Aspirin Is Related to Worse Clinical Outcomes of COVID-19
Retrospective database analysis of 22,660 patients tested for COVID-19 in South Korea. There was no significant difference in cases according to aspirin use. Aspirin use before COVID-19 was related to an increased death rate and aspirin use after COVID-19 was related to a higher risk of oxygen therapy.
risk of death, 700.0% higher, RR 8.00, p = 0.03, treatment 6 of 15 (40.0%), control 1 of 20 (5.0%), PSM, prior aspirin use.
|
risk of mechanical ventilation, 433.3% higher, RR 5.33, p = 0.14, treatment 4 of 15 (26.7%), control 1 of 20 (5.0%), PSM, prior aspirin use.
|
risk of ICU admission, 433.3% higher, RR 5.33, p = 0.14, treatment 4 of 15 (26.7%), control 1 of 20 (5.0%), PSM, prior aspirin use.
|
risk of case, 33.4% lower, RR 0.67, p = 0.29, treatment 15 of 136 (11.0%), control 20 of 136 (14.7%), NNT 27, adjusted per study, odds ratio converted to relative risk, PSM, logistic regression, prior aspirin use.
|
risk of death, 33.7% lower, RR 0.66, p = 0.22, treatment 14 of 124 (11.3%), control 23 of 135 (17.0%), NNT 17, PSM, aspirin treatment after diagnosis.
|
risk of mechanical ventilation, 102.2% higher, RR 2.02, p = 0.16, treatment 13 of 124 (10.5%), control 7 of 135 (5.2%), PSM, aspirin treatment after diagnosis.
|
risk of ICU admission, 90.5% higher, RR 1.91, p = 0.36, treatment 7 of 124 (5.6%), control 4 of 135 (3.0%), PSM, aspirin treatment after diagnosis.
|
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
|

Kim et al., 4 Sep 2021, retrospective, propensity score matching, South Korea, peer-reviewed, 7 authors.
Abstract: medicina
Article
Aspirin Is Related to Worse Clinical Outcomes of COVID-19
Isaac Kim 1,† , Siyeong Yoon 2,† , Minsup Kim 3 , Hyunil Lee 4 , Sinhyung Park 5 , Wonsang Kim 3 and
Soonchul Lee 2, *
1
2
3
4
5
*
†
Citation: Kim, I.; Yoon, S.; Kim, M.;
Lee, H.; Park, S.; Kim, W.; Lee, S.
Aspirin Is Related to Worse Clinical
Outcomes of COVID-19. Medicina
2021, 57, 931. https://doi.org/
10.3390/medicina57090931
Academic Editor: Pierpaolo Di Micco
Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine,
Seongnam 13488, Korea; isaac24@cha.ac.kr
Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine,
Seongnam 13488, Korea; tldud1105@naver.com
inCerebro Drug Discovery Institute, Seoul Technopark, Seoul 01811, Korea;
minsupkim@incerebro.com (M.K.); wonsangkim@incerebro.com (W.K.)
Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, Goyang 10380, Korea;
hyunil.lee7@gmail.com
Department of Orthopedic Surgery, Bucheon Hospital, Soonchunhyang University, Bucheon 14584, Korea;
greatpsh78@gmail.com
Correspondence: Lsceline78@gmail.com; Tel.: +82-31-780-5289; Fax: +82-31-881-7114
Contributed equally to co-first authors.
Abstract: Background and Objectives: Aspirin is used globally to reduce pain and inflammation;
however, its effect in patients with coronavirus disease (COVID-19) is not fully investigated and
remains controversial. We evaluated the association between aspirin and COVID-19 outcomes using
nationwide data from the Korean National Health Insurance System. Materials and Methods: This
was a retrospective observational cohort study that included 22,660 eligible patients who underwent
COVID-19 testing in South Korea between 1 January–31 July 2020. We identified all aspirin users
prescribed aspirin within two weeks before or after the index date. The primary outcome was
positivity for the COVID-19 test, and secondary outcomes included conventional oxygen therapy,
intensive care unit, mechanical ventilation, or death. We applied the propensity score matching
method to reduce the possible bias originating from the differences in patients’ baseline characteristics.
Results: Of those eligible, 662 patients were prescribed aspirin. Among them, 136 patients were on
aspirin within two weeks before diagnosis and 526 patients were on aspirin after diagnosis. The
COVID-19 test positivity rate was not significantly different according to aspirin use. Aspirin use
before COVID-19 was related to an increased death rate and aspirin use after COVID-19 was related
to a higher risk of the conventional oxygen therapy. Conclusion: Aspirin use was associated with
adverse effects in COVID-19 patients. Further studies for mechanisms are needed.
Received: 20 July 2021
Accepted: 2 September 2021
Keywords: COVID-19; aspirin; outcome
Published: 4 September 2021
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affiliations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, 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.
Submit