Key result
Low-dose aspirin use during ICU stay was associated with lower in-hospital mortality in critically ill patients with COVID-19 (HR 0.73; 95% CI 0.56-0.97; p=0.03).
Why the study?
Data were lacking on the role of aspirin in critically ill patients with COVID-19.
Does low-dose aspirin reduce in-hospital mortality in critically ill adult patients with COVID-19?
Cohort (n=352)
Yes
Does low-dose aspirin reduce in-hospital mortality in critically ill adult patients with COVID-19?
Hazard Ratio: 0.73 (95% CI 0.56–0.97)
p-value: p=0.03
Continuation of low-dose aspirin in critically ill COVID-19 patients may provide a mortality benefit, though it may be associated with an increased risk of significant bleeding.
May support continuing aspirin in COVID-19 ICU patients; leaves open causal confirmation and bleeding risks.
BACKGROUND: Aspirin is widely used as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. The literature has assessed and evaluated its role in hospitalized COVID-19 patients. However, no data are available regarding its role in COVID-19 critically ill patients. This study aimed to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in critically ill patients with COVID-19. METHOD: A multicenter, retrospective cohort study of all critically ill adult patients with confirmed COVID-19 admitted to intensive care units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome was in-hospital mortality, and other outcomes were considered secondary. Propensity score matching was used (1:1 ratio) based on the selected criteria. RESULTS: A total of 1033 patients were eligible, and 352 patients were included after propensity score matching. The in-hospital mortality (HR 0.73 [0.56, 0.97], p = 0.03) was lower in patients who received aspirin during stay. Conversely, patients who received aspirin had a higher odds of major bleeding than those in the control group (OR 2.92 [0.91, 9.36], p = 0.07); however, this was not statistically significant. Additionally, subgroup analysis showed a possible mortality benefit for patients who used aspirin therapy prior to hospitalization and continued during ICU stay (HR 0.72 [0.52, 1.01], p = 0.05), but not with the new initiation of aspirin (HR 1.22 [0.68, 2.20], p = 0.50). CONCLUSION: Continuation of aspirin therapy during ICU stay in critically ill patients with COVID-19 who were receiving it prior to ICU admission may have a mortality benefit; nevertheless, it may be associated with an increased risk of significant bleeding. Appropriate evaluation for safety versus benefits of utilizing aspirin therapy during ICU stay in COVID19 critically ill patients is highly recommended.
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Alharthi et al. (2022) conducted a cohort in Critically ill patients with COVID-19 (n=352). Low-dose aspirin vs. Control group (no aspirin) was evaluated on In-hospital mortality (HR 0.73, 95% CI 0.56-0.97, p=0.03). Low-dose aspirin use during ICU stay was associated with lower in-hospital mortality in critically ill patients with COVID-19 (HR 0.73; 95% CI 0.56-0.97; p=0.03).
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