TY - JOUR
T1 - Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019
AU - Chow, Jonathan H.
AU - Khanna, Ashish K.
AU - Kethireddy, Shravan
AU - Yamane, David
AU - Levine, Andrea
AU - Jackson, Amanda M.
AU - McCurdy, Michael T.
AU - Tabatabai, Ali
AU - Kumar, Gagan
AU - Park, Paul
AU - Benjenk, Ivy
AU - Menaker, Jay
AU - Ahmed, Nayab
AU - Glidewell, Evan
AU - Presutto, Elizabeth
AU - Cain, Shannon
AU - Haridasa, Naeha
AU - Field, Wesley
AU - Fowler, Jacob G.
AU - Trinh, Duy
AU - Johnson, Kathleen N.
AU - Kaur, Aman
AU - Lee, Amanda
AU - Sebastian, Kyle
AU - Ulrich, Allison
AU - Peña, Salvador
AU - Carpenter, Ross
AU - Sudhakar, Shruti
AU - Uppal, Pushpinder
AU - Fedeles, Benjamin T.
AU - Sachs, Aaron
AU - Dahbour, Layth
AU - Teeter, William
AU - Tanaka, Kenichi
AU - Galvagno, Samuel M.
AU - Herr, Daniel L.
AU - Scalea, Thomas M.
AU - Mazzeffi, Michael A.
N1 - Publisher Copyright:
Copyright © 2020 International Anesthesia Research Society.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users. CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.
AB - BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users. CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.
UR - https://www.scopus.com/pages/publications/85102964965
UR - https://www.scopus.com/pages/publications/85102964965#tab=citedBy
U2 - 10.1213/ANE.0000000000005292
DO - 10.1213/ANE.0000000000005292
M3 - Article
C2 - 33093359
AN - SCOPUS:85102964965
SN - 0003-2999
VL - 132
SP - 930
EP - 941
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 4
ER -