Family Medicine and Community Health (Mar 2021)

Rationales and uncertainties for aspirin use in COVID-19: a narrative review

  • Hazem A Sayed Ahmed,
  • Eric Merrell,
  • Mansoura Ismail,
  • Anwar I Joudeh,
  • Jeffrey B Riley,
  • Ahmed Shawkat,
  • Hanan Habeb,
  • Edward Darling,
  • Reda A Goweda,
  • Mohamed H Shehata,
  • Hossam Amin,
  • Gary F Nieman,
  • Hani Aiash

DOI
https://doi.org/10.1136/fmch-2020-000741
Journal volume & issue
Vol. 9, no. 2

Abstract

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Objectives To review the pathophysiology of COVID-19 disease, potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.Design Narrative review.Setting The online databases PubMed, OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021. International guidelines from relevant societies, journals and forums were also assessed for relevance.Participants Not applicable.Results A review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction, coagulopathy and dysregulated inflammation. Aspirin has anti-inflammatory effects, antiplatelet aggregation, anticoagulant properties as well as pleiotropic effects on endothelial function. During the COVID-19 pandemic, low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease, prevention of venous thromboembolism after total hip or knee replacement, prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children. Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19, whereas aspirin association with mortality is still debatable.Conclusion The authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40–70 years who are at high atherosclerotic cardiovascular disease risk, or an intermediate risk with a risk-enhancer and have a low risk of bleeding. Aspirin’s protective roles in COVID-19 associated with acute lung injury, vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.