Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study

Abstract

Background Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19. Methods This cohort study included 984 COVID-19 patients stratified according to ASA intake before hospitalization: ASA + ( n = 253) and ASA − ( n = 731). Patients were included in ASA + group if they received it daily in the 7 days before admission. 213 (83%) were on ASA 100 mg daily. Primary endpoint was a composite of in-hospital death and/or need for respiratory support upgrade, secondary endpoints were in-hospital death and need for respiratory support upgrade. Results Mean age was 72 [62; 81] with 69% of male patients. ASA + patients were significantly older, with higher prevalence of comorbidities. No significant differences regarding the degree of respiratory dysfunction were observed. At 30-day Kaplan-Meier analysis, ASA + patients had higher survival free from the primary endpoint and need for respiratory support upgrade, conversely in-hospital death did not significantly differ between groups. At multivariate analysis ASA intake was independently associated with a lower probability of reaching primary endpoint (HR 0.697, 95% C.I. 0.525–0.924; p = 0.012). Conclusions In COVID-19 patients undergoing hospitalization, pre-admission treatment with ASA is associated with better in-hospital outcome, mainly driven by less respiratory support upgrade.

Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID‐19 patients

“…A remarkable result was obtained with the beneficial role of previous antiplatelets use. Larger cohorts have already associated antiplatelets with better in-hospital outcomes 13,14 We may hypothesize that antiplatelets reduce the COVID-19 related thrombosis risk. But the number of events, predominantly in the survivors' groups, is too small to analyze properly this issue.…”

High-mobility group box 1 (HMGB1) in COVID-19: extrapolation of dangerous liaisons

“…Therefore, SA derivatives like acetylsalicylic acid could be effective in the management of COVID-19 by inhibiting HMGB1 and other inflammatory signaling pathways like NF-κB (Cacciapuoti and Cacciapuoti 2021 ). A cohort study involved 984 COVID-19 patients according to the use of acetylsalicylic acid before hospitalization, showed that COVID-19 patients with acetylsalicylic acid treatment had high survival rates compared to the non-user (Sisinni et al 2021 ). These observations suggest the protective role acetylsalicylic acid against COVID-19 severity by reducing platelet activation and thrombotic complications.…”

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

“…As mentioned above, values such as MPV and platelet distribution width are elevated in COVID-19 patients, possibly reflecting platelet activation [ 77 , 109 ], and the use of aspirin for at least one week prior to admission significantly reduced the induction of ventilation [ 110 ]. The use of antiplatelet agents reduced mortality and ventilator duration [ 111 ], decreased in-hospital mortality [ 112 ], and slightly increased the proportion of patients discharged alive within 28 days with the use of aspirin among hospitalized patients [ 113 ].…”