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 

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