Acetylsalicylic Acid and COVID-19 Prevention: A Comment.

We would like to share ideas on “Could low doses acetylsalicylic acid (ASA) prevent thrombotic complications in COVID-19 patients?” Cacciapuoti and Cacciapuoti noted that “adult individuals receiving low ASA doses and nowadays affected by SARS-CoV-2, could be protected against possible inflammatory and thrombotic complications.” Cacciapuoti and Cacciapuoti discussed on inhibition of platelet aggregability by low dose ASA. We agree for the proposed biomechanism. Nevertheless, we would like to draw attention to another side of the coin.

In COVID-19, thrombocytopenia is observed. Hemorrhagic complication in COVID-19 is considered as an important clinical problem. A basic question is whether ASA can cause unwanted adverse effect bleeding. Referring to another well-known viral disease, dengue, an immune thrombocytopenia occurs and using ASA can cause hemorrhagic complication. Whether the similar problem will occur if ASA is used for prevention of thrombotic complications in COVID-19 is an important clinical consideration. The immune thrombocytopenia is reported in COVID-19 and should not be forgotten.