Summary of COVID-19 aspirin studies

1. Bradbury et al., Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial

1,084 patient aspirin late treatment RCT: 16% lower mortality (p=0.05), 17% higher hospital discharge (p=0.08), and 21% lower progression (p=0.02).
RCT 1,557 critical patients, showing significantly lower mortality with aspirin, with 97.5% posterior probability of efficacy.
Mar 2022, JAMA, https://jamanetwork.com/journals/jama/fullarticle/2790488, https://c19p.org/bradbury

2. Chow et al., Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019

412 patient aspirin late treatment study: 47% lower mortality (p=0.02), 44% lower ventilation (p=0.007), and 43% lower ICU admission (p=0.007).
Retrospective 412 hospitalized patients, 98 treated with aspirin, showing lower mortality, ventilation, and ICU admission with treatment.
Mar 2021, Anesthesia & Analgesia, https://journals.lww.com/anesthesia-analgesia/fulltext/2021/04000/aspirin_use_is_associated_with_decreased.2.aspx, https://c19p.org/chow

3. Connors et al., Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19

280 patient aspirin early treatment RCT: 67% lower hospitalization (p=0.49) and 19% lower progression (p=0.78).
Early terminated RCT with 164 aspirin and 164 control patients in the USA with very few events, showing no significant difference with aspirin treatment for the combined endpoint of all-cause mortality, symptomatic venous or arterial thromboembolism, myocardial infarction, stroke, and hospitalization for cardiovascular or pulmonary indication. There was no mortality and no major bleeding events among participants that started treatment (there was one ITT placebo death).
Oct 2021, JAMA, https://jamanetwork.com/journals/jama/fullarticle/2785218, https://c19p.org/connors

4. Singla et al., A randomized controlled trial to evaluate outcomes with Aggrenox in patients with SARS-CoV-2 infection

98 patient aspirin late treatment RCT: 20% lower ventilation (p=1), 29% lower ICU admission (p=0.76), and 33% lower progression (p=0.74).
RCT 98 hospitalized patients in the USA, 49 treated with aspirin and dipyridamole, showing improved results with treatment, but without statistical significance.
Jan 2023, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0274243, https://c19p.org/singla

5. Tse et al., Aspirin is associated with lower risks of severe covid-19 disease: a population-based study

2,664 patient aspirin prophylaxis PSM study: 67% lower combined mortality/intubation (p=0.0003).
PSM retrospective 2,664 COVID-19 hospitalized patients receiving steroids/antiviral therapy in Hong Kong, showing lower risk of combined death/intubation with aspirin use.
Jun 2023, Heart, https://heart.bmj.com/content/109/Suppl_3/A244.2, https://c19p.org/tse

6. Liu et al., Effect of low-dose aspirin on mortality and viral duration of the hospitalized adults with COVID-19

232 patient aspirin late treatment PSM study: 75% lower mortality (p=0.03) and 2% slower viral clearance (p=0.94).
Retrospective PSM analysis of 232 hospitalized patients, 28 treated with aspirin, showing lower mortality with treatment. There was no significant difference in viral clearance.
Feb 2021, Medicine, https://journals.lww.com/md-journal/Fulltext/2021/02120/Effect_of_low_dose_aspirin_on_mortality_and_viral.41.aspx, https://c19p.org/liu2

7. Ghati et al., Statin and aspirin as adjuvant therapy in hospitalised patients with SARS-CoV-2 infection: a randomised clinical trial (RESIST trial)

661 patient aspirin late treatment RCT: 22% lower mortality (p=0.62), 9% lower ventilation (p=0.8), and 30% lower progression (p=0.46).
RCT hospitalized patients in India, 224 treated with atorvastatin, 225 with aspirin, and 225 with both, showing lower serum interleukin-6 levels with aspirin, but no statistically significant changes in other outcomes. Low dose aspirin 75mg daily for 10 days.
Jul 2022, BMC Infectious Diseases, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07570-5, https://c19p.org/ghati

8. Merzon et al., The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection

10,477 patient aspirin prophylaxis study: 28% fewer cases (p=0.04) and 10% faster viral clearance (p=0.05).
Retrospective 10,477 patients in Israel, showing lower risk of COVID-19 cases with existing aspiring use.
Feb 2021, The FEBS J., https://febs.onlinelibrary.wiley.com/doi/10.1111/febs.15784, https://c19p.org/merzon2

9. Zhao et al., Treatments Associated with Lower Mortality among Critically Ill COVID-19 Patients: A Retrospective Cohort Study

2,070 patient aspirin late treatment study: 43% lower mortality (p=0.0006).
Retrospective 2,070 hospitalized patients in the USA, showing lower mortality with aspirin treatment.
Sep 2021, Anesthesiology, https://pubs.asahq.org/anesthesiology/article-abstract/doi/10.1097/ALN.0000000000003999/117698/Treatments-Associated-with-Lower-Mortality-among?redirectedFrom=fulltext, https://c19p.org/zhao5

10. Osborne et al., Association of mortality and aspirin prescription for COVID-19 patients at the Veterans Health Administration

13,628 patient aspirin prophylaxis PSM study: 59% lower mortality (p<0.0001).
Retrospective PSM analysis of pre-existing aspirin use in the USA, showing lower mortality with treatment.
Feb 2021, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246825, https://c19p.org/osborne

11. Meizlish et al., Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: A propensity score-matched analysis

638 patient aspirin late treatment PSM study: 48% lower mortality (p=0.004).
Retrospective 638 matched hospitalized patients in the USA, 319 treated with aspirin, showing lower mortality with treatment.
Jan 2021, American J. Hematology, https://onlinelibrary.wiley.com/doi/10.1002/ajh.26102, https://c19p.org/meizlish

12. Lal et al., Pre-hospital aspirin use and patient outcomes in COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)

21,579 patient aspirin prophylaxis study: 11% lower mortality (p=0.01), 22% lower ICU admission (p<0.0001), and 9% lower progression (p=0.02).
Retrospective 21,579 hospitalized COVID-19 patients mostly in the USA, showing lower risk of mortality and severity with existing aspirin use.
May 2022, Archivos de Bronconeumología, https://www.sciencedirect.com/science/article/pii/S0300289622005105, https://c19p.org/lal

13. Husain et al., Beneficial effect of low dose aspirin (Acetyl salicylic acid) in adult Covid-19 patients: a retrospective observational study in Bangladesh

42 patient aspirin late treatment study: 96% lower progression (p=0.001).
Retrospective 42 patients in Bangladesh, 11 treated with aspirin, showing fewer complications with treatment.
Oct 2020, ResearchGate, https://www.researchgate.net/publication/344567523_Beneficial_effect_of_low_dose_aspirin_Acetyl_salicylic_acid_in_adult_Covid-19_patients_a_retrospective_observational_study_in_Bangladesh, https://c19p.org/husain

14. Al Harthi et al., Evaluation of Low-Dose Aspirin use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study

351 patient aspirin ICU PSM study: 27% lower mortality (p=0.03) and 5% shorter ICU admission (p=0.54).
Retrospective 1,033 critical condition patients, showing lower in-hospital mortality with aspirin in PSM analysis. Patients receiving aspirin also had a higher risk of significant bleeding, although not reaching statistical significance. Authors note that the use of aspirin during an ICU stay should be tailored to each patient.
Sep 2021, J. Intensive Care Medicine, https://journals.sagepub.com/doi/pdf/10.1177/08850666221093229, https://c19p.org/alharthi

15. Santoro et al., Aspirin Therapy on Prophylactic Anticoagulation for Patients Hospitalized With COVID-19: A Propensity Score-Matched Cohort Analysis of the HOPE-COVID-19 Registry

7,824 patient aspirin late treatment PSM study: 38% lower mortality (p=0.02).
HOPE-COVID-19 PSM retrospective 7,824 patients, comparing prophylactic anticoagulation with and without additional treatment with aspirin in hospitalized patients, showing lower mortality with aspirin treatment.
Jun 2022, J. the American Heart Association, https://www.ahajournals.org/doi/10.1161/JAHA.121.024530, https://c19p.org/santoro3

16. Ware et al., Incidence and Risk of Post-COVID-19 Thromboembolic Disease and the Impact of Aspirin Prescription; Nationwide Observational Cohort at the US Department of Veteran Affairs.

334,374 patient aspirin prophylaxis PSM study: 46% lower mortality (p=0.001).
PSM retrospective 334,374 COVID-19 patients showing decreased risk of venous thromboembolism, including pulmonary embolism and deep vein thrombosis, but increased risk of arterial thromboembolic disorders, including ischemic stroke and acute ischemic heart disease, with aspirin use prior to COVID-19 diagnosis. The increased risk of arterial disease may be associated with preexisting cardiovascular disease for which aspirin was already prescribed. All cause mortality was lower in the aspirin group, however authors do not discuss this result.
Apr 2024, medRxiv, https://www.medrxiv.org/content/10.1101/2024.04.10.24305647, https://c19p.org/ware

17. Abul et al., Association of mortality and aspirin use for COVID-19 residents at VA Community Living Center Nursing Homes

1,687 patient aspirin prophylaxis study: 33% lower mortality (p=0.03) and 20% lower hospitalization (p=0.13).
Retrospective 1,687 nursing home residents in the USA, showing significantly lower risk of mortality with chronic low-dose aspirin use. Low dose 81mg aspirin users had treatment ≥10 of 14 days prior to the positive COVID date, control patients had no aspirin use in the prior 14 days.
Aug 2022, medRxiv, https://www.medrxiv.org/content/10.1101/2022.08.03.22278392, https://c19p.org/abul

18. Goshua et al., Admission Rothman Index, Aspirin, and Intermediate Dose Anticoagulation Effects on Outcomes in COVID-19: A Multi-Site Propensity Matched Analysis

2,785 patient aspirin late treatment PSM study: 35% lower mortality (p=0.04), 49% higher ventilation (p=0.04), and 45% higher ICU admission (p=0.02).
PSM retrospective 2,785 hospitalized patients in the USA, showing lower mortality and higher ventilation and ICU admission with aspirin treatment.
Nov 2020, Blood, https://ashpublications.org/blood/article/136/Supplement%201/23/470342/Admission-Rothman-Index-Aspirin-and-Intermediate, https://c19p.org/goshua

19. RECOVERY Collaborative Group et al., Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

14,892 patient aspirin late treatment RCT: 4% lower mortality (p=0.35), 5% lower ventilation (p=0.32), 6% higher hospital discharge (p=0.006), and 11% shorter hospitalization.
RCT 14,892 late stage patients, 7,351 treated with aspirin, showing slightly improved discharge and hospitalization time, and no significant difference for mortality. Results are limited due to low dose (150mg daily), very late treatment (9 days post symptom onset), and 96% concurrent use of low molecular weight heparin. Greater benefits were seen for non-LMWH patients, and for very late (<= 7 days from onset) vs. extremely late (>7 days) treatment. For more discussion see [web.archive.org].
Nov 2021, RECOVERY Collaborative Group, The Lancet, https://www.sciencedirect.com/science/article/pii/S0140673621018250, https://c19p.org/recoverye

20. Ali et al., Effect of Aspirin Use on clinical Outcome among Critically Ill Patients with COVID-19

1,190 patient aspirin ICU study: 40% lower mortality (p<0.0001) and 37% lower ARDS (p=0.001).
Retrospective 1,190 ICU patients in Egypt, showing lower mortality with aspirin treatment. 150mg daily.
Oct 2022, Egyptian J. Anaesthesia, https://www.tandfonline.com/doi/full/10.1080/11101849.2022.2139104, https://c19p.org/ali6

21. Aidouni et al., The impact of asprin use on the outcome of patients admitted to the intensive care unit with COVID-19 infection

1,124 patient aspirin ICU study: 31% lower mortality (p=0.003) and 10% lower ventilation (p=0.33).
Prospective study of 1,124 COVID-19 ICU patients, showing lower mortality with aspirin treatment.
Nov 2022, Research Square, https://www.researchsquare.com/article/rs-2313880/v1, https://c19p.org/aidouni

22. Chow et al., Association of Pre-Hospital Antiplatelet Therapy with Survival in Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis

17,347 patient aspirin prophylaxis PSM study: 19% lower mortality (p=0.005) and 3% lower ventilation (p=0.21).
PSM retrospective 6,781 hospitalized patients ≥50 years old in the USA who were on pre-hospital antiplatelet therapy (84% aspirin), and 10,566 matched controls, showing lower mortality with treatment.
Aug 2021, J. Thrombosis and Haemostasis, https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.15517, https://c19p.org/chow2

23. Loucera et al., Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments

15,968 patient aspirin prophylaxis study: 18% lower mortality (p=0.0004).
Retrospective 15,968 COVID-19 hospitalized patients in Spain, showing lower mortality with existing use of several medications including metformin, HCQ, azithromycin, aspirin, vitamin D, vitamin C, and budesonide. Since only hospitalized patients are included, results do not reflect different probabilities of hospitalization across treatments.
Aug 2022, Virology J., https://virologyj.biomedcentral.com/articles/10.1186/s12985-023-02195-9, https://c19p.org/loucera3e

24. Chow et al., Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19

112,070 patient aspirin late treatment study: 13% lower mortality (p<0.0001).
Retrospective 112,269 hospitalized COVID-19 patients in the USA, showing lower mortality with aspirin treatment.
Mar 2022, JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790439, https://c19p.org/chow3

25. Malik et al., Effect of low dose acetylsalicylic acid and anticoagulant on clinical outcomes in COVID-19, analytical cross-sectional study

310 patient aspirin prophylaxis study: 14% lower mortality (p=0.72), 28% lower ICU admission (p=0.17), 25% lower ARDS (p=0.39), and 2% lower hospitalization (p=0.94).
Retrospective 539 patients in the USA, showing lower mortality, ICU admission, and ARDS with aspirin treatment, without statistical significance.
Jul 2022, Health Science Reports, https://onlinelibrary.wiley.com/doi/10.1002/hsr2.699, https://c19p.org/malik

26. Vinod et al., Effect of Aspirin Use on the Adverse Outcomes in Patients Hospitalized for COVID-19

376 patient aspirin late treatment study: 14% lower mortality (p=0.61), 30% lower ventilation (p=0.24), 40% lower progression (p=0.05), and 6% worse results (p=0.88).
Retrospective 376 hospitalized COVID-19 patients in the United States showing no significant differences with aspirin. Mortality, mechanical ventilation, and hypoxia were lower with treatment, without statistical significance.
Jun 2024, Cardiology Research, http://www.cardiologyres.org/index.php/Cardiologyres/article/view/1645, https://c19p.org/vinod

27. Karruli et al., Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience

32 patient aspirin ICU study: 46% lower mortality (p=0.63).
Retrospective 32 ICU patients showing lower mortality with aspirin treatment, without statistical significance.
Aug 2021, Microbial Drug Resistance, https://www.liebertpub.com/doi/full-xml/10.1089/mdr.2020.0489, https://c19p.org/karruli

28. Wang et al., A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward

58 patient aspirin prophylaxis study: 58% lower mortality (p=0.43).
Retrospective 58 multiple myeloma COVID-19 patients in the USA, showing no significant difference with aspirin treatment.
Jul 2020, J. Hematology & Oncology, https://jhoonline.biomedcentral.com/articles/10.1186/s13045-020-00934-x, https://c19p.org/wang3e

29. Haji Aghajani et al., Decreased in-hospital mortality associated with aspirin administration in hospitalized patients due to severe COVID-19

991 patient aspirin late treatment study: 25% lower mortality (p=0.04).
Retrospective 991 hospitalized patients in Iran, showing lower mortality with aspirin treatment.
Apr 2021, J. Medical Virology, https://onlinelibrary.wiley.com/doi/10.1002/jmv.27053, https://c19p.org/hajiaghajanie

30. Oh et al., Incidence and Mortality Associated with Cardiovascular Medication among Hypertensive COVID-19 Patients in South Korea

aspirin prophylaxis study: 1% lower mortality (p=0.95) and 12% fewer cases (p=0.04).
Retrospective database analysis of 328,374 adults in South Korea, showing lower risk of COVID-19 cases with aspirin use, but no difference in mortality for COVID-19 patients.
Jun 2021, Yonsei Medical J., https://eymj.org/DOIx.php?id=10.3349/ymj.2021.62.7.577, https://c19p.org/oh2

31. Ali et al., Cardiovascular complications are the primary drivers of mortality in hospitalized patients with SARS-CoV-2 community-acquired pneumonia

1,645 patient aspirin prophylaxis study: 28% lower mortality (p=0.07).
Retrospective 1,645 hospitalized patients in the USA, showing lower mortality with aspirin use, without statistical significance.
Nov 2022, Chest, https://www.sciencedirect.com/science/article/pii/S0012369222041617, https://c19p.org/ali7

32. Levy et al., Frail Older Adults with Presymptomatic SARS-CoV-2 Infection: Clinical Course and Prognosis

849 patient aspirin prophylaxis study: 26% lower combined mortality/hospitalization (p=0.13).
Retrospective 849 COVID-19+ patients in skilled nursing homes, showing lower risk of combined hospitalization/death with aspirin prophylaxis, not reaching statistical significance.
Jan 2022, Gerontology, https://www.karger.com/Article/FullText/521412, https://c19p.org/levye

33. Mehrizi et al., Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

917,198 patient aspirin late treatment study: 16% lower mortality (p<0.0001).
Retrospective study of 917,198 hospitalized COVID-19 cases covered by the Iran Health Insurance Organization over 26 months showing that antithrombotics, corticosteroids, and antivirals reduced mortality while diuretics, antibiotics, and antidiabetics increased it. Confounding makes some results very unreliable. For example, diuretics like furosemide are often used to treat fluid overload, which is more likely in ICU or advanced disease requiring aggressive fluid resuscitation. Hospitalization length has increased risk of significant confounding, for example longer hospitalization increases the chance of receiving a medication, and death may result in shorter hospitalization. Mortality results may be more reliable. Confounding by indication is likely to be significant for many medications. Authors adjustments have very limited severity information (admission type refers to ward vs. ER department on initial arrival). We can estimate the impact of confounding from typical usage..
Dec 2023, Frontiers in Public Health, https://www.frontiersin.org/articles/10.3389/fpubh.2023.1280434/full, https://c19p.org/mehrizie

34. Campbell et al., Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen and relationship with mortality among United States Veterans after testing positive for COVID-19

20,730 patient aspirin prophylaxis study: 3% lower mortality (p=0.06).
Retrospective 28,856 COVID-19 patients in the USA, showing no significant difference in mortality for chronic aspirin use vs. sporadic NSAID use. Since aspirin is available OTC and authors only tracked prescriptions, many patients classified as sporadic users may have been chronic users.
May 2022, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267462, https://c19p.org/campbell2

35. Zadeh et al., Effect of aspirin in COVID-19 outcomes of older adults with a history of coronary artery disease

aspirin prophylaxis study: 37% lower mortality (p=0.28) and 1% higher ICU admission (p=0.79).
Retrospective 4,017 coronary artery disease patients hospitalized for COVID-19 in the USA, showing no significant difference in outcomes with low dose aspirin use.
Dec 2022, Innovation in Aging, https://academic.oup.com/innovateage/article/6/Supplement_1/850/6939246, https://c19p.org/zadeh

36. Sahai et al., Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19

496 patient aspirin late treatment PSM study: 13% lower mortality (p=0.53).
PSM retrospective 1,994 PCR+ patients in the USA, not showing a significant difference in mortality with aspirin treatment.
May 2021, Vascular Medicine, https://journals.sagepub.com/doi/10.1177/1358863X211012754, https://c19p.org/sahai

37. Mura et al., Real-world evidence for improved outcomes with histamine antagonists and aspirin in 22,560 COVID-19 patients

1,054 patient aspirin late treatment PSM study: 15% lower mortality (p=0.08).
PSM retrospective TriNetX database analysis of 1,379 severe COVID-19 patients requiring respiratory support, showing lower mortality with aspirin (not reaching statistical significance) and famotidine, and improved results from the combination of both.
Mar 2021, Signal Transduction and Targeted Therapy, https://www.nature.com/articles/s41392-021-00689-y, https://c19p.org/mura

38. Sisinni et al., Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study

984 patient aspirin prophylaxis study: 7% higher mortality (p=0.65) and 30% lower combined mortality/intubation (p=0.01).
Retrospective 984 COVID-19 patients, 253 taking aspirin prior to admission, showing lower risk of respiratory support upgrade with treatment.
Oct 2021, Int. J. Cardiology, https://www.sciencedirect.com/science/article/abs/pii/S0167527321014996, https://c19p.org/sisinni

39. Drew et al., Aspirin and NSAID use and the risk of COVID-19

aspirin prophylaxis study: 22% lower progression (p=0.3) and 3% more cases (p=0.8).
Retrospective 2,736,091 individuals in the U.S., U.K., and Sweden, showing lower risk of hospital/clinic visits with aspirin use.
May 2021, medRxiv, https://www.medrxiv.org/content/10.1101/2021.04.28.21256261, https://c19p.org/drew

40. Gogtay et al., Retrospective analysis of aspirin's role in the severity of COVID-19 pneumonia

125 patient aspirin prophylaxis study: 6% higher mortality (p=0.87), 50% lower ventilation (p=0.16), and 49% lower ICU admission (p=0.41).
Retrospective 125 COVID+ hospitalized patients in the USA, showing no significant differences with aspirin prophylaxis.
Mar 2022, World J. Critical Care Medicine, https://www.wjgnet.com/2220-3141/full/v11/i2/92.htm, https://c19p.org/gogtay

41. Shamsi et al., Survival and Mortality in Hospitalized Children with COVID-19: A Referral Center Experience in Yazd, Iran

183 patient aspirin late treatment study: 96% lower mortality (p=0.22).
Retrospective 183 hospitalized pediatric COVID-19 patients in Iran, showing no significant difference in mortality with in unadjusted results.
Jul 2023, Canadian J. Infectious Diseases and Medical Microbiology, https://www.hindawi.com/journals/cjidmm/2023/5205188/, https://c19p.org/shamsie

42. Mustafa et al., Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan

444 patient aspirin late treatment study: 44% lower mortality (p=0.28).
Retrospective 444 hospitalized patients in Pakistan, showing lower mortality with aspirin treatment in unadjusted results, not reaching statistical significance.
Dec 2021, Exploratory Research in Clinical and Social Pharmacy, https://www.sciencedirect.com/science/article/pii/S2667276621001013, https://c19p.org/mustafae

43. Vahedian-Azimi et al., Association of In-hospital Use of Statins, Aspirin, and Renin-Angiotensin-Aldosterone Inhibitors with Mortality and ICU Admission Due to COVID-19

587 patient aspirin late treatment study: 22% lower mortality (p=0.56) and 10% higher ICU admission (p=0.67).
Retrospective 587 COVID+ hospitalized patients in Iran, showing no significant differences in outcomes with aspirin treatment.
Jul 2021, Identification of Biomarkers, New Treatments, and Vaccines for COVID-19, https://link.springer.com/chapter/10.1007%2F978-3-030-71697-4_17, https://c19p.org/vahedianazimi2

44. Bejan et al., DrugWAS: Drug‐wide Association Studies for COVID‐19 Drug Repurposing

9,229 patient aspirin prophylaxis study: 1% lower ventilation (p=0.97).
Retrospective 9,748 COVID-19 patients in the USA showing no signficant difference with aspirin use.
Feb 2021, Clinical Pharmacology & Therapeutics, https://onlinelibrary.wiley.com/doi/10.1002/cpt.2376, https://c19p.org/bejane

45. Yuan et al., Mortality and pre-hospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease

183 patient aspirin prophylaxis study: 4% lower mortality (p=0.89).
Retrospective 183 hospitalized patients in China, 52 taking low-dose aspirin prior to hospitalization, showing no significant difference with treatment.
Dec 2020, J. Cellular and Molecular Medicine, https://onlinelibrary.wiley.com/doi/10.1111/jcmm.16198, https://c19p.org/yuan

46. Elhadi et al., Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study

465 patient aspirin ICU study: 10% lower mortality (p=0.5).
Prospective study of 465 COVID-19 ICU patients in Libya showing no significant differences with treatment.
Apr 2021, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251085, https://c19p.org/elhadie

47. Eikelboom et al., Colchicine and aspirin in community patients with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

3,881 patient aspirin late treatment RCT: 9% higher mortality (p=0.84), 20% lower progression (p=0.21), and 17% lower hospitalization (p=0.31).
Late (5.4 days) outpatient RCT showing no significant difference in outcomes with aspirin treatment.
Oct 2022, The Lancet Respiratory Medicine, https://www.sciencedirect.com/science/article/pii/S2213260022002995, https://c19p.org/eikelboom2e

48. Ma et al., Sex Differences in Association Between Anti-Hypertensive Medications and Risk of COVID-19 in Middle-Aged and Older Adults

77,221 patient aspirin prophylaxis PSM study: 9% lower mortality (p=0.12), 2% lower hospitalization (p=0.47), 9% more symptomatic cases (p=0.18), and 7% more cases (p=0.09).
UK Biobank retrospective 77,271 patients aged 50-86, showing no significant differences with aspirin use. Matching lead to different results for the gender vs. overall analysis, for example the overall result for cases was OR 1.07, however both gender results are lower OR 0.97 and 1.02.
Aug 2021, Drugs & Aging, https://link.springer.com/article/10.1007%2Fs40266-021-00886-y, https://c19p.org/ma3

49. Son et al., Effect of aspirin on coronavirus disease 2019

21,669 patient aspirin prophylaxis PSM study: 11% lower mortality (p=0.67), 7% higher progression (p=0.8), and 11% more cases (p=0.21).
PSM retrospective case control study in South Korea, showing a trend towards lower mortality, but no significant differences with aspirin use.
Jul 2021, Medicine, https://journals.lww.com/10.1097/MD.0000000000026670, https://c19p.org/son

50. Azizi et al., A study on the effect of aspirin on clinical symptoms, laboratory indices, and outcomes in patients with COVID-19

262 patient aspirin prophylaxis study: no change in mortality (p=1).
Retrospective 131 COVID-19 patients with aspirin use and 131 matched controls in Iran, showing no significant difference in outcomes, however age matching used only two categories, 40-60 and 60+, therefore matching may be very poor given the relationship between age and COVID-19 risk. The percentages given for the control group death/recovery outcomes do not match the reported counts.
Feb 2023, J. Nephropharmacology, https://www.jnephropharmacology.com/Inpress/npj-10506.pdf, https://c19p.org/azizi

51. Nimer et al., The impact of vitamin and mineral supplements usage prior to COVID-19 infection on disease severity and hospitalization

2,148 patient aspirin prophylaxis study: 4% lower hospitalization (p=0.08) and 18% higher severe cases (p=0.28).
Retrospective 2,148 COVID-19 recovered patients in Jordan, showing no significant differences in the risk of severity and hospitalization with aspirin prophylaxis.
Feb 2022, Bosnian J. Basic Medical Sciences, https://www.bjbms.org/ojs/index.php/bjbms/article/view/7009, https://c19p.org/nimere

52. Alamdari et al., Mortality Risk Factors among Hospitalized COVID-19 Patients in a Major Referral Center in Iran

459 patient aspirin late treatment study: 28% higher mortality (p=0.52).
Retrospective 459 patients in Iran, 53 treated with aspirin, showing no significant difference with treatment.
Sep 2020, The Tohoku J. Experimental Medicine, https://www.jstage.jst.go.jp/article/tjem/252/1/252_73/_article/-char/ja/, https://c19p.org/alamdarie

53. Prieto-Campo et al., Impact of prior use of antiplatelets on COVID-19 susceptibility, progression, and severity: a population-based study

aspirin prophylaxis study: 13% higher mortality (p=0.38), 3% lower hospitalization (p=0.64), no change in progression (p=0.98), and 8% fewer cases (p=0.02).
Population-based case-control study of 86,602 people in Spain, shower lower risk of COVID-19 cases with low-dose aspirin, but no significant difference for severity, hospitalization, or mortality.
Jan 2024, Revista Española de Cardiología, https://www.sciencedirect.com/science/article/pii/S1885585724000148, https://c19p.org/prietocampo

54. Pourhoseingholi et al., Case Characteristics, Clinical Data, And Outcomes of Hospitalized COVID-19 Patients In Qom Province, Iran: A Prospective Cohort Study

2,468 patient aspirin late treatment study: 32% higher mortality (p=0.04).
Prospective study of 2,468 hospitalized COVID-19 patients in Iran, showing higher mortality with aspirin treatment. IR.MUQ.REC.1399.013.
May 2021, Research Square, https://www.researchsquare.com/article/rs-365321/v2, https://c19p.org/pourhoseingholie

55. Aweimer et al., Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany

149 patient aspirin ICU study: 10% higher mortality (p=0.43).
Retrospective 149 patients under invasive mechanical ventilation in Germany showing no significant difference in mortality with aspirin prophylaxis in unadjusted results.
Mar 2023, Scientific Reports, https://www.nature.com/articles/s41598-023-31944-7, https://c19p.org/aweimere

56. Abdelwahab et al., Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study

67 patient aspirin late treatment study: 8% higher ventilation (p=0.93).
Retrospective 225 hospitalized patients in Egypt, showing significantly lower thromboembolic events with aspirin treatment, but no significant difference in the need for mechanical ventilation.
Jul 2021, Clinical Drug Investigation, https://link.springer.com/article/10.1007/s40261-021-01061-2, https://c19p.org/abdelwahab

57. Mulhem et al., 3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study

3,219 patient aspirin prophylaxis study: 14% higher mortality (p=0.21).
Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06 [2.44-3.83]) suggest significant confounding by indication and confounding by time.
Apr 2021, BMJ Open, https://bmjopen.bmj.com/content/11/4/e042042.info, https://c19p.org/mulheme

58. Holt et al., Influence of inhibitors of the renin–angiotensin system on risk of acute respiratory distress syndrome in Danish hospitalized COVID-19 patients

689 patient aspirin prophylaxis study: 34% higher combined mortality/ICU admission (p=0.09).
Retrospective 689 hospitalized COVID-19 patients in Denmark, showing higher risk of ICU/death with aspirin use in unadjusted results subject to confounding by indication.
May 2020, J. Hypertension, https://journals.lww.com/10.1097/HJH.0000000000002515, https://c19p.org/holt2e

59. Morrison et al., COVID-19 outcomes in patients taking cardioprotective medications

13,585 patient aspirin prophylaxis PSM study: 8% lower mortality (p=0.52), 1% higher ventilation (p=0.96), 12% higher ICU admission (p=0.36), and 18% higher hospitalization (p=0.04).
Retrospective 13,585 COVID+ patients in the USA, showing higher hospitalization with aspirin use, and no significant difference for mortality, ventilation, and ICU admission.
Oct 2022, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0275787, https://c19p.org/morrisone

60. Azimi Pirsaraei et al., Anticoagulant Use in COVID-19 Patients: A Longitudinal Study From Zanjan, Iran

831 patient aspirin late treatment study: 97% higher mortality (p=0.002).
Retrospective 831 hospitalized COVID-19 patients showing higher mortality with aspirin treatment in unadjusted results.
Aug 2024, Cureus, https://www.cureus.com/articles/263779-anticoagulant-use-in-covid-19-patients-a-longitudinal-study-from-zanjan-iran, https://c19p.org/azimipirsaraei

61. Karimpour-Razkenari et al., Evaluating the Effects of Clinical Characteristics and Therapeutic Regimens on Mortality in Hospitalized Patients with Severe COVID-19

478 patient aspirin late treatment study: 123% higher mortality (p=0.008).
Retrospective 478 moderate to severe hospitalized patients in Iran, showing higher mortality with aspirin treatment. Authors note confounding by indication for aspirin treatment.
Oct 2022, J. Pharmaceutical Care, https://publish.kne-publishing.com/index.php/JPC/article/view/10790, https://c19p.org/karimpourrazkenari2e

62. Ramos-Rincón et al., Association between prior cardiometabolic therapy and in-hospital mortality in very old patients with type 2 diabetes mellitus hospitalized due to COVID-19. A nationwide observational study in Spain

790 patient aspirin prophylaxis study: 29% higher mortality (p=0.02).
Retrospective 790 hospitalized type 2 diabetes patients ≥80 years old in Spain, showing higher mortality with existing aspirin use.
Dec 2020, Research Square, https://www.researchsquare.com/article/rs-133358/v1, https://c19p.org/ramosrincone

63. Sakamaki et al., Insights from a multicenter nationwide cohort analysis in Japan on the association of underlying conditions and pharmacological interventions with COVID-19 disease severity

650,317 patient aspirin prophylaxis study: 37% higher severe cases (p<0.0001).
Retrospective 650,317 COVID-19 patients in Japan showing higher risk of severe COVID-19 with low-dose apirin use. Although cardiovascular disease should have been adjusted for (details of adjustments are not provided), there may be significant residual confounding because aspirin use might indicate more severe or complex cardiovascular issues not fully captured by the adjustment.
Sep 2024, Discover Public Health, https://ete-online.biomedcentral.com/articles/10.1186/s12982-024-00225-7, https://c19p.org/sakamakie

64. Monserrat Villatoro et al., A Case-Control of Patients with COVID-19 to Explore the Association of Previous Hospitalisation Use of Medication on the Mortality of COVID-19 Disease: A Propensity Score Matching Analysis

aspirin prophylaxis PSM study: 31% higher mortality (p=0.04).
PSM retrospective 3,712 hospitalized patients in Spain, showing lower mortality with existing use of azithromycin, bemiparine, budesonide-formoterol fumarate, cefuroxime, colchicine, enoxaparin, ipratropium bromide, loratadine, mepyramine theophylline acetate, oral rehydration salts, and salbutamol sulphate, and higher mortality with acetylsalicylic acid, digoxin, folic acid, mirtazapine, linagliptin, enalapril, atorvastatin, and allopurinol.
Jan 2022, Pharmaceuticals, https://www.mdpi.com/1424-8247/15/1/78, https://c19p.org/monserratvillatoroe

65. Pérez-Segura et al., Prognostic factors at admission on patients with cancer and COVID-19: Analysis of HOPE registry data

763 patient aspirin prophylaxis study: 49% higher mortality (p=0.0001).
Retrospective 770 COVID-19 patients with cancer, showing increased mortality with aspirin use in unadjusted results.
Oct 2021, Medicina Clínica, https://www.sciencedirect.com/science/article/pii/S238702062100485X, https://c19p.org/perezsegura

66. Basheer et al., Clinical Predictors of Mortality and Critical Illness in Patients with COVID-19 Pneumonia

390 patient aspirin prophylaxis study: 13% higher mortality (p=0.0003).
Retrospective 390 hospitalized patients in Israel, showing higher risk of mortality with prior aspirin use. Details of the analysis are not provided.
Oct 2021, Metabolites, https://www.mdpi.com/2218-1989/11/10/679, https://c19p.org/basheer

67. Lodigiani et al., Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

388 patient aspirin prophylaxis study: 21% higher ICU admission (p=0.52).
Retrospective 388 hospitalized COVID-19 patients in Italy showing higher use of aspirin in ICU patients, without statistical significance.
Jul 2020, Thrombosis Research, https://www.sciencedirect.com/science/article/pii/S0049384820301407, https://c19p.org/lodigiani

68. Eikelboom et al., Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

2,119 patient aspirin late treatment RCT: 5% higher mortality (p=0.66) and 8% lower progression (p=0.32).
RCT very late stage (baseline SpO2 77%) patients, showing no significant differences with rivaroxaban and aspirin treatment.
Oct 2022, The Lancet Respiratory Medicine, https://www.sciencedirect.com/science/article/pii/S2213260022002983, https://c19p.org/eikelboome

69. Botton et al., No association of low-dose aspirin with severe COVID-19 in France: A cohort of 31.1 million people without cardiovascular disease

31,072,642 patient aspirin prophylaxis study: 4% higher combined mortality/intubation (p=0.18) and 3% higher hospitalization (p=0.05).
Retrospective 31 million people without cardiovascular disease in France, showing no significant difference in hospitalization or combined intubation/death with low dose aspirin prophylaxis.
Jun 2022, Research and Practice in Thrombosis and Haemostasis, https://onlinelibrary.wiley.com/doi/10.1002/rth2.12743, https://c19p.org/botton

70. Pan et al., Pre-hospital antiplatelet medication use on COVID-19 disease severity

762 patient aspirin prophylaxis study: 13% higher mortality (p=0.63) and 2% higher combined mortality/intubation (p=0.93).
Retrospective 762 COVID+ hospitalized patients in the USA, 239 on antiplatelet medication (199 aspirin), showing no significant differences in outcomes. For more discussion see [sciencedirect.com].
May 2021, Heart & Lung, https://www.heartandlung.org/article/S0147-9563(21)00175-8/fulltext, https://c19p.org/pan

71. Formiga et al., Does admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry

20,641 patient aspirin prophylaxis PSM study: 3% higher mortality (p=0.48), 3% higher ventilation (p=0.75), and 4% higher ICU admission (p=0.65).
Retrospective 20,641 hospitalized patients in Spain, showing no significant difference in outcomes with existing aspirin use.
Nov 2021, Internal and Emergency Medicine, https://link.springer.com/10.1007/s11739-021-02870-1, https://c19p.org/formiga2

72. Lewandowski et al., Insulin and Metformin Administration: Unravelling the Multifaceted Association with Mortality across Various Clinical Settings Considering Type 2 Diabetes Mellitus and COVID-19

430 patient aspirin late treatment study: 70% higher mortality (p=0.02).
Retrospective 430 hospitalized COVID-19 patients with type 2 diabetes in Poland showing lower mortality with metformin and higher mortality with remdesivir, convalescent plasma, and aspirin in univariable analysis. These results were not statistically significant except for aspirin, and no baseline information per treatment is provided to assess confounding.
Mar 2024, Biomedicines, https://www.mdpi.com/2227-9059/12/3/605, https://c19p.org/lewandowski2e

73. Sullerot et al., Premorbid aspirin use is not associated with lower mortality in older inpatients with SARS-CoV-2 pneumonia

1,047 patient aspirin prophylaxis study: 10% higher mortality (p=0.52), 110% higher ICU admission (p=0.007), and 10% longer hospitalization (p=0.02).
Retrospective 1,047 pneumonia patients in 5 COVID-19 geriatric units in France and Switzerland, significantly higher ICU admission and longer hospital stays with existing aspirin treatment. Numbers in this study appear to be inconsistent, for example the abstract says 147 of 301 aspirin patients died, shown as 34.3%, while Table 1 shows 104 of 301 (34.6%).
Jan 2022, GeroScience, https://link.springer.com/article/10.1007%2Fs11357-021-00499-8, https://c19p.org/sullerot

74. Reese et al., Cyclooxygenase inhibitor use is associated with increased COVID-19 severity

9,842 patient aspirin prophylaxis PSM study: 61% higher mortality (p<0.0001) and 309% higher severe cases (p<0.0001).
N3C retrospective 250,533 patients showing significantly higher mortality with aspirin use. Note that aspirin results were not included in the journal version or v2 of this preprint.
Apr 2021, medRxiv, https://www.medrxiv.org/content/10.1101/2021.04.13.21255438v1, https://c19p.org/reesee

75. Kim et al., Aspirin Is Related to Worse Clinical Outcomes of COVID-19

272 patient aspirin prophylaxis PSM study: 700% higher mortality (p=0.03), 433% higher ventilation (p=0.14), 433% higher ICU admission (p=0.14), and 33% fewer cases (p=0.29).
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.
Sep 2021, Medicina, https://www.mdpi.com/1648-9144/57/9/931, https://c19p.org/kim2

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