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.