Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Adverse Outcome in COVID-19 Is Associated With an Aggravating Hypo-Responsive Platelet Phenotype

“…This hints toward a SARS-CoV-2 mediated mechanism to escape entrapment by activated platelets. Diminished platelet reactivity might explain, why anticoagulation can be beneficial in COVID-19 (44), while no effect of anti-platelet therapy could be observed in a randomized trial (45). In contrast, platelet hyporeactivity may affect their hemostatic capacity, contributing to an increased risk of hemorrhagic complications in critically-ill patients, which might be further exacerbated by anti-platelet medication.…”

Plasma Fibrinogen Independently Predicts Hypofibrinolysis in Severe COVID-19

“…Significantly higher maximal clot firmness (MCF) was observed in ECA tests; meanwhile, significantly lower IN-, and tPA-CFT were found in 'non-responders' compared to 'responders', indicating faster developing, larger and more solid clots despite aspirin treatment. A large randomized clinical trial (RECOVERY) found that aspirin did not improve survival for patients hospitalized with COVID-19 [20,21]. Therefore, there is an urgent need to identify aspirin low/non-responders providing a modified antiplatelet regime or alternative strategies (e.g., activated protein C, PAI-1 antagonists, and tissue plasminogen activators) to combat thrombosis in this disease.…”

Clinical update on COVID-19 for the emergency and critical care clinician: Medical management

“…Recent data suggest that aspirin use is associated with improved COVID-19 patient outcomes, including decreased risk of thromboembolism, mechanical ventilation, ICU admission, and mortality [ [90] , [91] , [92] , [93] , [94] , [95] , [96] ]. Aspirin has been proposed to act on the intracellular signaling pathway involved with viral replication and reduction in systemic inflammation, cytokine release, platelet activity, and hypercoagulability.…”

“…A meta-analysis of 6 studies with 13,993 patients with COVID-19 and an active prescription for low-dose aspirin found reduced mortality (RR 0.46, 95% CI 0.35 to 0.61) [ 94 ], and a second meta-analysis including 7 RCTs with 34,415 patients found aspirin was associated with reduced risk of mortality (RR 0.56, 95% CI 0.38 to 0.81) [ 95 ]. One of the highest quality studies is the RECOVERY Trial, an RCT that included 14,892 patients randomized to aspirin 150 mg daily by mouth or rectum compared to usual care alone [ 96 ]. Patients receiving aspirin had a shorter duration of hospital stay (median 8 days versus 9 days) and greater likelihood of discharge from the hospital alive within 28 days (RR 1.06, 95% CI 1.02 to 1.10).…”