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

Abstract

Introduction: Whether aspirin or other antiplatelet drugs can reduce mortality among patients with coronavirus disease (COVID-19) remains controversial.Methods: We identified randomized controlled trials, prospective cohort studies, and retrospective studies on associations between aspirin or other antiplatelet drug use and all-cause mortality among patients with COVID-19 in the PubMed database between March 2019 and September 2021. Newcastle–Ottawa Scale and Cochrane Risk of Bias Assessment Tool were used to assess the risk of bias. The I2 statistic was used to assess inconsistency among trial results. The summary risk ratio (RR) and odds ratio (OR) were obtained through the meta-analysis.Results: The 34 included studies comprised three randomized controlled trials, 27 retrospective studies, and 4 prospective cohort studies. The retrospective and prospective cohort studies showed low-to-moderate risks of bias per the Newcastle–Ottawa Scale score, while the randomized controlled trials showed low-to-high risks of bias per the Cochrane Risk of Bias Assessment Tool. The randomized controlled trials showed no significant effect of aspirin use on all-cause mortality in patients with COVID-19 {risk ratio (RR), 0.96 [95% confidence interval (CI) 0.90–1.03]}. In retrospective studies, aspirin reduced all-cause mortality in patients with COVID-19 by 20% [odds ratio (OR), 0.80 (95% CI 0.70–0.93)], while other antiplatelet drugs had no significant effects. In prospective cohort studies, aspirin decreased all-cause mortality in patients with COVID-19 by 15% [OR, 0.85 (95% CI 0.80–0.90)].Conclusion: The administration of aspirin may reduce all-cause mortality in patients with COVID-19.

Effect of Aspirin Use on the Adverse Outcomes in Patients Hospitalized for COVID-19

“…Numerous studies have demonstrated a pure mortality reduction in COVID-19 patients without other deleterious effects. A meta-analysis performed by Su et al, which included not only retrospective and prospective cohort studies but also four RCTs, noted that specifically, the cohort studies demonstrated mortality reduction, not the RCTs, although significance was not lost after the inclusion of the RCTs within the final analysis [24].…”

“…Numerous studies have demonstrated a pure mortality reduction in COVID-19 patients without other deleterious effects. A meta-analysis performed by Su et al, which included not only retrospective and prospective cohort studies but also four RCTs, noted that specifically, the cohort studies demonstrated mortality reduction, not the RCTs, although significance was not lost after the inclusion of the RCTs within the final analysis [ 24 ]. Another study performed by Chow et al also found that aspirin use, defined either as use within 24 h of or in the 7 days prior to hospital admission, was associated with reduced risk for mechanical ventilation, ICU admission, and in-hospital mortality [ 25 ].…”

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: A propensity score-matched cohort study.

“…Nevertheless, the data on the use of antiplatelet (AP) therapy in COVID-19 patients are con icting [28][29][30]. The meta-analysis by Wanting Su et al, which included 34 studies, showed that aspirin may reduce all-cause mortality in patients with COVID-19 by 15-20% [31].…”