Association of Mortality and Aspirin use for COVID-19 Residents at VA Community Living Center Nursing Homes

Author(s): Yasin Abul, Frank Devone, Thomas A Bayer, Christopher Halladay, Kevin McConeghy, Nadia Mujahid, Mriganka Singh, Ciera Leeder, Stefan Gravenstein, James L. Rudolph

Background/Objectives:

Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state and increased thrombotic risk in infected individuals. Several complex and varied coagulation abnormalities were proposed for this association. Acetylsalicylic acid(ASA, aspirin) is known to have anti-inflammatory, antithrombotic properties and its use was reported as having potency to reduce RNA synthesis and replication of some types of coronaviruses including human coronavirus-299E (CoV-229E) and Middle East Respiratory Syndrome (MERS)-CoV. We hypothesized that chronic low dose aspirin use may decrease COVID-19 mortality relative to ASA non-users.

Methods:

This is a retrospective, observational cohort analysis of residents residing at Veterans Affairs Community Living Centers from December 13, 2020, to September 18, 2021, with a positive SARS-CoV-2 PCR test. Low dose aspirin users had low dose (81mg) therapy (10 of 14 days) prior to the positive COVID date and were compared to aspirin non-users (no ASA in prior 14 days). The primary outcome was mortality at 30 and 56 days post positive test and hospitalization.

Results:

We identified 1.823 residents who had SARS-CoV-2 infection and 1,687 residents were eligible for the study. Aspirin use was independently associated with a reduced risk of 30 days of mortality (adjusted HR, 0.60, 95% CI, 0.40-0.90) and 56 days of mortality (adjusted HR, 0.67, 95% CI, 0.47-0.95)

Conclusions:

Chronic low dose aspirin use for primary or secondary prevention of cardiovascular events is associated with lower COVID-19 mortality. Although additional randomized controlled trials are required to understand these associations and the potential implications more fully for improving care, aspirin remains a medication with known side effects and clinical practice should not change based on these findings.