Aspirin has been proposed as a treatment for COVID-19 on the basis of its antithrombotic properties. A study published in The Lancet by the RECOVERY trial aimed to evaluate the efficacy and safety of Aspirin in patients admitted to hospital with COVID-19.
In their randomised controlled, open label, platform trial, several possible treatments were compared with usual care in patients hospitalised with COVID-19.
The trial took place at 177 hospitals in the United Kingdom, two hospitals in Indonesia and two hospitals in Nepal.
Adults were randomly allocated in a one-to-one ratio to either usual standard of care plus 150 mg of Aspirin once per day until discharge or usual standard of care alone using web-based simple randomisation with allocation concealment. The primary outcome was 28-day mortality.
Between 1 November 2020 and March 21, 2021, 14,892 of 22,560, that is 66% of patients enrolled into the RECOVERY trial and were eligible to be randomly allocated to Aspirin.
7351 patients were randomly allocated to receive Aspirin and 7541 patients received usual care alone.
Overall, 1222 that is 17% of the 7351 patients allocated to Aspirin and 1299 that is 17% of the 7541 patients allocated to usual care died within the 28 days.
Consistent results were seen in all pre-specified subgroups of patients. The patients allocated to Aspirin had a slightly shorter duration of hospitalisation and a higher proportion of discharge from hospital alive within 28 days.
Among patients not on invasive mechanical ventilation at baseline, there was no significant difference in the proportion meeting the composite endpoint of invasive mechanical ventilation or death.
Aspirin use was associated with a reduction in thrombotic events, but an increase in major bleeding events.
The study showed that in patients hospitalised with COVID-19, Aspirin was not associated with reductions in 28-day mortality or in the risk of progressing to invasive mechanical ventilation or death, but was associated with a small increase in the rate of being discharged live within 28 days.
This trial only studied patients with COVID-19 who were hospitalised and therefore was unable to provide evidence on the safety and efficacy of Aspirin used in other patient groups.
Unfortunately, in summary, the results of this large randomised trial did not support the addition of Aspirin to standard thromboprophylaxis or therapeutic anticoagulation in patients hospitalised with COVID-19.
The London General Practice, the leading London doctors’ clinic in Harley Street provides a full COVID-19 service from PCR swab tests , lateral flow covid testing to all PCR swabs required for travel by the various bodies and also a COVID safety net service for those suffering with COVID, whereby they receive a five-minute telephone call from a doctor daily for seven days.
The London General Practice also provides a multidisciplinary approach for the care of those suffering with long COVID.
Dr Paul Ettlinger
BM, DRCOG, MRCGP, FRIPH, DOccMed