Coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus has presented an unprecedented challenge to healthcare across the globe.

This viral illness is associated with immune response activation, pro-inflammatory cytokine release, overactivation of the coagulation cascade as well as platelet aggregation, resulting in micro and macrovascular thrombosis.¹

The microthrombi along with multisystemic endotheliitis cause multiorgan ischemia, eventually giving way to multiorgan dysfunction in COVID-19. Autopsy studies were done in lungs obtained from patients who died from COVID-19 which showed severe endothelial injury associated with the presence of an intracellular virus. Additionally, histologic analysis of pulmonary vessels in COVID-19 patients demonstrated thrombosis with microangiopathy.²

Acetylsalicylic acid (ASA), or Aspirin, is a known antiplatelet agent with inhibitory action on cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2).^1,3 Aspirin is well-known for its anti-inflammatory, analgesic, antipyretic, and antithrombotic effects,¹ and appears worth exploring for its plausible role in the management of COVID-19. Aspirin’s antiviral action has also been reported earlier.⁴

It is also suggested that statins could potentiate Aspirin therapy in patients with COVID-19. Statins are known for their pleiotropic effects on the endothelium, which include reduction of inflammation, oxidative stress, and pro-inflammatory mediators.³

Recently, a case series of 14 patients with confirmed COVID-19 was published in the Journal of the Brazilian Society of Tropical Medicine.³ All patients were given Aspirin therapy. Patients with risk factors for vascular disease were also given high-potency statin therapy. Patients were discharged as symptoms resolved and were advised to continue medications for a complementary time, based on their clinical evolution. Overall, 78.6% of patients had at least one comorbidity, which could have acted as a risk factor for poor prognosis in the evolution of this viral disease. Four patients developed secondary bacterial infections and three patients required to be hospitalized. None of the patients progressed to stage III, and all patients had remission of symptoms. Investigators noted 100% survival. It seems possible that Aspirin exerts its beneficial effects in COVID-19 management by fighting thrombosis or the coronavirus itself.

While this study is a case series and cannot yield a definite conclusion, it can still be hypothesized that Aspirin & Statins may have acted together and prevented endothelial damage in these patients.

Further studies should, therefore, be conducted to assess the role of Aspirin in the treatment of COVID-19.

References

1. 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.
2. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020 Jul 9;383(2):120-128.
3. Florêncio FKZ, Tenório MO, Macedo Jr ARA, de Lima SG, et al. Aspirin with or without statin in the treatment of endotheliitis, thrombosis, and ischemia in coronavirus disease. Rev Soc Bras Med Trop. 2020; 53: e20200472.
4. Gurbel PA, Bliden KP, Schrör K. Can an Old Ally Defeat a New Enemy? Circulation. 2020 Jul 28; 142(4): 315–317.