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- Title
Rationales and uncertainties for aspirin use in COVID-19: a narrative review.
- Authors
Ahmed, Hazem A. Sayed; Merrel, Eric; Ismail, Mansoura; Joudeh, Anwar I.; Riley, Jeffrey B.; Shawkat, Ahmed; Habeb, Hanan; Darling, Edward; Goweda, Reda A.; Shehata, Mohamed H.; Amin, Hossam; Nieman, Gary F.; Aiash, Hani
- Abstract
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.
- Subjects
COVID-19; ASPIRIN; COVID-19 pandemic; ENDOTHELIUM diseases; CARDIOVASCULAR diseases; TOTAL hip replacement; TOTAL knee replacement
- Publication
Family Medicine & Community Health, 2021, Vol 9, Issue 2, p1
- ISSN
2305-6983
- Publication type
Article
- DOI
10.1136/fmch-2020-000741