Active Prescription of Low-dose Aspirin During or Prior to Hospitalization and Mortality in COVID-19 — A Systematic Review and Meta-analysis of Adjusted Effect Estimates

Martha, Januar Wibawa; Pranata, Raymond; Lim, Michael Anthonius; Wibowo, Arief; Akbar, Mohammad Rizki

BACKGROUND: This study aims to investigate whether the active prescription of low-dose aspirin during or prior to hospitalization affects mortality in COVID-19 patients. Aspirin is often prescribed for secondary prevention in patients with cardiovascular disease and other comorbidities that might increase mortality, thus, may falsely demonstrate increased mortality. To reduce bias, we only enrolled studies that performed the adjusted analysis. METHODS: A systematic literature search was performed using PubMed, Scopus, Embase, and Clinicaltrials.gov from the inception of the database up until 16 April 2021. The exposure was active prescription of low-dose aspirin during or prior to hospitalization. The primary outcome was mortality. The pooled adjusted effect estimate was reported as relative risk (RR). RESULTS: There were 6 eligible studies that were included in this meta-analysis, comprising of 13,993 patients. The studies have a low-moderate risk of bias based on Newcastle-Ottawa Scale. Meta-analysis indicates that low-dose aspirin use was independently associated with reduced mortality (RR 0.46 [0.35, 0.61], p < 0.001; I(2): 36.2%). Subgroup analysis on in-hospital low-dose aspirin administration also showed statistically significant mortality reduction (RR 0.39 [0.16, 0.96], p < 0.001; I(2): 47.0%). CONCLUSION: Low-dose aspirin use is independently associated with reduced mortality in patients with COVID-19 with a low certainty of evidence. PROSPERO: CRD42021249440.