Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19

Authors

Jonathan H. Chow, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Ali Rahnavard, George Washington University Computational Biology Institute, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, Washington, DC.
Mardi Gomberg-Maitland, Division of Cardiology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Ranojoy Chatterjee, George Washington University Computational Biology Institute, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, Washington, DC.
Pranay Patodi, George Washington University Computational Biology Institute, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, Washington, DC.
David P. Yamane, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Andrea R. Levine, Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore.
Danielle Davison, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Katrina Hawkins, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Amanda M. Jackson, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland.
Megan T. Quintana, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
Allison S. Lankford, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore.
Ryan J. Keneally, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Mustafa Al-Mashat, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Daniel Fisher, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Jeffrey Williams, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Jeffrey S. Berger, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Michael A. Mazzeffi, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Keith A. Crandall, George Washington University Computational Biology Institute, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, Washington, DC.

Document Type

Journal Article

Publication Date

3-1-2022

Journal

JAMA network open

Volume

5

Issue

3

DOI

10.1001/jamanetworkopen.2022.3890

Abstract

Importance: Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin's efficacy in patients with moderate COVID-19 is not well studied. Objective: To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19. Design, Setting, and Participants: Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health's National COVID Cohort Collaborative (N3C). Exposure: Aspirin use within the first day of hospitalization. Main Outcome and Measures: The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups. Results: Among the 2 446 650 COVID-19-positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion. For the full cohort, Median age was 63 years (IQR, 47-74 years); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity. In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% CI, 0.79-0.92; P < .001). The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received aspirin (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = .004). Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage (0.8% aspirin vs 0.7% no aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = .72), cerebral hemorrhage (0.6% aspirin vs 0.4% no aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = .13), or blood transfusion (2.7% aspirin vs 2.3% no aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = .06). The composite of hemorrhagic complications did not occur more often in those receiving aspirin (3.7% aspirin vs 3.2% no aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = .054). Subgroups who appeared to benefit the most included patients older than 60 years (61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P < .001; >80 years: OR, 0.79; 95% CI, 0.69-0.91; P < .001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P < .001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = .003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P < .001; >3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P < .001). Conclusions and Relevance: In this cohort study of US adults hospitalized with moderate COVID-19, early aspirin use was associated with lower odds of 28-day in-hospital mortality. A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate aspirin's efficacy in patients with high-risk conditions.

APA Citation

Chow, Jonathan H.; Rahnavard, Ali; Gomberg-Maitland, Mardi; Chatterjee, Ranojoy; Patodi, Pranay; Yamane, David P.; Levine, Andrea R.; Davison, Danielle; Hawkins, Katrina; Jackson, Amanda M.; Quintana, Megan T.; Lankford, Allison S.; Keneally, Ryan J.; Al-Mashat, Mustafa; Fisher, Daniel; Williams, Jeffrey; Berger, Jeffrey S.; Mazzeffi, Michael A.; and Crandall, Keith A., "Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19" (2022). GW Authored Works. Paper 697.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/697

Department

Anesthesiology and Critical Care Medicine