National Center for Collaborative Healthcare Innovation, VA Palo Alto Healthcare System, Palo Alto, California, United States of America.
Department of Business Analytics, University of Iowa Tippie College of Business, Iowa City, Iowa, United States of America.
PLoS One. 2024 Sep 17;19(9):e0302612. doi: 10.1371/journal.pone.0302612. eCollection 2024.
COVID-19 triggers prothrombotic and proinflammatory changes, with thrombotic disease prevalent in up to 30% SARS-CoV-2 infected patients. Early work suggests that aspirin could prevent COVID-19 related thromboembolic disorders in some studies but not others. This study leverages data from the largest integrated healthcare system in the United States to better understand this association. Our objective was to evaluate the incidence and risk of COVID-19 associated acute thromboembolic disorders and the potential impact of aspirin.
This retrospective, observational study utilized national electronic health record data from the Veterans Health Administration. 334,374 Veterans who tested positive for COVID-19 from March 2, 2020, to June 13, 2022, were included, 81,830 of whom had preexisting aspirin prescription prior to their COVID-19 diagnosis. Patients with and without aspirin prescriptions were matched and the odds of post-COVID acute thromboembolic disorders were assessed.
10.1% of Veterans had a documented thromboembolic disorder within 12 months following their COVID-19 diagnosis. Those with specific comorbidities were at greatest risk. Preexisting aspirin prescription was associated with a significant decrease risk of post-COVID-19 thromboembolic disorders, including pulmonary embolism (OR [95% CI]: 0.69 [0.65, 0.74]) and deep vein thrombosis (OR [95% CI]: 0.76 [0.69, 0.83], but an increased risk of acute arterial diseases, including ischemic stroke (OR [95% CI]: 1.54 [1.46, 1.60]) and acute ischemic heart disease (1.33 [1.26, 1.39]).
Findings demonstrated that preexisting aspirin prescription prior to COVID-19 diagnosis was associated with significantly decreased risk of venous thromboembolism and pulmonary embolism but increased risk of acute arterial disease. The risk of arterial disease may be associated with increased COVID-19 prothrombotic effects superimposed on preexisting chronic cardiovascular disease for which aspirin was already prescribed. Prospective clinical trials may help to further assess the efficacy of aspirin use prior to COVID-19 diagnosis for the prevention of post-COVID-19 thromboembolic disorders.
COVID-19 引发促血栓形成和促炎变化，多达 30%的 SARS-CoV-2 感染患者患有血栓性疾病。早期研究表明，在一些研究中阿司匹林可以预防 COVID-19 相关的血栓栓塞性疾病，但在其他研究中则不然。本研究利用美国最大的综合医疗系统的数据，更好地了解这种关联。我们的目的是评估 COVID-19 相关急性血栓栓塞性疾病的发生率和风险，以及阿司匹林的潜在影响。
这是一项回顾性、观察性研究，利用了退伍军人事务部国家电子健康记录数据。纳入了 2020 年 3 月 2 日至 2022 年 6 月 13 日期间 COVID-19 检测呈阳性的 334374 名退伍军人，其中 81830 人在 COVID-19 诊断前有预先开具的阿司匹林处方。评估了有和没有阿司匹林处方的患者发生 COVID 后急性血栓栓塞性疾病的几率。
10.1%的退伍军人在 COVID-19 诊断后 12 个月内有记录的血栓栓塞性疾病。那些有特定合并症的人风险最大。预先开具的阿司匹林处方与 COVID-19 后血栓栓塞性疾病风险显著降低相关，包括肺栓塞（OR[95%CI]：0.69[0.65，0.74]）和深静脉血栓形成（OR[95%CI]：0.76[0.69，0.83]），但急性动脉疾病的风险增加，包括缺血性中风（OR[95%CI]：1.54[1.46，1.60]）和急性缺血性心脏病（1.33[1.26，1.39]）。
研究结果表明，COVID-19 诊断前预先开具的阿司匹林处方与静脉血栓栓塞和肺栓塞风险显著降低相关，但急性动脉疾病风险增加。动脉疾病的风险可能与 COVID-19 的促血栓形成作用增加有关，这种作用叠加在已经开具阿司匹林的慢性心血管疾病之上。前瞻性临床试验可能有助于进一步评估 COVID-19 诊断前使用阿司匹林预防 COVID-19 后血栓栓塞性疾病的疗效。
