PSM)
-102%
2.02 [0.83-4.90]
ventilation
13/124
7/135
Kim (PSM)
-91%
1.91 [0.57-6.35]
ICU
7/124
4/135
Basheer
-13%
1.13 [1.05-1.21]
death
45/140
29/250
Sisinni
-7%
1.07 [0.89-1.29]
death
93/253
251/731
Sisinni
30%
0.70 [0.53-0.92]
death/int.
253 (n)
731 (n)
Pérez-Segura
-49%
1.49 [1.20-1.80]
death
66/155
183/608
Formiga (PSM)
-3%
1.03 [0.94-1.13]
death
1,000/3,291
874/2,885
Formiga (PSM)
-3%
1.03 [0.85-1.25]
ventilation
213/3,291
181/2,885
Formiga (PSM)
-4%
1.04 [0.88-1.23]
ICU
283/3,291
238/2,885
Sullerot (PSW)
-10%
1.10 [0.81-1.49]
death
101/301
224/746
Sullerot (PSW)
-110%
2.10 [1.21-3.64]
ICU
22/301
26/746
Sullerot (PSW)
-10%
1.10 [1.01-1.20]
hosp. time
301 (n)
746 (n)
Monserrat .. (PSM)
-31%
1.31 [1.01-1.71]
death
n/a
n/a
Levy
26%
0.74 [0.49-1.10]
death/hosp.
29/159
178/690
Nimer
4%
0.96 [0.69-1.33]
hosp.
83/427
136/1,721
Nimer
-18%
1.18 [0.87-1.56]
severe case
98/427
162/1,721
Gogtay
-6%
1.06 [0.51-1.89]
death
12/38
21/87
Gogtay
50%
0.50 [0.18-1.22]
ventilation
5/38
21/87
Gogtay
49%
0.51 [0.06-1.46]
ICU
9/38
38/87
Campbell (PSW)
3%
0.97 [0.95-1.00]
death
419 (n)
20,311 (n)
Campbell (PSW)
2%
0.98 [0.95-1.00]
death
419 (n)
20,311 (n)
Lal
11%
0.89 [0.82-0.97]
death
4,691 (n)
16,888 (n)
Lal
22%
0.78 [0.73-0.84]
ICU
4,691 (n)
16,888 (n)
Lal
9%
0.91 [0.84-0.99]
progression
4,691 (n)
16,888 (n)
Botton
-4%
1.04 [0.98-1.10]
death/int.
population-based cohort
Botton
-3%
1.03 [1.00-1.06]
hosp.
population-based cohort
Malik
14%
0.86 [0.39-1.80]
death
15/87
24/223
Malik
28%
0.72 [0.44-1.11]
ICU
28/87
77/223
Malik
25%
0.75 [0.38-1.39]
ARDS
13/87
40/223
Malik
2%
0.98 [0.53-1.78]
hosp.
25 (n)
176 (n)
Abul
33%
0.67 [0.47-0.95]
death
46/511
201/1,176
Abul
40%
0.60 [0.40-0.90]
death
33/511
154/1,176
Abul
20%
0.80 [0.60-1.07]
hosp.
103/511
352/1,176
Loucera
18%
0.82 [0.74-0.92]
death
2,127 (n)
13,841 (n)
Morrison (PSM)
8%
0.92 [0.73-1.18]
death
1,667 (n)
1,667 (n)
Morrison (PSM)
-1%
1.01 [0.71-1.43]
ventilation
1,667 (n)
1,667 (n)
Morrison (PSM)
-12%
1.12 [0.88-1.43]
ICU
1,667 (n)
1,667 (n)
Morrison (PSM)
-18%
1.18 [1.00-1.39]
hosp.
1,667 (n)
1,667 (n)
Ali
28%
0.72 [0.51-1.03]
death
481 (n)
1,164 (n)
Zadeh
37%
0.63 [0.30-1.29]
death
n/a
n/a
Zadeh
-1%
1.01 [0.89-1.15]
ICU
n/a
n/a
Azizi
0%
1.00 [0.53-1.87]
death
17/131
17/131
Aweimer
-10%
1.10 [0.90-1.34]
death
34/44
74/105
Intubated patients
Tse (PSM)
67%
0.33 [0.18-0.59]
death/int.
2,664 (all patients)
Prieto-Campo
-13%
1.13 [0.86-1.48]
death
case control
Prieto-Campo
3%
0.97 [0.86-1.09]
hosp.
case control
Prieto-Campo
0%
1.00 [0.87-1.15]
progression
case control
Prieto-Campo
8%
0.92 [0.86-0.98]
cases
case control
Ware (PSM)
46%
0.54 [0.53-0.56]
death
population-based cohort
Sakamaki
-37%
1.37 [1.31-1.44]
severe case
population-based cohort
Aspirin COVID-19 outcomes
c19 early .org
November 2024
1 CT: study uses combined treatment
Favors aspirin
Favors control
Figure 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.
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