Aspirin with or without statin in the treatment of endotheliitis, thrombosis, and ischemia in coronavirus disease

Abstract

INTRODUCTION: In the genesis of coronavirus disease (COVID-19), there is a process of endotheliitis associated with thrombotic changes, no studies have reported the use of acetylsalicylic acid (ASA) as a possible therapeutic approach. Statins could potentiate the ASA therapy. METHODS: This is a series of 14 cases with a laboratory-confirmed diagnosis of COVID-19. All patients underwent the ASA therapy. Those who had risk factors for vascular disease also underwent the high-potency statin therapy. When symptoms were totally or practically resolved, patients were discharged and advised to continue medications for a complementary time, according to the clinical evolution of each patient. RESULTS: The mean age of monitored patients was 48.6 years. A total of 78.6% patients presented with at least one comorbidity, which could have contributed as a risk factor for a poor prognosis in the evolution of COVID-19. Four patients had secondary bacterial infections; three patients needed hospitalization. None of the cases progress to stage III, and all patients had remission of symptoms, with 100% survival. CONCLUSIONS: the process of endothelial dysfunction in COVID-19 involves disseminated thrombosis, initially microvascular and later expansion into larger vessels. ASA could act as a secondary prophylaxis and prevent thrombosis from developing and reaching stage III of the disease. As this was a case series, we cannot provide definitive conclusions; however, this study allows us to formulate hypotheses and support clinical trials to evaluate benefits of the ASA therapy in the treatment of COVID-19.

Antiplatelet therapy and outcome in COVID-19: the Health Outcome Predictive Evaluation Registry

“… 23 It may also have pleiotropic effects on the endothelium which could target potential development of endotheliitis, a potential complication of severe COVID-19. 24 …”

“…23 It may also have pleiotropic effects on the endothelium which could target potential development of endotheliitis, a potential complication of severe COVID-19. 24 The antiviral properties of APT are mainly related to their potential activity of suppressing platelet activation. Indeed, in several models of tissue injury during virus infection (influenza A virus, dengue, HIV-1, severe acute respiratory syndrome), severe inflammation is driven by unsuppressed platelet activation.…”

Effects of Statins on Outcomes in Hispanic Patients with COVID-19

“…Decreased expressivity may lead to less inflammation contributing to the lower detrimental outcomes. In addition, statins are also able to increase the production of nitric oxide, the amount of circulating endothelial progenitor cells, and inhibit apoptosis of endothelium, thus reducing the detrimental effects of the disseminated intravascular coagulation 17. With all the effects of statin therapy, patients infected with the virus may have lower adverse effects from the MI, stroke, and pneumothorax caused through the cytokine storm.…”

Rationales and uncertainties for aspirin use in COVID-19: a narrative review

“…COVID-19-induced endotheliitis provides a reasonable sound for treatment modalities to stabilise the endothelium while tackling SARS-CoV-2 replication, especially with anti-inflammatory, anticytokine drugs, ACE inhibitors and statins. 11 Florêncio et al 13 formulated a hypothesis that aspirin and statins play an essential role in preventing COVID-19-induced endotheliitis, and progression to severe forms.…”