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0 0.5 1 1.5 2+ Mortality -700% Improvement Relative Risk Ventilation -433% ICU admission -433% Case 33% Mortality (b) 34% Ventilation (b) -102% ICU admission (b) -91% Aspirin for COVID-19  Kim et al.  Prophylaxis Is prophylaxis with aspirin beneficial for COVID-19? PSM retrospective 272 patients in South Korea Higher mortality with aspirin (p=0.027) Kim et al., Medicina, September 2021 Favors aspirin Favors control

Aspirin Is Related to Worse Clinical Outcomes of COVID-19

Kim et al., Medicina, doi:10.3390/medicina57090931
Sep 2021  
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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.
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Aspirin Is Related to Worse Clinical Outcomes of COVID-19
Isaac Kim, Siyeong Yoon, Minsup Kim, Hyunil Lee, Sinhyung Park, Wonsang Kim, Soonchul Lee
Medicina, doi:10.3390/medicina57090931
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.
Author Contributions: I.K.: Project administration, data curation, formal analysis, writing the original draft. S.Y.: Data curation, formal analysis, writing original draft. M.K.: Data curation, formal analysis. H.L.: Manuscript review and editing. S.P.: Data curation. W.K.: Data curation. S.L.: Conceptualization, funding acquisition, investigation, methodology, manuscript review and editing. All authors have read and agreed to the published version of the manuscript. Institutional Review Board Statement: The study protocol was approved by the Institutional Review Board (IRB) of CHA University Bundang Hospital, Korea (IRB No. CHAMC 2020-08-004) and the Health Insurance Review and Assessment Service (NHIS-2021-1-084). Informed Consent Statement: Not applicable.
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