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Association of early Aspirin use with in-hospital mortality in patients with moderate COVID-19


Prior observational studies have suggested that Aspirin ( Acetylsalicylic acid ) use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but Aspirin’s efficacy in patients with moderate COVID-19 is not well studied.

The objective of the study was to assess whether early Aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19.

Observational cohort study has involved 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health’s National COVID Cohort Collaborative ( N3C ).

The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis.

Among the 2 446 650 COVID-19–positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion.
For the full cohort, median age was 63 years ( IQR, 47-74 years ); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity.

In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received Aspirin ( 10.2% vs 11.8%; odds ratio [ OR ], 0.85; 95% CI, 0.79-0.92; P less than 0.001 ).

The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received Aspirin ( 1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = 0.004 ).

Patients who received early Aspirin did not have higher rates of gastrointestinal hemorrhage ( 0.8% Aspirin vs 0.7% no-Aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = 0.72 ), cerebral hemorrhage ( 0.6% Aspirin vs 0.4% no-Aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = 0.13 ), or blood transfusion ( 2.7% Aspirin vs 2.3% no-Aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = 0.06 ).

The composite of hemorrhagic complications did not occur more often in those receiving Aspirin ( 3.7% Aspirin vs 3.2% no-Aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = 0.054 ).

Subgroups who appeared to benefit the most included patients older than 60 years ( 61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P less than 0.001; less than 80 years: OR, 0.79; 95% CI, 0.69-0.91; P less than 0.001 ) and patients with comorbidities ( 1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P less than 0.001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = 0.003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P less than 0.001; more than 3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P less than 0.001 ).

In conclusion, tn this cohort study of US adults hospitalized with moderate COVID-19, early Aspirin use was associated with lower odds of 28-day in-hospital mortality.
A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate Aspirin’s efficacy in patients with high-risk conditions. ( Xagena )

Chow JH et al, JAMA Netw Open 2022;5(3):e223890. doi:10.1001/jamanetworkopen.2022.3890

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