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

Publication ,  Journal Article
Chow, JH; Rahnavard, A; Gomberg-Maitland, M; Chatterjee, R; Patodi, P; Yamane, DP; Levine, AR; Davison, D; Hawkins, K; Jackson, AM; Fisher, D ...
Published in: JAMA Netw Open
March 1, 2022

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.

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Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

March 1, 2022

Volume

5

Issue

3

Start / End Page

e223890

Location

United States

Related Subject Headings

  • United States
  • Middle Aged
  • Humans
  • Hospitalization
  • Hospital Mortality
  • Cohort Studies
  • COVID-19
  • Aspirin
  • Adult
  • 42 Health sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chow, J. H., Rahnavard, A., Gomberg-Maitland, M., Chatterjee, R., Patodi, P., Yamane, D. P., … N3C Consortium and ANCHOR Investigators, . (2022). Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19. JAMA Netw Open, 5(3), e223890. https://doi.org/10.1001/jamanetworkopen.2022.3890
Chow, Jonathan H., Ali Rahnavard, Mardi Gomberg-Maitland, Ranojoy Chatterjee, Pranay Patodi, David P. Yamane, Andrea R. Levine, et al. “Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19.JAMA Netw Open 5, no. 3 (March 1, 2022): e223890. https://doi.org/10.1001/jamanetworkopen.2022.3890.
Chow JH, Rahnavard A, Gomberg-Maitland M, Chatterjee R, Patodi P, Yamane DP, et al. Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19. JAMA Netw Open. 2022 Mar 1;5(3):e223890.
Chow, Jonathan H., et al. “Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19.JAMA Netw Open, vol. 5, no. 3, Mar. 2022, p. e223890. Pubmed, doi:10.1001/jamanetworkopen.2022.3890.
Chow JH, Rahnavard A, Gomberg-Maitland M, Chatterjee R, Patodi P, Yamane DP, Levine AR, Davison D, Hawkins K, Jackson AM, Quintana MT, Lankford AS, Keneally RJ, Al-Mashat M, Fisher D, Williams J, Berger JS, Mazzeffi MA, Crandall KA, N3C Consortium and ANCHOR Investigators. Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19. JAMA Netw Open. 2022 Mar 1;5(3):e223890.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

March 1, 2022

Volume

5

Issue

3

Start / End Page

e223890

Location

United States

Related Subject Headings

  • United States
  • Middle Aged
  • Humans
  • Hospitalization
  • Hospital Mortality
  • Cohort Studies
  • COVID-19
  • Aspirin
  • Adult
  • 42 Health sciences