Decreased In-Hospital Mortality Associated with Aspirin Administration in Hospitalized Patients Due to Severe COVID-19
et al., Journal of Medical Virology, doi:10.1002/jmv.27053, Apr 2021
Retrospective 991 hospitalized patients in Iran focusing on aspirin use but also showing results for HCQ, remdesivir, and favipiravir.
Potential risks of favipiravir include kidney injury1-3, liver injury2-4, and mutagenicity, carcinogenicity, teratogenicity, embryotoxicity, and the creation of dangerous variants5-11.
|
risk of death, 26.1% lower, HR 0.74, p = 0.28, treatment 40, control 951, univariate Cox proportional regression.
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
1.
Abdulaziz et al., Clinical Features and Prognosis of Acute Kidney Injury in Hospital-Admitted Patients with COVID-19 in Egypt: A Single-Center Experience, Mansoura Medical Journal, doi:10.58775/2735-3990.1433.
2.
Ülger et al., Experimental evaluation of favipiravir (T-705)-induced liver and kidney toxicity in rats, Food and Chemical Toxicology, doi:10.1016/j.fct.2025.115472.
3.
El-Fetouh et al., Experimental Studies on Some Drugs Used in Covid-19 Treatment (Favipiravir and Dexamethasone) in Albino Rats, Journal of Advanced Veterinary Research, 13:10, www.advetresearch.com/index.php/AVR/article/view/1635.
4.
Almutairi et al., Liver Injury in Favipiravir-Treated COVID-19 Patients: Retrospective Single-Center Cohort Study, Tropical Medicine and Infectious Disease, doi:10.3390/tropicalmed8020129.
5.
Zhirnov et al., Favipiravir: the hidden threat of mutagenic action, Journal of microbiology, epidemiology and immunobiology, doi:10.36233/0372-9311-114.
6.
Waters et al., Human genetic risk of treatment with antiviral nucleoside analog drugs that induce lethal mutagenesis: the special case of molnupiravir, Environmental and Molecular Mutagenesis, doi:10.1002/em.22471.
7.
Hadj Hassine et al., Lethal Mutagenesis of RNA Viruses and Approved Drugs with Antiviral Mutagenic Activity, Viruses, doi:10.3390/v14040841.
8.
Shum, C., An investigational study into the drug-associated mutational signature in SARS-CoV-2 viruses, The University of Hong Kong, PhD Thesis, hub.hku.hk/handle/10722/344396.
9.
Shiraki et al., Convenient screening of the reproductive toxicity of favipiravir and antiviral drugs in Caenorhabditis elegans, Heliyon, doi:10.1016/j.heliyon.2024.e35331.
Haji Aghajani et al., 29 Apr 2021, retrospective, Iran, peer-reviewed, 7 authors.
Decreased in‐hospital mortality associated with aspirin administration in hospitalized patients due to severe COVID‐19
Journal of Medical Virology, doi:10.1002/jmv.27053
Hypercoagulability and thrombosis caused by coronavirus disease 2019 (COVID-19) are related to the higher mortality rate. Because of limited data on the antiplatelet effect, we aimed to evaluate the impact of aspirin add-on therapy on the outcome of the patients hospitalized due to severe COVID-19. In this cohort study, patients with a confirmed diagnosis of severe COVID-19 admitted to Imam Hossein Medical
The main limitations of our study were the retrospective pattern of the study and lack of data about the probable adverse effect of aspirin, such as bleeding components. In conclusion, based on the result of our study, in patients who received aspirin, a relevant underlying condition such as hypertension, diabetes, and coronary artery disease was more prevalent. These patients had a more severe course of the disease and a longer duration of hospitalization. By adjustment of the effect of underlying conditions and confounding factors, aspirin use in severe hospitalized COVID-19 patients is independently associated with a 25% decrease in mortality rate. So, by considering all the probable described mechanisms and the results of other studies in this regard, we recommend using aspirin during the hospital stay for all patients with the diagnosis of severe COVID-19.
ACKNOWLEDGMENT This study was supported via the Deputy of research and technology, Shahid Beheshti University of Medical Sciences, Iran. No specific grants from funding agencies, commercial, and non-profit sectors were received.
CONFLICT OF INTERESTS The authors declare that there are no conflicts of interest.
AUTHOR CONTRIBUTIONS
References
Abou-Ismail, Diamond, Kapoor, Arafah, Nayak, The hypercoagulable state in COVID-19: incidence, pathophysiology, and management, Thromb Res, doi:10.1016/j.thromres.2020.06.029
Aghajani, Moradi, Amini, Decreased in-hospital mortality associated with aspirin administration in hospitalized patients due to severe COVID-19, J Med Virol
Barrett, Moore, Yaffe, Moore, ISTH interim guidance on recognition and management of coagulopathy in COVID-19: a comment, J Thromb Haemost, doi:10.1111/jth.14860
Carfora, Spiniello, Ricciolino, Anticoagulant treatment in COVID-19: a narrative review, J Thromb Thrombolysis, doi:10.1007/s11239-020-02242-0
Chow, Khanna, Kethireddy, Aspirin use is associated with decreased mechanical ventilation, ICU admission, and inhospital mortality in hospitalized patients with COVID-19
Cicci, Iyer, Clarke, Mazzella, Aspirin for the primary prevention of cardiovascular disease: a review of the literature and considerations for clinical practice, Cardiol Rev, doi:10.1097/CRD.0000000000000297
Godino, Scotti, Maugeri, Antithrombotic therapy in patients with COVID-19?-Rationale and evidence, Int J Cardiol, doi:10.1016/j.ijcard.2020.09.064
Levi, Thachil, Iba, Coagulation abnormalities and thrombosis in patients with COVID-19, Lancet Hematol, doi:10.1016/S2352-3026(20)30145-9
Mcfadyen, Stevens, Peter, The emerging threat of (Micro) thrombosis in COVID-19 and its therapeutic implications, Circ Res, doi:10.1161/CIRCRESAHA.120.317447
Mulcahy, Ghulam-Smith, Mamidi, Oropharyngeal hemorrhage in patients with COVID-19: a multi-institutional case series, Am J Otolaryngol, doi:10.1016/j.amjoto.2020.102691
Porfidia, Valeriani, Pola, Porreca, Rutjes et al., Venous thromboembolism in patients with COVID-19: systematic review and meta-analysis, Thromb Res, doi:10.1016/j.thromres.2020.08.020
Rapkiewicz, Mai, Carsons, Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: a case series, EClinicalMedicine, doi:10.1016/j.eclinm.2020.100434
Sivaloganathan, Ladikou, Chevassut, COVID-19 mortality in patients on anticoagulants and antiplatelet agents, Br J Haematol, doi:10.1111/bjh.16968
Vasanthakumar, Beta-adrenergic blockers as a potential treatment for COVID-19 patients, BioEssays, doi:10.1002/bies.202000094
Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention, JAMA, doi:10.1001/jama.2020.2648
Yuan, Chen, Li, Chen, Wang et al., Mortality and prehospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease, J Cell Mol Med, doi:10.1111/jcmm.16198
Zhang, Zhu, Cai, Association of inpatient use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19, Circ Res, doi:10.1161/CIRCRESAHA.120.317134
Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet, doi:10.1016/S0140-6736(20)30566-3
DOI record:
{
"DOI": "10.1002/jmv.27053",
"ISSN": [
"0146-6615",
"1096-9071"
],
"URL": "http://dx.doi.org/10.1002/jmv.27053",
"alternative-id": [
"10.1002/jmv.27053"
],
"archive": [
"Portico"
],
"assertion": [
{
"group": {
"label": "Publication History",
"name": "publication_history"
},
"label": "Received",
"name": "received",
"order": 0,
"value": "2021-02-14"
},
{
"group": {
"label": "Publication History",
"name": "publication_history"
},
"label": "Accepted",
"name": "accepted",
"order": 1,
"value": "2021-04-26"
},
{
"group": {
"label": "Publication History",
"name": "publication_history"
},
"label": "Published",
"name": "published",
"order": 2,
"value": "2021-05-08"
}
],
"author": [
{
"affiliation": [
{
"name": "Prevention of Cardiovascular Disease Research Center, Imam Hossein Hospital Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"family": "Haji Aghajani",
"given": "Mohammad",
"sequence": "first"
},
{
"ORCID": "http://orcid.org/0000-0001-5754-535X",
"affiliation": [
{
"name": "Department of Clinical Pharmacy, School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"authenticated-orcid": false,
"family": "Moradi",
"given": "Omid",
"sequence": "additional"
},
{
"affiliation": [
{
"name": "Department of Clinical Pharmacy, School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"family": "Amini",
"given": "Hossein",
"sequence": "additional"
},
{
"affiliation": [
{
"name": "Department of Hematology and Medical Oncology Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"family": "Azhdari Tehrani",
"given": "Hamed",
"sequence": "additional"
},
{
"affiliation": [
{
"name": "Department of Hematology and Medical Oncology Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"family": "Pourheidar",
"given": "Elham",
"sequence": "additional"
},
{
"ORCID": "http://orcid.org/0000-0001-7146-170X",
"affiliation": [
{
"name": "Clinical Research Development Unit of Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"authenticated-orcid": false,
"family": "Rabiei",
"given": "Mohammad M.",
"sequence": "additional"
},
{
"affiliation": [
{
"name": "Prevention of Cardiovascular Disease Research Center, Imam Hossein Hospital Shahid Beheshti University of Medical Sciences Tehran Iran"
},
{
"name": "Department of Clinical Pharmacy, School of Pharmacy Shahid Beheshti University of Medical Sciences Tehran Iran"
}
],
"family": "Sistanizad",
"given": "Mohammad",
"sequence": "additional"
}
],
"container-title": [
"Journal of Medical Virology"
],
"content-domain": {
"crossmark-restriction": true,
"domain": [
"onlinelibrary.wiley.com"
]
},
"created": {
"date-parts": [
[
2021,
4,
29
]
],
"date-time": "2021-04-29T10:11:32Z",
"timestamp": 1619691092000
},
"deposited": {
"date-parts": [
[
2021,
7,
16
]
],
"date-time": "2021-07-16T20:42:02Z",
"timestamp": 1626468122000
},
"indexed": {
"date-parts": [
[
2022,
1,
13
]
],
"date-time": "2022-01-13T19:48:55Z",
"timestamp": 1642103335659
},
"is-referenced-by-count": 9,
"issn-type": [
{
"type": "print",
"value": "0146-6615"
},
{
"type": "electronic",
"value": "1096-9071"
}
],
"issue": "9",
"issued": {
"date-parts": [
[
2021,
5,
8
]
]
},
"journal-issue": {
"issue": "9",
"published-print": {
"date-parts": [
[
2021,
9
]
]
}
},
"language": "en",
"license": [
{
"URL": "http://onlinelibrary.wiley.com/termsAndConditions#vor",
"content-version": "vor",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2021,
5,
8
]
],
"date-time": "2021-05-08T00:00:00Z",
"timestamp": 1620432000000
}
},
{
"URL": "http://doi.wiley.com/10.1002/tdm_license_1.1",
"content-version": "tdm",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2021,
5,
8
]
],
"date-time": "2021-05-08T00:00:00Z",
"timestamp": 1620432000000
}
}
],
"link": [
{
"URL": "https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.27053",
"content-type": "application/pdf",
"content-version": "vor",
"intended-application": "text-mining"
},
{
"URL": "https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jmv.27053",
"content-type": "application/xml",
"content-version": "vor",
"intended-application": "text-mining"
},
{
"URL": "https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.27053",
"content-type": "unspecified",
"content-version": "vor",
"intended-application": "similarity-checking"
}
],
"member": "311",
"original-title": [],
"page": "5390-5395",
"prefix": "10.1002",
"published": {
"date-parts": [
[
2021,
5,
8
]
]
},
"published-online": {
"date-parts": [
[
2021,
5,
8
]
]
},
"published-print": {
"date-parts": [
[
2021,
9
]
]
},
"publisher": "Wiley",
"reference": [
{
"DOI": "10.1111/bjh.16968",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_2_1"
},
{
"article-title": "Aspirin use is associated with decreased mechanical ventilation, ICU admission, and in‐hospital mortality in hospitalized patients with COVID‐19 [published online ahead of print]",
"author": "Chow JH",
"journal-title": "Anesth Analg",
"key": "e_1_2_8_3_1",
"year": "2020"
},
{
"DOI": "10.1007/s11239-020-02242-0",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_4_1"
},
{
"DOI": "10.1016/j.thromres.2020.06.029",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_5_1"
},
{
"DOI": "10.1016/j.thromres.2020.08.020",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_6_1"
},
{
"DOI": "10.1016/j.amjoto.2020.102691",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_7_1"
},
{
"DOI": "10.1016/j.ijcard.2020.09.064",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_8_1"
},
{
"DOI": "10.1097/CRD.0000000000000297",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_9_1"
},
{
"DOI": "10.1001/jama.2020.2648",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_10_1"
},
{
"DOI": "10.1016/S0140-6736(20)30566-3",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_11_1"
},
{
"DOI": "10.1002/bies.202000094",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_12_1"
},
{
"DOI": "10.1161/CIRCRESAHA.120.317134",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_13_1"
},
{
"DOI": "10.1016/S2352-3026(20)30145-9",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_14_1"
},
{
"DOI": "10.1161/CIRCRESAHA.120.317447",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_15_1"
},
{
"DOI": "10.1016/j.eclinm.2020.100434",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_16_1"
},
{
"DOI": "10.1111/jth.14860",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_17_1"
},
{
"DOI": "10.1111/jcmm.16198",
"doi-asserted-by": "publisher",
"key": "e_1_2_8_18_1"
}
],
"reference-count": 17,
"references-count": 17,
"relation": {},
"score": 1,
"short-container-title": [
"J Med Virol"
],
"short-title": [],
"source": "Crossref",
"subject": [
"Infectious Diseases",
"Virology"
],
"subtitle": [],
"title": [
"Decreased in‐hospital mortality associated with aspirin administration in hospitalized patients due to severe COVID‐19"
],
"type": "journal-article",
"update-policy": "http://dx.doi.org/10.1002/crossmark_policy",
"volume": "93"
}
Late treatment
is less effective
is less effective
aghajani