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0 0.5 1 1.5 2+ Case 28% Improvement Relative Risk Mortality 62% Time to viral- 10% Time to viral- (b) 15% Aspirin for COVID-19  Merzon et al.  Prophylaxis Is prophylaxis with aspirin beneficial for COVID-19? Retrospective 10,477 patients in Israel Fewer cases (p=0.041) and faster viral clearance (p=0.045) Merzon et al., The FEBS J., February 2021 Favors aspirin Favors control

The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection

Merzon et al., The FEBS Journal, doi:10.1111/febs.15784
Feb 2021  
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Retrospective 10,477 patients in Israel, showing lower risk of COVID-19 cases with existing aspiring use.
risk of case, 27.6% lower, RR 0.72, p = 0.04, treatment 73 of 1,621 (4.5%), control 589 of 8,856 (6.7%), NNT 47, adjusted per study, odds ratio converted to relative risk.
risk of death, 62.4% lower, RR 0.38, p = 0.51, treatment 1 of 21 (4.8%), control 6 of 91 (6.6%), adjusted per study, odds ratio converted to relative risk.
time to viral-, 9.6% lower, relative time 0.90, p = 0.045, treatment 73, control 589, time to 2nd negative test.
time to viral-, 14.8% lower, relative time 0.85, p = 0.005, treatment 73, control 589, time to 1st negative test.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Merzon et al., 23 Feb 2021, retrospective, Israel, peer-reviewed, 8 authors.
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The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID‐19 infection
Eugene Merzon, Ilan Green, Shlomo Vinker, Avivit Golan‐cohen, Alessandro Gorohovski, Eva Avramovich, Milana Frenkel‐morgenstern, Eli Magen
The FEBS Journal, doi:10.1111/febs.15784
Acetylsalicylic acid (aspirin) is commonly used for primary and secondary prevention of cardiovascular diseases. Aspirin use is associated with better outcomes among COVID-19 positive patients. We hypothesized that the aspirin use for primary cardiovascular disease prevention might have a protective effect on COVID-19 susceptibility and disease duration. We conducted a retrospective population-based cross-sectional study, utilizing data from the Leumit Health Services database. The proportion of patients treated with aspirin was significantly lower among the COVID-19-positive group, as compared to the COVID-19-negative group [73 (11.03%) vs. 1548 (15.77%); P = 0.001]. Aspirin use was associated with lower likelihood of COVID-19 infection, as compared to nonusers (adjusted OR 0.71 (95% CI, 0.52 to 0.99; P = 0.041). Aspirin users were older (68.06 AE 12.79 vs. 56.63 AE 12.28 years of age; P < 0.001), presented a lower BMI (28.77 AE 5.4 vs. 30.37 AE 4.55; P < 0.0189), and showed higher prevalence of hypertension (56, 76.71%), diabetes (47, 64.38%), and COPD (11, 15.07%) than the aspirin nonusers (151, 25.64%, P < 0.001; 130, 22.07%, P < 0.001; and 43, 7.3%, P = 0.023, respectively). Moreover, COVID-19 disease duration (considered as the time between the first positive and second negative COVID-19 RT-PCR test results) among aspirin users was significantly shorter, as compared to aspirin nonusers (19.8 AE 7.8 vs. 21.9 AE 7.9 P = 0.045). Among hospitalized COVID-positive patients, a higher proportion of surviving subjects were treated with aspirin (20, 19.05%), as opposed to 1 dead subject (14.29%), although this difference was not significant (P = 0.449). In conclusion, we observed an inverse association between the likelihood of COVID-19 infection, disease duration and mortality, and aspirin use for primary prevention.
Abbreviations COVID-19, coronavirus SARS-CoV-2; CVD, cardiovascular disease; LHS, Leumit Health Services; SES, socioeconomic status; STING, stimulator of interferon genes. Conflict of interest The authors declare no conflict of interest. Author contributions EM and ElM have designed the study, EM, IG, SV, AGC, MF-M, and ElM have analyzed the data, AG and MF-M have produced figures, EM has supervised the study, and all authors have written the manuscript. Peer Review The peer review history for this article is available at
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