Wijaya Indra, Andhika Rizky, Huang Ian, Purwiga Aga, Budiman Kevin Yonatan
Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
Clin Epidemiol Glob Health. 2021 Oct-Dec;12:100883. doi: 10.1016/j.cegh.2021.100883. Epub 2021 Oct 30.
Repurposing the use of aspirin to treat hospitalized patients with COVID-19 is a sensible approach. However, several previous studies showed conflicting results. This meta-analysis was aimed to assess the effect of aspirin on the outcome in patients with COVID-19.
Systematic search using relevant keywords was carried out via several electronic databases until February 21, 2021 Research studies on adults COVID-19 patients with documentation on the use of aspirin and reported our outcomes of interest were included in the analysis. Our main outcome of interest was all types of mortality, while the incidence of thrombosis and bleeding were considered as secondary outcomes. Estimated risk estimates of the included studies were then pooled using DerSimonian-Laird random-effect models regardless heterogeneity.
Seven studies with a total of 34,415 patients were included in this systematic review and meta-analysis. The use of aspirin was associated with a reduced risk of mortality (RR 0.56, 95% CI 0.38-0.81, P = 0.002; I: 68%, P = 0.005). Sensitivity analysis by differentiating in-hospital (active aspirin prescription) and pre-hospital use of aspirin could significantly reduce the heterogeneity (I: 1%, P = 0.4). Only one study reported the incidence of major bleeding between aspirin and non-aspirin users (6.1% vs. 7.6%, P = 0.61). The association between the use of aspirin and the incidence of thrombosis were contradictory in two studies.
The use of aspirin was significantly associated with a reduced risk of mortality among patients with COVID-19. Due to limited studies, the effect of aspirin on the incidence of thrombosis and bleeding in patients with COVID-19 could not be drawn definitively.
重新利用阿司匹林治疗新冠肺炎住院患者是一种明智的方法。然而，此前的几项研究结果相互矛盾。本荟萃分析旨在评估阿司匹林对新冠肺炎患者预后的影响。
通过几个电子数据库，使用相关关键词进行系统检索，直至2021年2月21日。纳入分析的研究为关于成年新冠肺炎患者使用阿司匹林的文献记录以及报告了我们感兴趣结局的研究。我们感兴趣的主要结局是所有类型的死亡率，而血栓形成和出血的发生率被视为次要结局。然后，无论异质性如何，使用DerSimonian-Laird随机效应模型汇总纳入研究的估计风险估计值。
本系统评价和荟萃分析纳入了7项研究，共34415例患者。使用阿司匹林与降低死亡风险相关（风险比0.56，95%置信区间0.38 - 0.81，P = 0.002；I²：68%，P = 0.005）。通过区分住院期间（阿司匹林主动处方）和院前使用阿司匹林进行敏感性分析可显著降低异质性（I²：1%，P = 0.4）。只有一项研究报告了阿司匹林使用者和非阿司匹林使用者之间的大出血发生率（6.1%对7.6%，P = 0.61）。两项研究中阿司匹林使用与血栓形成发生率之间的关联相互矛盾。
使用阿司匹林与新冠肺炎患者死亡风险降低显著相关。由于研究有限，无法明确阿司匹林对新冠肺炎患者血栓形成和出血发生率的影响。
