Effect of aspirin on coronavirus disease 2019
PSM retrospective case control study in South Korea, showing a trend towards lower mortality, but no significant differences with aspirin use.
risk of death, 24.0% lower, OR 0.76, p = 0.52, treatment 37 of 128 (28.9%) cases,
31 of 128 (24.2%) controls, adjusted per study, case control OR, group 1, model 2 (most data in group and adjustments), multivariable.
risk of progression, 7.0% higher, OR 1.07, p = 0.80, treatment 77 of 339 (22.7%) cases,
58 of 339 (17.1%) controls, adjusted per study, case control OR, complications, group 1, model 2 (most data in group and adjustments), multivariable.
risk of case, 11.0% higher, OR 1.11, p = 0.21, treatment 313 of 3,825 (8.2%) cases,
617 of 7,650 (8.1%) controls, adjusted per study, case control OR, group 1, PSM 1, model 2 (most data in group and adjustments), multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Son et al., 30 Jul 2021, retrospective, propensity score matching, South Korea, peer-reviewed, 6 authors.
Effect of aspirin on coronavirus disease 2019
A nationwide case-control study in South Korea
Minkook Son, MDa, Myung-giun Noh, MDa, Jeong Hoon Lee, PhDb, Jeongkuk Seo, MDc,
Hansoo Park, MD, PhDa, Sung Yang, PhDa,d,
Several studies reported that aspirin can potentially help prevent infection and serious complications of coronavirus disease (COVID19), but no study has elucidated a deﬁnitive association between aspirin and COVID-19. This study aims to investigate the association
between aspirin and COVID-19.
This case-control study used demographic, clinical, and health screening laboratory test data collected from the National Health
Insurance Service database. Patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
infection until June 4, 2020, were matched with control patients using propensity score matching according to their SARS-CoV-2
status, the composite of complications, and death. The composite of complications included intensive care unit admission, use of
vasopressors, high-ﬂow oxygen therapy, renal replacement therapy, extracorporeal membrane oxygenation, and death. Exposure to
aspirin was deﬁned as having a prescription for aspirin for more than 14 days, including the index date. After matching, multivariableadjusted conditional logistic regression analysis was performed. To conﬁrm the robustness of this study, we used 2 study groups, 3
propensity score matching methods, and 3 models for conditional logistic regression analyses.
The crude odds ratio and 95% conﬁdence interval for SARS-CoV-2 infection between the groups without and with exposure to
aspirin were 1.21 (1.04–1.41), but the adjusted odds ratios (95% conﬁdence interval) were not signiﬁcant. There was no association
between aspirin exposure and COVID-19 status. Multiple statistical analyses, including subgroup analysis, revealed consistent
results. Furthermore, the results of analysis for complications and death were not signiﬁcant. Aspirin exposure was not associated
with COVID-19-related complications and mortality in COVID-19 patients.
In this nationwide population-based case-control study, aspirin use was not associated with SARS-CoV-2 infection or related
complications. With several ongoing randomized controlled trials of aspirin in COVID-19 patients, more studies would be able to
conﬁrm the effectiveness of aspirin in COVID-19.
Abbreviations: CCI = Charlson Comorbidity Index, CI = conﬁdence interval, COVID-19 = coronavirus disease, KCDC = Korea
Centers for Disease Control and Prevention, NHIS = National Health Insurance Service, NSAIDs = nonsteroidal anti-inﬂammatory
drugs, OR = odds ratio, PSM = propensity score matching, SMD = standardized mean difference, WHO = World Health
Keywords: aspirin, COVID-19, infections, Republic of Korea
Editor: Bruno M. Carneiro.
MS and MN contributed equally to this work.
This work was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korea government (MSIT) (No. 2020R1A5A8018367 and
2021R1A2C3008169). The funders had no role in the study design, data collection and analysis, decision for publication, or preparation of the manuscript.
The authors have no conﬂicts of interest to disclose.
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