Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Tropical Medicine, Faculty of Medicine, Port Said University, Port Fuad, Egypt.
Clin Drug Investig. 2021 Aug;41(8):723-732. doi: 10.1007/s40261-021-01061-2. Epub 2021 Jul 30.
Low-dose acetylsalicylic acid (ASA, aspirin) is a well-known and frequently studied drug for primary and secondary prevention of disease due to its anti-inflammatory and coagulopathic effects. COVID-19 complications are attributed to the role of thrombo-inflammation. Studies regarding the use of low-dose ASA in COVID-19 are limited. For this reason, we propose that the use of low-dose ASA may have protective effects in COVID-19-related thromboembolism and lung injury. This study was conducted to assess the efficacy of low-dose ASA compared with enoxaparin, an anticoagulant, for the prevention of thrombosis and mechanical ventilation.
We conducted a retrospective cohort study on COVID-19-confirmed hospitalized patients at the Mansoura University Quarantine Hospital, outpatients, and home-isolated patients from September to December 2020 in Mansoura governorate, Egypt. Binary logistic regression analysis was used to assess the effect of ASA compared with enoxaparin on thromboembolism, and mechanical ventilation needs.
This study included 225 COVID-19 patients. Use of ASA-only (81-162 mg orally daily) was significantly associated with reduced thromboembolism (OR 0.163, p = 0.020), but both low-dose ASA and enoxaparin, and enoxaparin-only (0.5 mg/kg subcutaneously (SC) daily as prophylactic dose or 1 mg/kg SC every 12 hours as therapeutic dose) were more protective (odds ratio [OR] 0.010, OR 0.071, respectively, p < 0.001). Neither ASA-only nor enoxaparin-only were associated with a reduction in mechanical ventilation needs. Concomitant use of low-dose ASA and enoxaparin was associated with reduced mechanical ventilation (OR 0.032, 95% CI 0.004-0.226, p = 0.001).
Low-dose ASA-only use may reduce the incidence of COVID-19-associated thromboembolism, but the reduction may be less than that of enoxaparin-only, and both ASA and enoxaparin. Concomitant use of ASA and enoxaparin demonstrates promising results with regard to the reduction of thrombotic events, and mechanical ventilation needs.
小剂量乙酰水杨酸（ASA，阿司匹林）具有抗炎和抗凝血作用，常用于疾病的一级和二级预防，是一种众所周知且经常研究的药物。COVID-19 的并发症归因于血栓炎症的作用。关于 COVID-19 中小剂量 ASA 的使用的研究有限。因此，我们认为小剂量 ASA 可能对 COVID-19 相关的血栓栓塞和肺损伤具有保护作用。本研究旨在评估与抗凝剂依诺肝素相比，小剂量 ASA 用于预防血栓形成和机械通气的疗效。
我们对 2020 年 9 月至 12 月在埃及曼苏拉省曼苏拉大学检疫医院、门诊和居家隔离的 COVID-19 确诊住院患者进行了回顾性队列研究。使用二元逻辑回归分析评估 ASA 与依诺肝素对血栓栓塞和机械通气需求的影响。
本研究共纳入 225 例 COVID-19 患者。仅使用 ASA（每天口服 81-162mg）与血栓栓塞发生率降低显著相关（OR 0.163，p=0.020），但小剂量 ASA 与依诺肝素联合使用以及仅使用依诺肝素（预防剂量为每天皮下注射 0.5mg/kg 或治疗剂量为每 12 小时皮下注射 1mg/kg）更具保护作用（比值比 [OR] 分别为 0.010、0.071，均 p<0.001）。仅使用 ASA 或依诺肝素均与机械通气需求的降低无关。小剂量 ASA 与依诺肝素联合使用与机械通气减少相关（OR 0.032，95%CI 0.004-0.226，p=0.001）。
仅使用小剂量 ASA 可能降低 COVID-19 相关血栓栓塞的发生率，但与仅使用依诺肝素相比，这种降低可能较小，且与 ASA 和依诺肝素均相关。ASA 和依诺肝素联合使用在减少血栓事件和机械通气需求方面显示出有前景的结果。
