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. 2021 Dec 1:344:240-245.
doi: 10.1016/j.ijcard.2021.09.058. Epub 2021 Oct 4.

Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study

Antonio Sisinni  1 , Luca Rossi  2 , Antonio Battista  3 , Enrico Poletti  1 , Federica Battista  4 , Rosa Alessia Battista  5 , Alessandro Malagoli  2 , Andrea Biagi  2 , Alessia Zanni  2 , Concetta Sticozzi  2 , Greta Comastri  2 , Massimiliano M Marrocco-Trischitta  6 , Alberto Monello  2 , Alberto Margonato  7 , Francesco Bandera  1 , Pasquale Vergara  8 , Marco Guazzi  9 , Cosmo Godino  10
Affiliations
Free PMC article

Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study

Antonio Sisinni et al. Int J Cardiol. .
Free PMC article

Abstract

Background: Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19.

Methods: This cohort study included 984 COVID-19 patients stratified according to ASA intake before hospitalization: ASA+ (n = 253) and ASA- (n = 731). Patients were included in ASA+ group if they received it daily in the 7 days before admission. 213 (83%) were on ASA 100 mg daily. Primary endpoint was a composite of in-hospital death and/or need for respiratory support upgrade, secondary endpoints were in-hospital death and need for respiratory support upgrade.

Results: Mean age was 72 [62; 81] with 69% of male patients. ASA+ patients were significantly older, with higher prevalence of comorbidities. No significant differences regarding the degree of respiratory dysfunction were observed. At 30-day Kaplan-Meier analysis, ASA+ patients had higher survival free from the primary endpoint and need for respiratory support upgrade, conversely in-hospital death did not significantly differ between groups. At multivariate analysis ASA intake was independently associated with a lower probability of reaching primary endpoint (HR 0.697, 95% C.I. 0.525-0.924; p = 0.012).

Conclusions: In COVID-19 patients undergoing hospitalization, pre-admission treatment with ASA is associated with better in-hospital outcome, mainly driven by less respiratory support upgrade.

Keywords: Acetylsalicylic acid; COVID-19; Platelet aggregation inhibitors; SARS-CoV-2; Thrombosis.

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Conflict of interest statement

The authors report no relationships that could be construed as a conflict of interest.

Figures

Fig. 1
Fig. 1
Entire study cohort 30-day Kaplan-Meier analysis of primary and secondary endpoints. Entire study cohort 30-day Kaplan-Meier analysis of survival free from primary endpoint (panel A), in-hospital death (panel B) and need for respiratory support upgrade (panel C). ASA: acetylsalicylic acid.
Fig. 2
Fig. 2
Forest plot showing results from multivariate Cox regression analysis regarding primary endpoint. ASA: acetylsalicylic acid. eGFR: estimated glomerular filtration rate. N/L: neutrophils to lymphocytes ratio. Data are presented as hazard ratio (HR) with 95% confidence interval (CI).
See this image and copyright information in PMC

Comment in

  • Further evidence for the use of aspirin in COVID-19.
    Tantry US, Bliden KP, Gurbel PA. Tantry US, et al. Int J Cardiol. 2022 Jan 1;346:107-108. doi: 10.1016/j.ijcard.2021.11.021. Epub 2021 Nov 12. Int J Cardiol. 2022. PMID: 34774888 Free PMC article. No abstract available.

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