Patients who received aspirin in addition to prophylactic anticoagulation during hospitalization for COVID-19 had lower rates of inpatient mortality, according to a registry study.
The HOPE COVID-19 study prospectively registered 8,168 patients hospitalized for COVID-19 in Spain, Italy, Ecuador, Cuba, Germany, China, or Canada. Of 7,824 patients with complete data, 360 (4.6%) received anticoagulation plus aspirin and 2,949 (37.6%) received anticoagulation alone. Researchers propensity score-matched 298 patients from each group to assess the effect of aspirin on inpatient mortality. Results were published by the Journal of the American Heart Association on June 22.
In-hospital mortality was significantly lower in the group of patients who received both anticoagulation and aspirin than in those who got only anticoagulation (15% vs. 21%; P=0.01). A multivariable analysis that included age, sex, hypertension, diabetes, kidney failure, and receipt of mechanical ventilation found that aspirin treatment was associated with lower risk of in-hospital mortality (hazard ratio, 0.62; 95% CI, 0.42 to 0.92; P=0.018).
The study authors noted the mixed existing evidence on the effects of anticoagulation in patients with COVID-19, but they said that “antiplatelet therapy could be an additional therapeutic target to prevent or treat microthrombi.” The combination of prophylactic anticoagulation and aspirin “may represent a possible therapeutic approach for patients hospitalized with COVID-19,” the authors concluded. They cautioned that confirmatory randomized trials and a careful evaluation of each patient's thromboembolic and bleeding risks are needed.