Eur J Clin Pharmacol

. 2022 Jun 22.
doi: 10.1007/s00228-022-03356-5. Online ahead of print.
Does aspirin have an effect on risk of death in patients with COVID-19? A meta-analysis

Shaodi Ma # 1 , Wanying Su # 1 , Chenyu Sun # 2 , Scott Lowe 3 , Zhen Zhou 4 , Haixia Liu 1 , Guangbo Qu 1 , Weihang Xia 1 , Peng Xie 1 , Birong Wu 1 , Juan Gao 1 , Linya Feng 1 , Yehuan Sun 5 6 7



Purpose: The coronavirus disease 2019 (COVID-19) pandemic has shown unprecedented impact world-wide since the eruption in late 2019. Importantly, emerging reports suggest an increased risk of thromboembolism development in patients with COVID-19. Meanwhile, it is found that aspirin reduced mortality in critically ill patients with non-COVID-19 acute respiratory distress syndrome. Therefore, a meta-analysis was performed to investigate the effects of aspirin on COVID-19 mortality.
Methods: A systematic literature search was conducted in 10 electronic databases and 4 registries. Random effects models were used to calculate pooled relative risks (RRs) with 95% confidence intervals (Cis) to estimate the effect of aspirin on COVID-19 mortality. Relevant subgroup analyses and sensitivity analyses were also performed.
Results: The results showed that aspirin use was associated with a reduction in COVID-19 mortality (adjusted RR 0.69; 95% CI 0.50-0.95; P < 0.001). Subgroup analysis found that the low-dose group was associated with a reduced COVID-19 mortality (adjusted RR 0.64; 95% CI 0.48-0.85; P < 0.01). Aspirin use was associated with reduced COVID-19 mortality in Europe and America (crude RR 0.71; 95% CI 0.52-0.98; P = 0.04), and results from cohort studies suggested that aspirin use was a protective factor for COVID-19 mortality (adjusted RR 0.73; 95% CI 0.52-0.99; P = 0.04). Meanwhile, aspirin use was not associated with bleeding risk (crude RR 1.22; 95% CI 0.80-1.87; P = 0.96).
Conclusions: This meta-analysis found that aspirin use was associated with a reduction in mortality in patients with COVID-19 and not with an increased risk of bleeding.

Keywords: Aspirin; Bleed; COVID-19; Meta-analysis; Mortality.