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Hospitalized patients with COVID-2019: Aspirin is associated with decreased mechanical ventilation, intensive care unit admission, and in-hospital mortality


Coronavirus disease-2019 ( COVID-19 ) is associated with hypercoagulability and increased thrombotic risk in critically ill patients.
No studies have evaluated whether Aspirin ( Acetylsalicylic acid ) use is associated with reduced risk of mechanical ventilation, intensive care unit ( ICU ) admission, and in-hospital mortality.

A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed.

The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality.
Adjusted hazard ratios ( HRs ) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions.

Four hundred twelve patients were included in the study. Three hundred fourteen patients ( 76.3% ) did not receive Aspirin, while 98 patients ( 23.7% ) received Aspirin within 24 hours of admission or 7 days before admission.

Aspirin use had a crude association with less mechanical ventilation ( 35.7% Aspirin versus 48.4% non-Aspirin, P = 0.03 ) and ICU admission ( 38.8% Aspirin versus 51.0% non-Aspirin, P = 0.04 ), but no crude association with in-hospital mortality ( 26.5% Aspirin versus 23.2% non-Aspirin, P = 0.51 ).

After adjusting for 8 confounding variables, Aspirin use was independently associated with decreased risk of mechanical ventilation ( adjusted HR, 0.56, 95% confidence interval [ CI ], 0.37-0.85, P = 0.007 ), ICU admission ( adjusted HR, 0.57, 95% CI, 0.38-0.85, P = 0.005 ), and in-hospital mortality ( adjusted HR, 0.53, 95% CI, 0.31-0.90, P = 0.02 ).

There were no differences in major bleeding ( P = 0.69 ) or overt thrombosis ( P = 0.82 ) between Aspirin users and non-Aspirin users.

In conclusion, Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients.
However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between Aspirin use and reduced lung injury and mortality in COVID-19 patients. ( Xagena )

Chow JH et al, Anesthesia & Analgesia 2021;132: 930-941

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