Evaluation of low-dose aspirin use among COVID-19 critically ill patients: A Multicenter Propensity Score Matched Study

Abstract

BackgroundMultiple medications with anti-inflammatory effects have been used to manage the hyper-inflammatory response associated with COVID-19. Aspirin is used widely as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. Its role in hospitalized COVID-19 patients has been assessed and evaluated in the literature. However, no data regards its role in COVID-19 critically ill patients. Therefore, this study aims to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in COVID-19 critically ill patients. MethodThis is a multicenter, retrospective cohort study for all adult critically ill patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome is the in-hospital mortality; other outcomes were considered secondary. Propensity score-matched used based on patient’s age, SOFA score, MV status within 24 hours of ICU admission, prone position status, ischemic heart disease (IHD), and stroke as co-existing illness. We considered a P value of < 0.05 statistically significant.ResultsA total of 1033 patients were eligible; 352 patients were included after propensity score matching (1:1 ratio). The in-hospital mortality (HR (95%CI): 0.73 (0.56, 0.97), p-value=0.03) were lower in patients who received aspirin during hospital stay. On the other hand, patients who received aspirin have a higher risk of major bleeding compared to the control group (OR (95%CI): 2.92 (0.91, 9.36), p-value=0.07); but was not statistically significant.ConclusionAspirin use in COVID-19 critically ill patients may have a mortality benefit; nevertheless, it may be linked with an increased risk of significant bleeding. The benefit-risk evaluation for aspirin usage during an ICU stay should be tailored to each patient.

Cardiovascular Complications in Coronavirus Disease 2019—Pathogenesis and Management

“…An observational study of mainly ICU critically ill patients suggested that aspirin therapy prior to hospitalization and continued during ICU stay was associated with lower mortality (HR ¼ 0.72 [0.52, 1.01]; p ¼ 0.05), but not when it was newly initiated (HR ¼ 1.22 [0.68, 2.20]; p ¼ 0.50). 78 However, another study on hospitalized patients aged 75 years or older did not show a survival effect but showed longer hospital length of stay in patients taking aspirin compared with those who were not (11 vs. 10 days, p ¼ 0.024), more likely to be transferred to ICU, (7.5 vs. 3.6%, p ¼ 0.007). 77 During the acute phase of the disease, the use of antiplatelet agents evaluated in the RECOVERY trial was not associated with a survival benefit (RR, 0.96; 95% CI, 0.89-1.04; p ¼ 0.35).…”

Associations between the use of aspirin or other antiplatelet drugs and all-cause mortality among patients with COVID-19: A meta-analysis

“…Data were abstracted by four authors (WS, HM, ZG, and QC) from 34 studies, (Abu-Jamous et al, 2020;Alamdari et al, 2020;Giacomelli et al, 2020;Lodigiani et al, 2020;Russo et al, 2020;Sahai et al, 2020;Tremblay et al, 2020;Chow et al, 2021a;Chow et al, 2021b;Connors et al, 2021;Fröhlich et al, 2021;Haji Aghajani et al, 2021;Ho et al, 2021;Kim et al, 2021;Liu et al, 2021;Meizlish et al, 2021;Merzon et al, 2021;Mura et al, 2021;Osborne et al, 2021;Pan et al, 2021;Sisinni et al, 2021;Son et al, 2021;Xiang et al, 2021;Yuan et al, 2021;Zhao et al, 2021;Zhou et al, 2021;Al Harthi et al, 2022;Santoro et al, 2022a;Chow et al, 2022;Formiga et al, 2022;Gogtay et al, 2022;RECOVERY Collaborative GroupAbbas et al, 2022; REMAP-CAP Writing Committee for the REMAP-CAP InvestigatorsBradbury et al, 2022;Sullerot et al, 2022), including three randomized controlled trials, (Connors et al, 2021;RECOVERY Collaborative GroupAbbas et al, 2022; REMAP-CAP Writing Committee for the REMAP-CAP InvestigatorsBradbury et al, 2022), 27 retrospective studies, (Abu-Jamous et al, 2020;Alamdari et al, 2020;…”