Aspirin and death in Covid-19 A systematic review and meta-analysis

Abstract

Thrombotic events are common during COVID-19 infection. Aspirin might be\nbeneficial. Objective: Systematic review and meta-analysis of deaths in\nusers and non-users of aspirin. Data sources: Pubmed Medline, Google\nscholar, Clinicaltrials.gov, Cochrane, to June 8, 2021, Study selection:\nStudies providing adjusted or matched evaluation of association of\nexposure to aspirin and death in COVID-19 patients were included. Data\nextraction and synthesis: Data were used as published, as Odds ratio,\nhazard ratio or relative risks and 95% CI from which log(OR) and SE\nwere recalculated. These were entered in an inverse variance odds ratios\nrandom-effects model, using RevMan 5.4 (the Cochrane Collaboration).\nMain outcomes and measure: The prespecified outcome studied was death.\nResults: Nine studies (8 observational, one interventional) included\n14989 patients exposed to aspirin and 15857 unexposed. Overall Odds\nRatio of death in aspirin exposed patients in a random effects model was\n0.63, 95% confidence interval [0.40-0.99], I2 94%. Using a\nfixed-effect model did not change much the result (0.76 [0.71-0.81],\nremoving the Recovery trial (OR 0.43 [0.38-0.49], I271%, or the two\nlargest studies (0.66 [0.47-0.93], I2 38%) reduced heterogeneity\nwithout materially altering the results. The funnel plot showed no\nevident publication bias Conclusion: this meta-analysis suggests that\nthe use of aspirin may be associated with a lower risk of death in\nCOVID-19. Considering the results of the Recovery Study, it would appear\npreferable to continue aspirin in patients who have a non-covid\nindication, but possibly useless to add it if they don’t.