Association of Mortality and Aspirin Prescription for COVID-19 Patients at the Veterans Health Administration

Abstract

There is growing evidence that thrombotic and inflammatory pathways contribute to the severity of COVID-19. Common medications such as aspirin, that mitigate these pathways, may decrease COVID-19 mortality. This assessment was designed to quantify the correlation between aspirin and mortality for COVID-19 positive patients in our care. Data from the Veterans Health Administration national electronic health record database was utilized for the evaluation. Veterans from across the country with a first positive COVID-19 polymerase chain reaction lab result were included in the evaluation which comprised 28,350 patients from March 2, 2020 to September 13, 2020 for the 14-day mortality cohort and 26,346 patients from March 2, 2020 to August 28, 2020 for the 30-day mortality cohort. Patients were matched via propensity scores and the odds of mortality were then compared. Among COVID-19 positive Veterans, preexisting aspirin prescription was associated with a statistically and clinically significant decrease in overall mortality at 14-days (OR 0.38, 95% CI 0.32-0.46) and at 30-days (OR 0.38, 95% CI 0.33-0.45), cutting the odds of mortality by more than half. Findings demonstrated that pre-diagnosis aspirin prescription was strongly associated with decreased mortality rates for Veterans diagnosed with COVID-19. Prospective evaluation is required to more completely assess this correlation and its implications for patient care.

Critical Influenza and COVID-19—A Comparative Nationwide Case-Control Study

“…Antiplatelet therapy may have beneficial effects in severe COVID-19 through several mechanisms including inhibition of platelet aggregation, reduction of platelet-derived inflammation, blocking thrombogenic neutrophil extracellular traps, and reducing disseminated intravascular coagulation. Low-dose aspirin has been used as a line of therapy, and several observational studies have reported that aspirin is associated with a reduced risk of adverse outcome in COVID-19 (58, 59). In line with oral anticoagulants, premorbid treatment with platelet inhibitors was associated with a reduction in the risk of contracting critical COVID-19 but not influenza in our study.…”

Role of neutrophils, platelets, and extracellular vesicles and their interactions in COVID‐19‐associated thrombopathy

“…of thrombotic events, extracorporeal oxygenation, and mortality. 143 In addition, recent results from REMAP-CAP, ACTIV-4a, and ATTACC trials showed that an initial strategy based on therapeutic dose of heparin improved survival of non-critically ill patients and reduced the use of cardiovascular or respiratory support compared to usual-care thromboprophylaxis 144 but did not improve outcomes in critically ill patients. 142…”

“…A retrospective analysis has recently emphasized that, among COVID-19-positive veterans, pre-diagnosis aspirin prescription was associated with a 2-fold decrease in 14-day and 30-day overall mortality. 143 Although the results of ACTCOVID19 (NCT04324463)…”

Science's Response to CoVID‐19

“…Nevertheless, IL‐6 inhibitors are being trialed; several of these also may have inherent antiviral activity [292] . Several other treatments have been proposed to suppress the principal symptoms of the disease, such as aspirin (shown to have little clinical effect in a study of 183 patients in China, [293] although pre‐existing aspirin prescription was found to decrease mortality), [294] tocizumab, [295] an immunosuppressive, and colchicine, an anti‐inflammatory molecule used to treat gout [256] (initial patient data indicate a positive response in mild to severe CoVID‐19 cases) [296] . Oxidative stress is an important contributing factor to serious CoVID‐19 cases and there are reports that CoVID‐19 infection may suppress cellular antioxidant response [297] .…”