Abstract
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an ongoing viral pandemic marked by increased risk of thrombotic events. However, the role of platelets in the elevated observed thrombotic risk in COVID-19 and utility of antiplatelet agents in attenuating thrombosis is unknown. We aimed to determine if the antiplatelet effect of aspirin may mitigate risk of myocardial infarction, cerebrovascular accident, and venous thromboembolism in COVID-19. We evaluated 22,072 symptomatic patients tested for COVID-19. Propensity-matched analyses were performed to determine if treatment with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) affected thrombotic outcomes in COVID-19. Neither aspirin nor NSAIDs affected mortality in COVID-19. Thus, aspirin does not appear to prevent thrombosis and death in COVID-19. The mechanisms of thrombosis in COVID-19, therefore, appear distinct and the role of platelets as direct mediators of SARS-CoV-2-mediated thrombosis warrants further investigation.
Highlights
COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and curiously displays a propensity for thrombosis in multiple vascular beds
In propensity-matched patients treated with aspirin, the incidence of myocardial infarction (MI) (2.0% vs 0.81%) and venous thromboembolism (VTE) (4.0% vs 1.6%) were not different, but aspirin therapy was associated with a higher incidence of thrombotic stroke (3.6% vs 0.40%)
In propensity-matched patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs), the incidence of MI (0.68% vs 0.23%), VTE (2.0% vs 0.90%), and thrombotic stroke (1.1% vs 0.45%) was not significantly different individually or as a combined endpoint (Table 3)
Summary
COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and curiously displays a propensity for thrombosis in multiple vascular beds. COVID-19-related thrombosis may contribute to severe organ injury and death. The incidence of thrombotic events was as high as 31% in one cohort.[1] Clinical and autopsy studies of patients with COVID-19 suggest an increased risk of microthrombi, venous thromboembolism (VTE), and ischemic stroke.[2,3] Activated platelets are circulating mediators of thrombosis and, may serve as a logical therapeutic target in COVID-19. Several registered clinical trials will prospectively evaluate patient outcomes following low-dose aspirin in the context of SARS-CoV-2 infection, but high-quality observational data in the interim are lacking
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