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Aspirin and death in Covid-19 A systematic review and meta-analysis
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  • Nicholas Moore (NO NEW ASSIGNMENTS),
  • Nicolas Thurin,
  • Pauline Bosco-Lévy,
  • Patrick Blin,
  • cecile Droz
Nicholas Moore (NO NEW ASSIGNMENTS)
University of Bordeaux
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Nicolas Thurin
University of Bordeaux
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Pauline Bosco-Lévy
University of Bordeaux
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Patrick Blin
University of Bordeaux
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cecile Droz
University of Bordeaux
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Abstract

Thrombotic events are common during COVID-19 infection. Aspirin might be beneficial. Objective: Systematic review and meta-analysis of deaths in users and non-users of aspirin. Data sources: Pubmed Medline, Google scholar, Clinicaltrials.gov, Cochrane, to June 8, 2021, Study selection: Studies providing adjusted or matched evaluation of association of exposure to aspirin and death in COVID-19 patients were included. Data extraction and synthesis: Data were used as published, as Odds ratio, hazard ratio or relative risks and 95% CI from which log(OR) and SE were recalculated. These were entered in an inverse variance odds ratios random-effects model, using RevMan 5.4 (the Cochrane Collaboration). Main outcomes and measure: The prespecified outcome studied was death. Results: Nine studies (8 observational, one interventional) included 14989 patients exposed to aspirin and 15857 unexposed. Overall Odds Ratio of death in aspirin exposed patients in a random effects model was 0.63, 95% confidence interval [0.40-0.99], I2 94%. Using a fixed-effect model did not change much the result (0.76 [0.71-0.81], removing the Recovery trial (OR 0.43 [0.38-0.49], I271%, or the two largest studies (0.66 [0.47-0.93], I2 38%) reduced heterogeneity without materially altering the results. The funnel plot showed no evident publication bias Conclusion: this meta-analysis suggests that the use of aspirin may be associated with a lower risk of death in COVID-19. Considering the results of the Recovery Study, it would appear preferable to continue aspirin in patients who have a non-covid indication, but possibly useless to add it if they don’t.

Peer review status:UNDER REVIEW

16 Jun 2021Submitted to British Journal of Clinical Pharmacology
19 Jun 2021Assigned to Editor
19 Jun 2021Submission Checks Completed
27 Aug 2021Reviewer(s) Assigned