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Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19

IMPORTANCE: Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin’s efficacy in patients with moderate COVID-19 is not well studied. OBJECTIVE: To assess whether early aspirin use is associated with...

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Autores principales: Chow, Jonathan H., Rahnavard, Ali, Gomberg-Maitland, Mardi, Chatterjee, Ranojoy, Patodi, Pranay, Yamane, David P., Levine, Andrea R., Davison, Danielle, Hawkins, Katrina, Jackson, Amanda M., Quintana, Megan T., Lankford, Allison S., Keneally, Ryan J., Al-Mashat, Mustafa, Fisher, Daniel, Williams, Jeffrey, Berger, Jeffrey S., Mazzeffi, Michael A., Crandall, Keith A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948531/
https://www.ncbi.nlm.nih.gov/pubmed/35323950
http://dx.doi.org/10.1001/jamanetworkopen.2022.3890
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author Chow, Jonathan H.
Rahnavard, Ali
Gomberg-Maitland, Mardi
Chatterjee, Ranojoy
Patodi, Pranay
Yamane, David P.
Levine, Andrea R.
Davison, Danielle
Hawkins, Katrina
Jackson, Amanda M.
Quintana, Megan T.
Lankford, Allison S.
Keneally, Ryan J.
Al-Mashat, Mustafa
Fisher, Daniel
Williams, Jeffrey
Berger, Jeffrey S.
Mazzeffi, Michael A.
Crandall, Keith A.
author_facet Chow, Jonathan H.
Rahnavard, Ali
Gomberg-Maitland, Mardi
Chatterjee, Ranojoy
Patodi, Pranay
Yamane, David P.
Levine, Andrea R.
Davison, Danielle
Hawkins, Katrina
Jackson, Amanda M.
Quintana, Megan T.
Lankford, Allison S.
Keneally, Ryan J.
Al-Mashat, Mustafa
Fisher, Daniel
Williams, Jeffrey
Berger, Jeffrey S.
Mazzeffi, Michael A.
Crandall, Keith A.
author_sort Chow, Jonathan H.
collection PubMed
description IMPORTANCE: Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin’s efficacy in patients with moderate COVID-19 is not well studied. OBJECTIVE: To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health’s National COVID Cohort Collaborative (N3C). EXPOSURE: Aspirin use within the first day of hospitalization. MAIN OUTCOME AND MEASURES: The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups. RESULTS: Among the 2 446 650 COVID-19–positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion. For the full cohort, Median age was 63 years (IQR, 47-74 years); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity. In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% CI, 0.79-0.92; P < .001). The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received aspirin (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = .004). Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage (0.8% aspirin vs 0.7% no aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = .72), cerebral hemorrhage (0.6% aspirin vs 0.4% no aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = .13), or blood transfusion (2.7% aspirin vs 2.3% no aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = .06). The composite of hemorrhagic complications did not occur more often in those receiving aspirin (3.7% aspirin vs 3.2% no aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = .054). Subgroups who appeared to benefit the most included patients older than 60 years (61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P < .001; >80 years: OR, 0.79; 95% CI, 0.69-0.91; P < .001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P < .001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = .003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P < .001; >3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study of US adults hospitalized with moderate COVID-19, early aspirin use was associated with lower odds of 28-day in-hospital mortality. A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate aspirin’s efficacy in patients with high-risk conditions.
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spelling pubmed-89485312022-04-11 Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19 Chow, Jonathan H. Rahnavard, Ali Gomberg-Maitland, Mardi Chatterjee, Ranojoy Patodi, Pranay Yamane, David P. Levine, Andrea R. Davison, Danielle Hawkins, Katrina Jackson, Amanda M. Quintana, Megan T. Lankford, Allison S. Keneally, Ryan J. Al-Mashat, Mustafa Fisher, Daniel Williams, Jeffrey Berger, Jeffrey S. Mazzeffi, Michael A. Crandall, Keith A. JAMA Netw Open Original Investigation IMPORTANCE: Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin’s efficacy in patients with moderate COVID-19 is not well studied. OBJECTIVE: To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health’s National COVID Cohort Collaborative (N3C). EXPOSURE: Aspirin use within the first day of hospitalization. MAIN OUTCOME AND MEASURES: The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups. RESULTS: Among the 2 446 650 COVID-19–positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion. For the full cohort, Median age was 63 years (IQR, 47-74 years); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity. In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% CI, 0.79-0.92; P < .001). The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received aspirin (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = .004). Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage (0.8% aspirin vs 0.7% no aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = .72), cerebral hemorrhage (0.6% aspirin vs 0.4% no aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = .13), or blood transfusion (2.7% aspirin vs 2.3% no aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = .06). The composite of hemorrhagic complications did not occur more often in those receiving aspirin (3.7% aspirin vs 3.2% no aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = .054). Subgroups who appeared to benefit the most included patients older than 60 years (61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P < .001; >80 years: OR, 0.79; 95% CI, 0.69-0.91; P < .001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P < .001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = .003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P < .001; >3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study of US adults hospitalized with moderate COVID-19, early aspirin use was associated with lower odds of 28-day in-hospital mortality. A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate aspirin’s efficacy in patients with high-risk conditions. American Medical Association 2022-03-24 /pmc/articles/PMC8948531/ /pubmed/35323950 http://dx.doi.org/10.1001/jamanetworkopen.2022.3890 Text en Copyright 2022 Chow JH et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Chow, Jonathan H.
Rahnavard, Ali
Gomberg-Maitland, Mardi
Chatterjee, Ranojoy
Patodi, Pranay
Yamane, David P.
Levine, Andrea R.
Davison, Danielle
Hawkins, Katrina
Jackson, Amanda M.
Quintana, Megan T.
Lankford, Allison S.
Keneally, Ryan J.
Al-Mashat, Mustafa
Fisher, Daniel
Williams, Jeffrey
Berger, Jeffrey S.
Mazzeffi, Michael A.
Crandall, Keith A.
Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
title Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
title_full Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
title_fullStr Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
title_full_unstemmed Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
title_short Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19
title_sort association of early aspirin use with in-hospital mortality in patients with moderate covid-19
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948531/
https://www.ncbi.nlm.nih.gov/pubmed/35323950
http://dx.doi.org/10.1001/jamanetworkopen.2022.3890
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