The Novel Aspirin as Breakthrough Drug for COVID-19: A Narrative Review

Abstract

Introduction: Aspirin has justifiably been called the first miracle drug. In this article, we highlight the history of Aspirin, a novel mechanism of action, and its use in cardiovascular and other diseases. Also included is a brief statement of emerging new applications. Objective: We highlight principal mechanisms by which Aspirin inhibits acute inflammation and alters platelet-biology; therefore, hypothesized that Aspirin might prove highly beneficial as a novel therapeutic drug for combating severe acute inflammation and thrombosis associated with the cytokine storm in COVID -19 patients. The communiqué also suggests possible strategies for maximizing the gain of Aspirin as a wonder-drug of the future. Discussion: Interestingly, some fascinating studies demonstrated Aspirin's superior benefits with dangerous side effects. Aspirin inhibits COX-1 (cyclooxygenase-1). Its impact on COX-2 is more delicate because it “turns off” COX-2's production of prostaglandins but “switches on” the enzymatic ability to produce novel protective lipid mediators. The established mechanism of action of Aspirin is the inhibition of prostaglandin synthesis. However, further evidence showed that aspirin-elicited nitric oxide exerts anti-inflammatory effects in the microcirculation by inhibiting leukocyte– endothelium interactions. Interestingly, aspirin-triggered lipoxin formation may provide a novel mechanism underlying Aspirin's clinical benefits. Interestingly, Aspirin reduces the risk of a cardiovascular event by about 30 percent. Also, Aspirin has been associated with a reduced risk of colorectal cancer, and possibly a few other digestive tract cancers. Conclusion: The current emerging interest is to conduct further study to provide evidence for Aspirin as the novel therapeutic drug for combating severe acute inflammation and thrombosis associated with the cytokine storm in COVID-19 patients. Besides, the most wanted is The RECOVERY II (Randomized Evaluation of COVID-19 Therapy II) trial to be established as a randomized clinical trial to test the effectiveness of low-dose Aspirin as an anti-inflammatory and antithrombotic treatment in COVID-19 patients.

COVID-19 and the role of cytokines in this disease

“…In addition, in another study, researchers examined the anti-inflammatory role of salicylates and the progression of coronary plaque and its volume (Hauser et al 2016). Studies have shown that acetylsalicylic acid attenuates the activation of inflammatory cytokines dependent on the NF-κB signalling pathway and, on the other hand, can improve respiratory function in patients with SARS-CoV-2 infection (Taha et al 2020;Alegbeleye et al 2020). Considering the effects of salicylates in various studies, in a large clinical trial, its effects in reducing various inflammatory cytokines caused by cytokine storm and therapeutic effects in COVID-19 can be investigated.…”

Evaluation of Low-Dose Aspirin use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study

“…It was postulated that combating thrombus formation through different pathways, such as antiplatelet or direct thrombin inhibitors, could potentially help overcome the cytokine storm associated with COVID-19 patients. 22 Interestingly, we observed a twofold increase in the all thrombosis cases in aspirin recipients. This observation could potentially be explained by the fact that these patients, due to their underlying risk, may require an additional new therapeutic approach or higher doses of aspirin may be warranted.…”

Severe COVID-19—A Review of Suggested Mechanisms Based on the Role of Extracellular Matrix Stiffness

“…Aspirin decreases platelet turnover and prevents thrombus formation [ 116 ]. Aspirin mitigates severe COVID-19 complications [ 117 ]. Thus, it can be expected that, coupled with other effective drugs, aspirin could reduce death rate in critically ill COVID-19 patients.…”