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Scientists at Michigan State University in the United States conducted a systematic review and meta-analysis to compare the death rate in 2019 coronavirus disease (COVID-19) patients who use and do not aspirin . The results reveal that the use of aspirin is associated with a significant reduction in overall and hospital mortality rates. The study is currently available on the medRxiv * preprint server.
Background
As of July 13, 2021, worldwide, 186 million confirmed cases of COVID-19, including 4 million deaths, have been registered with the World Health Organization. Although a significant proportion of COVID-19 patients remain asymptomatic or mildly symptomatic, the disease can cause serious complications in susceptible people, including the elderly and those with co-morbidities. In critically affected hospitalized COVID-19 patients, an estimated mortality rate of 11.5% was reported in a recent study.
According to the available literature, the pathogenesis of severe COVID-19 is associated with immune dysfunction, excessive inflammation, hypercoagulation, and cardiopulmonary thrombosis. Based on these observations, scientists in the present study hypothesized that taking aspirin could reduce the severity of COVID-19 through its anti-inflammatory, antithrombotic and immunomodulatory effects.
Study design
In the meta-analysis, scientists included recently published and unpublished studies from the PubMed, MEDLINE, EMBASE, and Cochrane databases that reported the effect of low-dose aspirin consumption on COVID-related mortality. 19. Studies that specifically compared aspirin use with no aspirin use in COVID-19 patients and reported mortality events were included in the meta-analysis. The main objective of the analysis was to determine all-cause and hospital mortality rates.
Scientists used the Newcastle-Ottawa scale to assess the quality of the included studies. For each study, the scale provides a maximum of 9 points. A study with a score of 6 or higher is considered a high quality publication with a low risk of bias.
Important Notes
Out of over 900 studies initially included, scientists ultimately selected five studies for the final qualitative and quantitative analyzes. All of the studies selected were retrospective cohort studies, of which four involved hospitalized COVID-19 patients and one involved out-of-hospital patients. According to the Newcastle-Ottawa scale scores, four out of five studies were of high quality and one of low quality.
In the last five studies, there were 6,797 participants in the aspirin group and 7,268 participants in the group without aspirin. Pooled data from 5 studies found that aspirin consumption is associated with a 53% reduction in all-cause mortality in COVID-19 patients. In the case of hospitalized COVID-19 patients, analysis found that aspirin use is associated with a 49% reduction in hospital mortality.
Importance of the study
The study highlights the potential importance of aspirin intake in reducing the risk of mortality in hospitalized and out-of-hospital COVID-19 patients. Besides anti-inflammatory and antiplatelet effects, aspirin is known to have antiviral effects against seasonal and pathogenic coronaviruses, such as human coronavirus-229E and Middle East respiratory syndrome coronavirus (MERS-CoV). Additionally, aspirin has been used as one of the therapeutic interventions in COVID-19 patients.
As the scientists have mentioned, this study has some limitations. Due to the unavailability of clinical trial data for aspirin, the current analysis only included observational studies. In addition, the majority of the studies selected are single-center studies conducted in the United States and China. Thus, the results may not be generalized to the world population.
*Important Notice
medRxiv publishes preliminary scientific reports which are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.
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