Aspirin Therapy on Prophylactic Anticoagulation for Patients Hospitalized With COVID‐19

Journal of the American Heart Association: published on Jun 2022

COVID‐19 is an infectious illness, with an increased risk of thromboembolism. The overall rate of venous thromboembolism and arterial thromboembolism among patients with COVID‐19 is 21% and 2%, respectively.

Therefore, this complication represents an important therapeutic target that could be prevented by antithrombotic therapy. Data on anticoagulation therapy in patients with COVID‐19 are still debatable.

Randomized trials showed no benefit for therapeutic anticoagulation in critically ill patients, while in non‐critically ill patients there are contrasting data on optimal anticoagulation strategy.

On the other side, antiplatelet therapy in patients with COVID‐19 could provide some benefit in terms of mortality reduction and a large randomized trial (RECOVERY [Randomized evaluation of COVID‐19 Therapy]) showed that aspirin therapy is associated with a 1.2% absolute increase in survival.

The aim of this study was therefore to evaluate the impact on survival of prophylactic anticoagulation (PAC) with aspirin over PAC alone in patients hospitalized with COVID‐19 in an observational multicenter study after propensity score matching.

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In this international multicenter prospective registry including 8168 patients hospitalized for COVID-19, the cumulative incidence of in-hospital mortality was lower (15% vs 21%) in patients treated with a combination of prophylactic anticoagulation and aspirin compared with those treated with prophylactic anticoagulation alone.

After multivariable adjustment, treatment with aspirin was associated with a 38% lower risk of in-hospital mortality.

Aspirin treatment was associated with lower risk of in‐hospital mortality at multivariable analysis including age, sex, hypertension, diabetes, renal failure, and invasive ventilation.

These data suggest that treatment with aspirin in addition to prophylactic anticoagulation may be a possible therapeutic approach in hospitalized patients with COVID-19; however, careful patient selection and evaluation of bleeding risk are warranted.

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Abstract

Background

COVID-19 is an infectious illness, featured by an increased risk of thromboembolism. However, no standard antithrombotic therapy is currently recommended for patients hospitalized with COVID-19. The aim of this study was to evaluate safety and efficacy of additional therapy with aspirin over prophylactic anticoagulation (PAC) in patients hospitalized with COVID-19 and its impact on survival.

Methods and Results

A total of 8168 patients hospitalized for COVID-19 were enrolled in a multicenter-international prospective registry (HOPE COVID-19). Clinical data and in-hospital complications, including mortality, were recorded. Study population included patients treated with PAC or with PAC and aspirin. A comparison of clinical outcomes between patients treated with PAC versus PAC and aspirin was performed using an adjusted analysis with propensity score matching. Of 7824 patients with complete data, 360 (4.6%) received PAC and aspirin and 2949 (37.6%) PAC. Propensity-score matching yielded 298 patients from each group. In the propensity score-matched population, cumulative incidence of in-hospital mortality was lower in patients treated with PAC and aspirin versus PAC (15% versus 21%). At multivariable analysis in propensity matched population of patients with COVID-19, including age, sex, hypertension, diabetes, kidney failure, and invasive ventilation, aspirin treatment was associated with lower risk of in-hospital mortality.

Conclusions

Combination PAC and aspirin was associated with lower mortality risk among patients hospitalized with COVID-19 in a propensity score matched population compared to PAC alone.

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