SARS-CoV-2 is the novel coronavirus that is causing the Coronavirus Disease 2019 (COVID-19). There are over 41 million confirmed cases of COVID-19 globally and the death toll has crossed the 1 million mark (as on October 22, 2020).¹

While most patients develop mild symptoms, some may develop pneumonia, and even multi-organ failure, or cytokine storm.² COVID-19 patients have often been reported to develop thrombotic complications. This viral disease is associated with the release of pro-inflammatory cytokines, excessively activated coagulation cascade and platelet aggregation. This results in micro- and macrovascular thrombosis.³

Aspirin is an anti-inflammatory, analgesic, antipyretic, and antithrombotic drug. The drug reduces inflammation as well as platelet aggregation, and also has antiviral effects against RNA and DNA viruses.³

Considering the aforementioned effects of Aspirin, it appears plausible to explore the role of this drug in patients with COVID-19.

A nationwide survey* was conducted among 363 healthcare professionals (HCPs), including consulting physicians, cardiologists, diabetologists, endocrinologists, etc., to understand the place of Aspirin in primary prevention in patients recovered from COVID -19 with increased CV risk. Online survey questionnaire was sent to all the participating HCPs with the following questions:

Do you believe that patients recovered from COVID-19 infection are at high risk for cardiovascular (CV) complications?

Which of the following risk factor/s do you think are strongly associated with CV complication in patients recovered from COVID-19?

According to you, what is the best modality for screening CVD in patients recovered from COVID-19?

According to you, what is the best modality for laboratory investigation for screening CVD in patients recovered from COVID-19?

What is your opinion about Aspirin being given to COVID-19 patients after discharge from the hospital?

According to you, what is the prophylaxis dosage of Aspirin for patients recovered from COVID-19?

What is your opinion about statin being given to COVID-19 patients after discharge from the hospital?

According to you, what is the prophylaxis dosage of statin for patients recovered from COVID-19?

What will be the duration of treatment of Aspirin and/or statin for CVD prophylaxis in patients recovered from COVID-19?

Do you feel a combination of Aspirin & statin will improve patient compliance in COVID-19?

The survey revealed the following outcomes:

• More than 50% of the HCPs were of the opinion that patients recovered from COVID-19 are at high risk of CV complications.
• 75% of the HCPs agreed that old age and diabetes mellitus (DM) along with hypertension are major risk factors for CV complications in post-COVID-19.
• 70% of the HCPs agreed that screening of CV complications in post-COVID-19 phase must be done in patients with history of ASCVD.
• 70% of the HCPs agreed that Aspirin should be given to all COVID-19 patients after discharge.
• 26% of the HCPs agreed that Aspirin must be given to high risk patients recovered from COVID-19.

Additionally, about 55% of the HCPs agreed that 75mg of Aspirin must be given for prophylaxis in patients recovered from COVID-19, and 22% agreed that 150mg of Aspirin must be given for prophylaxis in patients recovered from COVID-19. 

Concluding remarks

COVID-19 is an acute manageable, imumunogenic, thrombo-inflammatory viral pandemic disease with a significant post-viral inflammatory response.

The survey results mentioned above clearly suggest that a vast majority of HCPs agreed that Aspirin should be given to all COVID-19 patients after discharge from hospital. Additionally, 26% of them agreed that it must be given to high risk patients who have recovered from COVID-19.

Persistent inflammation is evident by continuous rise in cytokine markers, especially C-reactive protein (CRP) (IL-6, D-dimer). Once the virus is non-replicative, residual mild inflammation requires vascular protection and necessitates the need of oral anticoagulants in acute phase, followed by an antiplatelet agent like Aspirin (75-150 mg) for 3-6 months.

References

1. Available from: https://www.worldometers.info/coronavirus/.
2. Alegbeleye BJ, Akpoveso O-OP, Alegbeleye AJ, et al. The Novel Aspirin as Breakthrough Drug for COVID-19: A Narrative Review. Iberoamerican Journal of Medicine 00 (2020) XXX–XXX. Available from: http://www.iberoamericanjm.periodikos.com.br/article/10.5281/zenodo.3970519/pdf/iberoamericanjm-0-AheadOfPrint-5f27e24b0e882515560e4939.pdf.
3. Bianconi V, Violi F, Fallarino F, et al. Is Acetylsalicylic Acid a Safe and Potentially Useful Choice for Adult Patients with COVID‑19? Drugs 2020;80(14):1383-1396.

* The survey was conducted by the Heart Care Foundation of India with an educational grant from USV.

 Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA