24 Oct Aspirin Linked to Improved Outcomes in Hospitalized COVID-19 Patients
MedicalResearch.com Interview with:
Michael Mazzeffi MD MPH MSc
Associate Professor of Anesthesiology
Division Chief Anesthesiology Critical Care Medicine
Medical Director Rapid Response Team
MedicalResearch.com: What is the background for this study?
Response: We have known for some time that COVID19 is characterized by hypercoagulability or excess blood clotting. In fact, the incidence of blood clots in the lungs (pulmonary emboli) is as high 20% and is two to three times more common in COVID19 than in severe influenza. Further, autopsies of patients who died from COVID19 have shown that endothelial cells (cells that line the blood vessels) are damaged and that “micro clots” form in multiple organs. Together, these findings strongly suggest that excess blood clotting and endothelial cell dysfunction are defining features of severe COVID19.
For several months, my colleagues and I have been interested in whether aspirin might improve outcomes in patients with severe COVID19. In prior observational research studies, aspirin was found to be protective in patients with severe lung injury. The general idea is that aspirin reduces platelet aggregates in the lung and this improves outcome. Unfortunately, in a prior randomized controlled study (LIPS-A) aspirin was not shown to reduce the incidence of acute respiratory distress syndrome. Nevertheless, COVID19 has unique features that make aspirin more likely to be effective. Mainly COVID19 is associated with hypercoagulability to a greater degree than in other viral illnesses.
MedicalResearch.com: What are the main findings?
Response: In our study, which we acknowledge is not a randomized controlled trial, we found that aspirin was associated with a reduced need for mechanical ventilation, ICU admission, and death in hospitalized patients with COVID19. The effect size was rather large, with the adjusted hazard for death being 0.53 (approximately half) at any timepoint. Our analysis controlled for multiple confounding variables including demographics and comorbid conditions.
MedicalResearch.com: What should readers take away from your report?
Response: I think the main thing to take away is that this is a very exciting finding because aspirin is widely available, inexpensive, and has a well-established risk profile.
Before we can be sure that there is a causal relationship between aspirin and improved outcomes in COVID19, our findings must be reproduced in a randomized controlled trial. This is the highest level of evidence in medical practice. If high risk patients want to consider taking aspirin now, they must first discuss it with their primary care doctor and weigh the risks and benefits.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The next steps are:
1) to see if our results can be reproduced in other large data registries of COVID19 patients and
2) to quickly start a randomized controlled trial of aspirin use in hospitalized patients with COVID19.
MedicalResearch.com: Is there anything else you would like to add?
Response: I would like to thank the investigators that contributed to this study and the journal Anesthesia and Analgesia for carefully reviewing our analysis. I would also like to acknowledge Jonathan Chow the study’s first author who worked tirelessly on this project. Our greatest hope is that these findings can help patients afflicted by this terrible disease.
I have no disclosures or conflicts of interest.
Chow, Jonathan H. MD; Khanna, Ashish K. MD2,3; Kethireddy, Shravan MD4; Yamane, David MD5; Levine, Andrea MD6; Jackson, Amanda M. MD, MAJ, MC, USA7; McCurdy, Michael T. MD7; Tabatabai, Ali MD6,8; Kumar, Gagan MD4; Park, Paul MD9; Benjenk, Ivy RN, MPH.10; Menaker, Jay MD8,11; Ahmed, Nayab MD12; Glidewell, Evan MD13; Presutto, Elizabeth MD9; Cain, Shannon M.D.14; Haridasa, Naeha B.S10; Field, Wesley MD12; Fowler, Jacob G. B.S.13; Trinh, Duy MD9; Johnson, Kathleen N. B.S.13; Kaur, Aman DO12; Lee, Amanda B.S.9; Sebastian, Kyle MD13; Ulrich, Allison MD9; Peña, Salvador MD, PhD13; Carpenter, Ross MD9; Sudhakar, Shruti MD9; Uppal, Pushpinder MD9; Fedeles, Benjamin T. MD, Capt., USAF, MC9; Sachs, Aaron MD9; Dahbour, Layth MD9; Teeter, William MD8,15; Tanaka, Kenichi MD16; Galvagno, Samuel M. DO, PhD1,8; Herr, Daniel L. MD7; Scalea, Thomas M. MD8,11; Mazzeffi, Michael A. MD, MPH1,16Aspirin Use is Associated with Decreased Mechanical Ventilation, ICU Admission, and In-Hospital Mortality in Hospitalized Patients with COVID-19, Anesthesia & Analgesia: October 21, 2020 – Volume Publish Ahead of Print – Issue – doi: 10.1213/ANE.0000000000005292
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