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COVID-19 Vaccine Updates
Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients1. Reduced mechanical ventilation, ICU admission, and in-hospital mortality in hospitalized patients with COVID-19 have been reported to be linked with a new study published in the Anaesthesia & Analgesia Journal2.
In a retrospective, observational cohort study including adult COVID-19 patients admitted to different hospitals in the United States during March 2020 and July 2020, 76.3% did not receive Aspirin, 23.7% received Aspirin within a day of admission or seven days before admission. The findings reported that Aspirin use had a crude association with less mechanical ventilation (35.7% Aspirin vs 48.4% non-Aspirin, p=0.03) and ICU admission (38.8% Aspirin vs 51.0% non-Aspirin, p=0.04); however, no relationship with in-hospital mortality (26.5% Aspirin vs 23.2% non-Aspirin, p=0.51) was noted. After adjusting for 8 confounding variables, Aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR 0.56, 95% CI 0.37-0.85, p=0.007), ICU admission (adjusted HR 0.57, 95% CI 0.38-0.85, p=0.005), and in-hospital mortality (adjusted HR 0.53, 95% CI 0.31-0.90, p=0.02). Study authors have concluded that the use of Aspirin may be a potential option for reducing outcomes in hospitalized COVID-19 patients. Also, there were no differences in major bleeding (p=0.69) or overt thrombosis (p=0.82) between Aspirin users and non-Aspirin users2.
It is established that COVID-19 is a disease associated with hypercoagulability and pulmonary micro-thrombosis with thrombocytopenia, elevated fibrin degradation products, prothrombin time and activated partial thromboplastin time prolongation, venous thromboembolism and disseminated intravascular coagulation. It has been seen that heparin can reduce mortality in mechanically ventilated COVID-19 patients. Since Aspirin is a COX-1 inhibitor and reduces thromboxane A2 synthesis, platelet aggregation, and thrombus formation, it is hypothesized to have similar potential benefits. We know that certain specific treatments with undisputable safety and efficacy are needed for controlling viral replication, inflammation, and thrombotic risk during COVID-19. In this regard, Aspirin may be considered as an anti-inflammatory and antithrombotic effect, along with some antiviral activity against both DNA and RNA virus. However, large scale clinical trials are still needed to establish the safety and promising efficacy of Aspirin as a therapeutic candidate in patients with COVID-191.
- Bianconi V, Violi F, Fallarino F, Pignatelli P, Sahebkar A, Pirro M. Is acetylsalicylic acid a safe and potentially useful choice for adult patients with COVID-19? Drugs. July 2020; 80: 1383-1396. DOI: 1007/s40265-020-01365-1
- Chow J, Khanna A, Kethireddy S, Yamane D, Levine A, et al. Aspirin use is associated with decreased mechanical ventilation, ICU admission, and In-hospital mortality in hospitalized patients with COVID-19. Anesthesia and Analgesia. October 2020-volume publish ahead of print. DOI: 1213/ANE.0000000000005292