Association of mortality and aspirin prescription for COVID-19 patients at the Veterans Health Administration
Thomas F Osborne, Zachary P Veigulis, David M Arreola, Satish M Mahajan, Eliane Röösli, Catherine M Curtin
PLOS ONE, doi:10.1371/journal.pone.0246825
There is growing evidence that thrombotic and inflammatory pathways contribute to the severity of COVID-19. Common medications such as aspirin, that mitigate these pathways, may decrease COVID-19 mortality. This retrospective assessment was designed to quantify the correlation between pre-diagnosis aspirin and mortality for COVID-19 positive patients in our care. Data from the Veterans Health Administration national electronic health record database was utilized for the evaluation. Veterans from across the country with a first positive COVID-19 polymerase chain reaction lab result were included in the evaluation which comprised 35,370 patients from March 2, 2020 to September 13, 2020 for the 14-day mortality cohort and 32,836 patients from March 2, 2020 to August 28, 2020 for the 30-day mortality cohort. Patients were matched via propensity scores and the odds of mortality were then compared. Among COVID-19 positive Veterans, preexisting aspirin prescription was associated with a statistically and clinically significant decrease in overall mortality at 14days (OR 0.38, 95% CI 0.32-0.46) and at 30-days (OR 0.38, 95% CI 0.33-0.45), cutting the odds of mortality by more than half. Findings demonstrated that pre-diagnosis aspirin prescription was strongly associated with decreased mortality rates for Veterans diagnosed with COVID-19. Prospective evaluation is required to more completely assess this correlation and its implications for patient care.
Supporting information S1 Table . The 31 medication variables utilized in the logistic regression analysis. If a unique medication was present in more than 10% of the cohort, it was included as its own variable. All other medications were grouped as "other" by drug class. This resulted in the inclusion of 31 variables across 14 separate medication classes. (DOCX)
S2 Table. The variables utilized to calculate the CAN 1-year mortality model (version 2.5). (DOCX)
Author Contributions Conceptualization: Thomas F. Osborne, Zachary P. Veigulis. Data curation: Zachary P. Veigulis, David M. Arreola, Satish M. Mahajan. Formal analysis: Thomas F. Osborne, Zachary P. Veigulis, David M. Arreola, Satish M. Mahajan, Eliane Ro ¨o ¨sli, Catherine M. Curtin. Investigation: Thomas F. Osborne, Zachary P. Veigulis, David M. Arreola, Satish M. Mahajan, Catherine M. Curtin. Methodology: Thomas F. Osborne, Satish M. Mahajan, Eliane Ro ¨o ¨sli, Catherine M. Curtin. Project administration: Thomas F. Osborne. Supervision: Thomas F. Osborne, Catherine M. Curtin. Validation: Zachary P. Veigulis, Eliane Ro ¨o ¨sli, Catherine M. Curtin. Writing -original draft: Thomas F. Osborne. Writing -review & editing: Zachary P. Veigulis, David M. Arreola, Satish M. Mahajan, Eliane Ro ¨o ¨sli, Catherine M. Curtin.
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'abstract': '<jats:p>There is growing evidence that thrombotic and inflammatory pathways contribute to the '
'severity of COVID-19. Common medications such as aspirin, that mitigate these pathways, may '
'decrease COVID-19 mortality. This retrospective assessment was designed to quantify the '
'correlation between pre-diagnosis aspirin and mortality for COVID-19 positive patients in our '
'care. Data from the Veterans Health Administration national electronic health record database '
'was utilized for the evaluation. Veterans from across the country with a first positive '
'COVID-19 polymerase chain reaction lab result were included in the evaluation which comprised '
'35,370 patients from March 2, 2020 to September 13, 2020 for the 14-day mortality cohort and '
'32,836 patients from March 2, 2020 to August 28, 2020 for the 30-day mortality cohort. '
'Patients were matched via propensity scores and the odds of mortality were then compared. '
'Among COVID-19 positive Veterans, preexisting aspirin prescription was associated with a '
'statistically and clinically significant decrease in overall mortality at 14-days (OR 0.38, '
'95% CI 0.32–0.46) and at 30-days (OR 0.38, 95% CI 0.33–0.45), cutting the odds of mortality '
'by more than half. Findings demonstrated that pre-diagnosis aspirin prescription was strongly '
'associated with decreased mortality rates for Veterans diagnosed with COVID-19. Prospective '
'evaluation is required to more completely assess this correlation and its implications for '
'patient care.</jats:p>',
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