Rationales and uncertainties for aspirin use in COVID-19: a narrative review

Fam Med Community Health. 2021 Apr;9(2):e000741. doi: 10.1136/fmch-2020-000741.


Objectives: To review the pathophysiology of COVID-19 disease, potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.

Design: Narrative review.

Setting: The online databases PubMed, OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021. International guidelines from relevant societies, journals and forums were also assessed for relevance.

Participants: Not applicable.

Results: A review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction, coagulopathy and dysregulated inflammation. Aspirin has anti-inflammatory effects, antiplatelet aggregation, anticoagulant properties as well as pleiotropic effects on endothelial function. During the COVID-19 pandemic, low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease, prevention of venous thromboembolism after total hip or knee replacement, prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children. Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19, whereas aspirin association with mortality is still debatable.

Conclusion: The authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40-70 years who are at high atherosclerotic cardiovascular disease risk, or an intermediate risk with a risk-enhancer and have a low risk of bleeding. Aspirin's protective roles in COVID-19 associated with acute lung injury, vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.

Keywords: COVID-19; cardiovascular diseases; global health; infectious disease medicine; respiratory system.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal* / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal* / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal* / therapeutic use
  • Aspirin* / administration & dosage
  • Aspirin* / adverse effects
  • Aspirin* / therapeutic use
  • COVID-19* / complications
  • COVID-19* / physiopathology
  • COVID-19* / therapy
  • Humans
  • Inflammation
  • Middle Aged
  • Practice Guidelines as Topic
  • Thromboembolism* / drug therapy
  • Thromboembolism* / etiology
  • Thromboembolism* / prevention & control


  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin