The effects of aspirin on the outcome of COVID-19: A systematic review and meta-analysis

Aspirin and Infection: A Narrative Review

“…Although still largely unknown, the mechanisms underlying the most severe clinical manifestations involve hyperinflammation (the so-called cytokine storm) and a prothrombotic status, with relevant platelet activation, microvascular thrombosis and embolization. Therefore, a strong pathophysiological rationale for a potential therapeutic role for ASA in COVID-19 has been advocated because of its anti-inflammatory, antiplatelet aggregation and anticoagulant effects, as well as its modulation of the immune system and possible inhibition of viral replication and/or entry [ 138 , 139 , 140 ].…”

“…Since ASA is largely prescribed worldwide for the primary prevention of cardiovascular diseases, several studies retrospectively analyzed the effects of antiplatelet action of low-dose (81–100 mg/day) ASA in COVID-19. Based on this literature, a total of five systematic reviews with meta-analysis were published [ 140 , 141 , 142 , 143 , 144 ]. The most recent was conducted by Martha et al and included six studies comprising 13,993 patients [ 141 ].…”

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 propensity score-matched study of 638 hospitalized patients with COVID-19 found reduced in-hospital mortality with aspirin (HR 0.52, 95% CI 0.34 to 0.81) [ 93 ]. 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 ].…”

Immune-Mediated Platelet Activation in COVID-19 and Vaccine-Induced Immune Thrombotic Thrombocytopenia

“…Several clinical trials have been initiated to evaluate the effects of antiplatelet drugs in patients with COVID-19. A meta-analysis showed a reduction in mortality in COVID-19 patients treated with aspirin ( 73 ). A recent multinational observational study reported that anti-platelet therapy (aspirin as monotherapy in 88% of the patients) is associated with a reduced mortality risk in multivariable analyses ( 74 ).…”