Unit of Internal Medicine, Department of Medicine, Hospital "Santa Maria Della Misericordia", University of Perugia, Piazzale Menghini, 1, 06129, Perugia, Italy.
Department of Clinical, Internal Medicine and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Drugs. 2020 Sep;80(14):1383-1396. doi: 10.1007/s40265-020-01365-1.
Severe Acute Respiratory Syndrome-Coronavirus-2 is responsible for the current pandemic that has led to more than 10 million confirmed cases of Coronavirus Disease-19 (COVID-19) and over 500,000 deaths worldwide (4 July 2020). Virus-mediated injury to multiple organs, mainly the respiratory tract, activation of immune response with the release of pro-inflammatory cytokines, and overactivation of the coagulation cascade and platelet aggregation leading to micro- and macrovascular thrombosis are the main pathological features of COVID-19. Empirical multidrug therapeutic approaches to treat COVID-19 are currently used with extremely uncertain outcomes, and many others are being tested in clinical trials. Acetylsalicylic acid (ASA) has both anti-inflammatory and antithrombotic effects. In addition, a significant ASA-mediated antiviral activity against DNA and RNA viruses, including different human coronaviruses, has been documented. The use of ASA in patients with different types of infections has been associated with reduced thrombo-inflammation and lower rates of clinical complications and in-hospital mortality. However, safety issues related both to the risk of bleeding and to that of developing rare but serious liver and brain damage mostly among children (i.e., Reye's syndrome) should be considered. Hence, whether ASA might be a safe and reasonable therapeutic candidate to be tested in clinical trials involving adults with COVID-19 deserves further attention. In this review we provide a critical appraisal of current evidence on the anti-inflammatory, antithrombotic, and antiviral effects of ASA, from both a pre-clinical and a clinical perspective. In addition, the potential benefits and risks of use of ASA have been put in the context of the adult-restricted COVID-19 population.
严重急性呼吸综合征冠状病毒 2 是导致当前大流行的罪魁祸首，已导致全球超过 1000 万例新冠肺炎（COVID-19）确诊病例和超过 50 万人死亡（2020 年 7 月 4 日）。病毒对多个器官（主要是呼吸道）的损伤、免疫反应的激活以及促炎细胞因子的释放、凝血级联和血小板聚集的过度激活导致微血管和大血管血栓形成是 COVID-19 的主要病理特征。目前，针对 COVID-19 的经验性多药物治疗方法疗效不确定，许多其他方法正在临床试验中进行测试。乙酰水杨酸（ASA）具有抗炎和抗血栓作用。此外，已证明 ASA 对 DNA 和 RNA 病毒（包括不同的人类冠状病毒）具有显著的抗病毒活性。ASA 在不同类型感染患者中的使用与减少血栓炎症以及降低临床并发症和住院死亡率相关。然而，与出血风险和在儿童中（即雷氏综合征）发生罕见但严重的肝和脑损伤风险相关的安全问题都应该考虑。因此，ASA 是否可能是一种安全合理的治疗候选药物，值得在涉及 COVID-19 的成年患者的临床试验中进一步关注。在这篇综述中，我们从临床前和临床角度对 ASA 的抗炎、抗血栓和抗病毒作用的现有证据进行了批判性评估。此外，我们还将 ASA 的使用的潜在益处和风险放在了 COVID-19 成年患者的背景下进行了讨论。
