9/2/2023 0 Comments Alice harrison tim holt![]() ![]() 5 Aspirin is an affordable, globally available drug which at low doses irreversibly inhibits the cyclooxygenase-1 enzyme, which is responsible for production of thromboxane A2 and proinflammatory prostaglandins. 3, 4Īnti-platelet therapy might have beneficial effects in severe COVID-19 through several mechanisms, including inhibition of platelet aggregation, reduction of platelet-derived inflammation, and blocking of thrombogenic neutrophil extracellular traps. 1, 2 The risk of thromboembolic complications is reported to be higher in COVID-19 than in other acute medical illnesses and viral respiratory infections, and is associated with worse prognosis. Thrombosis is a key feature of severe COVID-19, with 5–30% of hospitalised patients (depending on illness severity) having a major venous thromboembolic event (mostly pulmonary embolism) and up to 3% of patients having an arterial thromboembolic event, particularly myocardial infarction and ischaemic stroke. Aspirin use was associated with a reduction in thrombotic events (4♶% vs 5♳% absolute reduction 0♶%, SE 0♴%) and an increase in major bleeding events (1♶% vs 1♰% absolute increase 0♶%, SE 0♲%). ![]() ![]() 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 (21% vs 22% risk ratio 0♹6, 95% CI 0♹0–1♰3 p=0♲3). Patients allocated to aspirin had a slightly shorter duration of hospitalisation (median 8 days, IQR 5 to >28, vs 9 days, IQR 5 to >28) and a higher proportion were discharged from hospital alive within 28 days (75% vs 74% rate ratio 1♰6, 95% CI 1♰2–1♱0 p=0♰062). Consistent results were seen in all prespecified subgroups of patients. Overall, 1222 (17%) of 7351 patients allocated to aspirin and 1299 (17%) of 7541 patients allocated to usual care died within 28 days (rate ratio 0♹6, 95% CI 0♸9–1♰4 p=0♳5). 7351 patients were randomly allocated (1:1) to receive aspirin and 7541 patients to receive usual care alone. Individuals wishing to request access should complete the form at and e-mail Nov 1, 2020, and March 21, 2021, 14 892 (66%) of 22 560 patients enrolled into the RECOVERY trial were eligible to be randomly allocated to aspirin. Data will be made available in line with the policy and procedures described at. The Steering Committee will have the right to review and comment on any draft manuscripts before publication. However, the Steering Committee will need to be satisfied that any proposed publication is of high quality, honours the commitments made to the study participants in the consent documentation and ethical approvals, and is compliant with relevant legal and regulatory requirements (eg, relating to data protection and privacy). Deidentified participant data will be made available to researchers registered with an appropriate institution within 3 months of publication. As described in the protocol, the trial Steering Committee will facilitate the use of the study data and approval will not be unreasonably withheld. The protocol, consent form, statistical analysis plan, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, and other relevant study materials are available online at.
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