Aspirin has anti-inflammatory, analgesic, antipyretic, and antithrombotic effects. It is well documented that thrombotic complications are frequent in those with COVID-19. The clinical evidence looking at aspirin alone as treatment in COVID-19 is currently limited. Anticoagulation is currently recommended in patients with COVID-19 infections who are thought to be mostly bed bound.
Not recommended due to the lack of appropriately powered studies to definitively recommend aspirin therapy.
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Major peer-reviewed studies
“Enhanced platelet inhibition treatment improves hypoxemia in patients with severe Covid-19 and hypercoagulability. A case control, proof of concept study” Maurizio Viecca, Dejan Radovanovic, Giovanni Battista Forleo, Pierachille Santus. Enhanced platelet inhibition treatment improves hypoxemia in patients with severe Covid-19 and hypercoagulability. A case control, proof of concept study. Pharmacological Research. Volume 158, 2020.
This was a single center, investigator initiated, compassionate use, proof of concept, case control, phase IIb study looking to support the proof of antiplatelet therapy in COVID-19 positive patients. The study looked at a total of 5 patients who received tirofiban infusion, aspirin 250 mg infusion, and oral clopidogrel 300 mg (75 mg daily continued for 30 days). This was compared to a control of heparin at standard operating procedures. It was found that patients receiving antiplatelet therapy might see an improvement in ventilation/perfusion ratio.
“Aspirin Use is Associated with Decreased Mechanical Ventilation, ICU Admission, and In-Hospital Mortality in Hospitalized Patients with COVID-19” Chow JH, Khanna AK, Kethireddy S, et al. Aspirin use is associated with decreased mechanical ventilation, ICU admission, and in-hospital mortality in hospitalized patients with COVID-19. Anesth Analg. Published online October 21, 2020.
This retrospective, observational cohort study looked at 412 COVID-19 patients, and looked to determine whether the need for mechanical ventilation was affected by aspirin. This study showed that aspirin may possibly lead to decreased need for mechanical ventilation, but this study was not appropriately powered to be definitive.
Current clinical trials
- “Protective Effect of Aspirin on COVID-19 Patients (PEAC)”
- “The LEAD COVID-19 Trial: Low-risk, Early Aspirin and Vitamin D to Reduce COVID-19 Hospitalizations (LEAD COVID-19)”
- “COVID-19 Positive Outpatient Thrombosis Prevention in Adults Aged 40-80”
- “Hemostasis in COVID-19: an Adaptive Clinical Trial”
- “Preventing Cardiac Complication of COVID-19 Disease With Early Acute Coronary Syndrome Therapy: A Randomised Controlled Trial. (C-19-ACS)”
- “Australasian COVID-19 Trial (ASCOT) ADAptive Platform Trial (ASCOT ADAPT)”