Jonathan H Chow1, Ashish K Khanna2,3, Shravan Kethireddy4, David Yamane5, Andrea Levine6, Amanda M Jackson7, Michael T McCurdy6, Ali Tabatabai6,8, Gagan Kumar4, Paul Park9, Ivy Benjenk1, Jay Menaker1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17, Nayab Ahmed11, Evan Glidewell12, Elizabeth Presutto9, Shannon Cain13, Naeha Haridasa1, Wesley Field11, Jacob G Fowler12, Duy Trinh9, Kathleen N Johnson12, Aman Kaur11, Amanda Lee9, Kyle Sebastian12, Allison Ulrich9, Salvador Peña12, Ross Carpenter9, Shruti Sudhakar9, Pushpinder Uppal9, Benjamin T Fedeles9, Aaron Sachs9, Layth Dahbour9, William Teeter8,14, Kenichi Tanaka17, Samuel M Galvagno8, Daniel L Herr8, Thomas M Scalea8,10, Michael A Mazzeffi15. 1. From the Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington, DC. 2. Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Outcomes Research Consortium, Cleveland, Ohio. 4. Division of Pulmonary and Critical Care, Department of Medicine, Northeast Georgia Health System, Gainesville, Georgia. 5. Departments of Emergency Medicine, Anesthesiology, and Critical Care Medicine, George Washington University School of Medicine, Washington, DC. 6. Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland. 7. Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland. 8. Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. 9. Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. 10. Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 11. Department of Medicine, Northeast Georgia Health System, Gainesville, Georgia. 12. Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina. 13. Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC. 14. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland. 15. Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. 16. Department of Surgery, University of California San Francisco, San Francisco, California. 17. Department of Anesthesiology, The University of Oklahoma School of Medicine, Oklahoma City, Oklahoma.
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.
BACKGROUND:Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically illpatients. 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-19patients. 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-19patients.
Authors: Omar H Fahmy; Farah M Daas; Vidyulata Salunkhe; Jessica L Petrey; Ediz F Cosar; Julio Ramirez; Ozan Akca Journal: Crit Care Explor Date: 2021-05-20
Authors: Mohammad Haji Aghajani; Omid Moradi; Hossein Amini; Hamed Azhdari Tehrani; Elham Pourheidar; Mohammad M Rabiei; Mohammad Sistanizad Journal: J Med Virol Date: 2021-05-08 Impact factor: 20.693