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Evaluation of Low-Dose Aspirin use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score
Abdullah F Al Harthi1,2,3, Ohoud Aljuhani4,5, Ghazwa B Korayem6
1Pharmaceutical Care Department, 48168King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Insights
Low-dose aspirin use in critically ill COVID-19 patients may reduce mortality, especially when continued from pre-hospitalization. However, this benefit must be weighed against a potential increase in bleeding risk.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Infectious Diseases
Background:
- Aspirin (acetylsalicylic acid) is a widely recognized cardioprotective agent with antiplatelet and anti-inflammatory effects.
- Existing research has explored aspirin's role in hospitalized COVID-19 patients, but data for critically ill patients were lacking.
- This study addresses the knowledge gap concerning aspirin's impact on outcomes in intensive care unit (ICU) patients with severe COVID-19.
Purpose of the Study:
- To evaluate the effect of low-dose aspirin (81-100 mg) on mortality and other outcomes in critically ill COVID-19 patients.
- To investigate whether continuing aspirin therapy initiated before ICU admission influences patient outcomes.
- To assess the safety profile of aspirin use in this patient population, focusing on major bleeding events.
Main Methods:
- A multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 admitted to ICUs.
- Patients were divided into two groups: those who received aspirin during their ICU stay and those who did not.
- Propensity score matching (1:1 ratio) was employed to control for confounding variables, with in-hospital mortality as the primary outcome.
Main Results:
- After propensity score matching, 352 patients were analyzed. In-hospital mortality was significantly lower in the aspirin group (HR 0.73; p=0.03).
- Patients receiving aspirin showed a trend towards higher odds of major bleeding (OR 2.92; p=0.07), though this was not statistically significant.
- Subgroup analysis indicated a potential mortality benefit for patients who continued aspirin from pre-hospitalization (HR 0.72; p=0.05), but not for new aspirin initiations in the ICU (HR 1.22; p=0.50).
Conclusions:
- Continuation of aspirin therapy in critically ill COVID-19 patients already on the medication prior to ICU admission may be associated with reduced mortality.
- The potential benefit of aspirin must be carefully considered alongside an observed, albeit not statistically significant, increased risk of major bleeding.
- Further research is recommended to rigorously evaluate the risk-benefit profile of aspirin use in critically ill COVID-19 patients during their ICU stay.
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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