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Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019.

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Author information

Affiliations

  • 1. From the Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington, DC.
      Authors
    • Chow JH 1
    • Benjenk I 1
    • Menaker J 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
    • Haridasa N 1
    (4 authors)
  • 2. Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
      Authors
    • Khanna AK 2
    • Menaker J 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
    (2 authors)
  • 3. Division of Pulmonary and Critical Care, Department of Medicine, Northeast Georgia Health System, Gainesville, Georgia.
      Authors
    • Kethireddy S 3
    • Kumar G 3
    • Menaker J 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
    (3 authors)
  • 4. Departments of Emergency Medicine, Anesthesiology, and Critical Care Medicine, George Washington University School of Medicine, Washington, DC.
      Authors
    • Yamane D 4
    • Menaker J 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
    (2 authors)
  • 5. Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
      Authors
    • Levine A 5
    • McCurdy MT 5
    • Tabatabai A 5, 11
    • Menaker J 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
    (4 authors)
    • Show all (13)

ORCIDs linked to this article

Anesthesia and Analgesia, 01 Apr 2021, 132(4):930-941
https://doi.org/10.1213/ane.0000000000005292 PMID: 33093359 

A comment on this article appears in "Is Aspirin the True Protective Therapy in Coronavirus Disease 2019 Patients?" Anesth Analg. 2021 Sep 1;133(3):e41. A comment on this article appears in "Aspirin Use, Mechanical Ventilation, and Inhospital Mortality in Coronavirus Disease 2019: Are We Missing Something?" Anesth Analg. 2021 Aug 1;133(2):e31-e33. A comment on this article appears in "Is Aspirin Effective in Preventing Intensive Care Unit Admission in Patients With Coronavirus Disease 2019 Pneumonia?" Anesth Analg. 2021 May 1;132(5):e89-e90. Show all (5)

Abstract 

Background

Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.

Methods

A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions.

Results

Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users.

Conclusions

Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.

Full text links 

Read article at publisher's site: https://doi.org/10.1213/ane.0000000000005292

Read article for free, from open access legal sources, via Unpaywall: https://journals.lww.com/anesthesia-analgesia/Fulltext/2021/04000/Aspirin_Use_Is_Associated_With_Decreased.2.aspxUnpaywall

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