Analysis of Prior Aspirin Treatment on in-Hospital Outcome of Geriatric COVID-19 Infected Patients
Khaoula Zekri-Nechar, José Barberán, José J Zamorano-León, María Durbán, Alcira Andrés-Castillo, Carlos Navarro-Cuellar, Antonio López-Farré, Ana López-De-Andrés, Rodrigo Jiménez-García, Carlos H Martínez-Martínez
Medicina, doi:10.3390/medicina58111649
Background and Objectives: Aspirin (ASA) is a commonly used antithrombotic drug that has been demonstrated to reduce venous thromboembolism. The aim was to analyze if geriatric COVID-19 patients undergoing a 100 mg/day Aspirin (ASA) treatment prior to hospitalization differ in hospital outcome compared to patients without previous ASA therapy. Materials and Methods: An observational retrospective study was carried out using an anonymized database including geriatric COVID-19 patients (March to April 2020) admitted to Madrid Hospitals Group. A group of COVID-19 patients were treated with low ASA (100 mg/day) prior to COVID-19 infection. Results: Geriatric ASA-treated patients were older (mean age over 70 years; n = 41), had higher frequency of hypertension and hyperlipidemia, and upon admission had higher D-dimer levels than non-ASAtreated patients (mean age over 73 years; n = 160). However, patients under ASA treatment did not show more frequent pulmonary thromboembolism (PE) than non-ASA-treated patients. ASA-treated geriatric COVID-19-infected patients in-hospital < 30 days all-cause mortality was more frequent than in non-ASA-treated COVID-19 patients. In ASA-treated COVID-19-infected geriatric patients, anticoagulant therapy with low molecular weight heparin (LMWH) significantly reduced need of ICU care, but tended to increase in-hospital < 30 days all-cause mortality. Conclusions: Prior treatment with a low dose of ASA in COVID-19-infected geriatric patients increased frequency of in-hospital < 30 days all-cause mortality, although it seemed to not increase PE frequency despite D-dimer levels upon admission being higher than in non-ASA users. In ASA-treated geriatric COVID-19-infected patients, addition of LMWH therapy reduced frequency of ICU care, but tended to increase in-hospital < 30 days all-cause mortality.
Data Availability Statement: This study was carried out using an anonymized database provided by Madrid Hospitals Group. Data are from COVID-19-infected patients admitted in their hospital net that they made kindly available to some Spanish researchers within the program: COVID-19 data saves lives in Spain.
Conflicts of Interest: The authors declare that they have no conflict of interest.
References
Alamdari, Afaghi, Rahimi, Tarki, Tavana et al., Mortality Risk Factors among Hospitalized COVID-19 Patients in a Major Referral Center in Iran, Tohoku J. Exp. Med,
doi:10.1620/tjem.252.73
Becattini, Agnelli, Schenone, Eichinger, Bucherini et al., Aspirin for preventing the recurrence of venous thromboembolism, N. Engl. J. Med,
doi:10.1056/NEJMoa1114238
Berenguer, Ryan, Rodríguez-Baño, Jarrín, Carratalà et al., for the COVID-19@Spain Study. Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain, Clin. Microbiol. Infect,
doi:10.1016/j.cmi.2020.07.024
Brighton, Eikelboom, Mann, Mister, Gallus et al., Low-dose aspirin for preventing recurrent venous thromboembolism, N. Engl. J. Med,
doi:10.1056/NEJMoa1210384
Canoglu, Saylan, Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection, Ann. Saudi Med,
doi:10.5144/0256-4947.2020.462
Chen, Zhou, Dong, Qu, Gong et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study, Lancet,
doi:10.1016/S0140-6736(20)30211-7
Choi, Kim, Kang, The Potential Role of Dyslipidemia in COVID-19 Severity: An Umbrella Review of Systematic Reviews, J. Lipid Atheroscler,
doi:10.12997/jla.2020.9.3.435
Clausen, Sandoval, Spliid, Pihl, Perrett et al., SARS-CoV-2 Infection Depends on Cellular Heparan Sulfate and ACE2, Cell,
doi:10.1016/j.cell.2020.09.033
Eikelboom, Hirsh, Weitz, Johnston, Yi et al., Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events, Circulation,
doi:10.1161/01.CIR.0000013777.21160.07
Glatthaar-Saalmüller, Mair, Saalmüller, Antiviral activity of aspirin against RNA viruses of the respiratory tract-an in vitro study, Influenza Other Respir. Viruses,
doi:10.1111/irv.12421
Goligher, Bradbury, Mcverry, Lawler, Berger et al., Therapeutic Anticoagulation with Heparin in Critically Ill Patients with COVID-19, N. Engl. J. Med
Gratz, Wiegele, Maleczek, Herkner, Schöchl et al., Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis, Front. Med,
doi:10.3389/fmed.2021.647917
Lawler, Goligher, Berger, Neal, Mcverry et al., Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with COVID-19, N. Engl. J. Med
Leentjens, Van Haaps, Wessels, Schutgens, Middeldorp, COVID-19-associated coagulopathy and antithrombotic agents-lessons after 1 year, Lancet Haematol,
doi:10.1016/S2352-3026(21)00105-8
Malas, Naazie, Elsayed, Mathlouthi, Marmor et al., Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis, EClinicalMedicine,
doi:10.1016/j.eclinm.2020.100639
Martha, Pranata, Lim, Wibowo, Akbar, Active prescription of low-dose aspirin during or prior to hospitalization and mortality in COVID-19: A systematic review and meta-analysis of adjusted effect estimates, Int. J. Infect. Dis,
doi:10.1016/j.ijid.2021.05.016
Nikolich-Zugich, Knox, Rios, Natt, Bhattacharya et al., SARS-CoV-2 and COVID-19 in older adults: What we may expect regarding pathogenesis, immune responses, and outcomes, Geroscience,
doi:10.1007/s11357-020-00186-0
O'brien, Duncan, Kirsh, Allen, King et al., Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial, Lancet
Pavoni, Gianesello, Pazzi, Stera, Meconi et al., Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action, Thromb. Res,
doi:10.1016/j.thromres.2020.09.013
Pranata, Huang, Lim, Wahjoepramono, July, Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19-systematic review, meta-analysis, and meta-regression, J. Stroke Cerebrovasc. Dis,
doi:10.1016/j.jstrokecerebrovasdis.2020.104949
Qin, Dong, Zhang, Hu, Chen et al., Low molecular weight heparin and 28-day mortality among patients with coronavirus disease 2019: A cohort study in the early epidemic era, Thromb. Res,
doi:10.1016/j.thromres.2020.11.020
Richardson, Hirsch, Narasimhan, Crawford, Mcginn et al., the Northwell COVID-19 Research Consortium. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area, JAMA,
doi:10.1001/jama.2020.6775
Signes-Costa, Núñez-Gil, Soriano, Arroyo-Espliguero, Eid et al., Prevalence and 30-Day Mortality in Hospitalized Patients with COVID-19 and Prior Lung Diseases, Arch. Bronconeumol,
doi:10.1016/j.arbres.2020.11.012
Simes, Becattini, Agnelli, Eikelboom, Kirby et al., INSPIRE Study Investigators (International Collaboration of Aspirin Trials for Recurrent Venous Thromboembolism). Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE collaboration, Circulation,
doi:10.1161/CIRCULATIONAHA.114.008828
Speir, Yu, Ferrans, Huang, Epstein, Aspirin attenuates cytomegalovirus infectivity and gene expression mediated by cyclooxygenase-2 in coronary artery smooth muscle cells, Circ. Res,
doi:10.1161/01.RES.83.2.210
Tang, Bai, Chen, Gong, Li et al., Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy, J. Thromb. Haemost,
doi:10.1111/jth.14817
Thachil, Tang, Gando, Falanga, Cattaneo et al., ISTH interim guidance on recognition and management of coagulopathy in COVID-19, J. Thromb. Haemost,
doi:10.1111/jth.14810
Walz-Cicconi, Weller, Dose-related effect of acetylsalicylic acid on replication of varicella zoster virus in vitro, Proc. Natl. Acad. Sci,
doi:10.1073/pnas.81.16.5223
Wijaya, Andhika, Huang, Purwiga, Budiman, The effects of aspirin on the outcome of COVID-19: A systematic review and meta-analysis, Clin. Epidemiol. Glob. Health,
doi:10.1016/j.cegh.2021.100883
Yuan, Chen, Li, Chen, Wang et al., Mortality and pre-hospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease, J. Cell. Mol. Med,
doi:10.1111/jcmm.16198