Effects of Aspirin on Clinical Outcomes of COVID-19: A Meta-Analysis
Objective: To systematically evaluate the effect of aspirin on the clinical outcome of patients with COVID-19. Methods: PubMed database was searched by computer to collect studies on the effects of aspirin on clinical outcomes of patients with COVID-19. The search period was from December 1, 2019 to October 31, 2022. Literature screening, data extraction and bias risk assessment of included studies were completed independently by two researchers. After that, RevMan 5.4 software was used for meta-analysis. Results: Twenty studies involving 221,263 patients were included. The results of meta-analysis showed that the mortality rate of patients with COVID-19 in aspirin group and control group [OR = 1.09, 95% CI (0.93, 1.29), P = 0.28], progression to ICU [OR = 1.86, 95% CI (0.53, 6.60), P = 0.33], use of mechanical ventilation [OR = 0.94, 95% CI (0.68, 1.31), P = 0.73], occurrence of thrombotic events [OR = 1.34, 95% CI (0.77, 2.32), P = 0.30], major bleeding events [OR = 1.25, 95% CI (0.85, 1.83), P = 0.26] was not statistically significant. Conclusion: Aspirin has no protective effect on mortality, thrombosis and major bleeding events, progression to ICU, and use of mechanical ventilation in patients with COVID-19. However, on account of the limitations in the quality and quantity of included studies, more high-quality studies are needed to confirm these conclusions.
Aspirin
纳入年龄在18岁以上的COVID-19患者。
1) 研究人群包括确诊的COVID-19感染患者且年龄在18岁以上;2) 研究中报告了阿司匹林的使用情况;3) 阿司匹林使用者的死亡率有报告或可以计算,并与非阿司匹林使用者进行比较。
死亡率。
1) 结局指标不相符的文献;2) 重复发表的文献;3) 无法获取全文的文献;4) 数据模糊、不完整或数据无法获取者。
初步检索出相关文献356篇,按照纳入和排除标准严格筛选后,最终纳入20
见
作者 |
国家 |
研究类型 |
例数 |
男/女 |
死亡 |
血栓 |
出血 |
机械通气 |
入住ICU |
NOS |
(对照组/试验组) |
(对照组/试验组) |
(对照组/试验组) |
(对照组/试验组) |
(对照组/试验组) |
(对照组/试验组) |
(对照组/试验组) |
||||
Chow 2021a
|
USA |
Retrospective |
98/314 |
244/NR |
26/73 |
45,532 |
45,467 |
35/152 |
38/160 |
8 |
Formiga 2021
|
Spanish |
Retrospective |
3291/2885 |
3757/2419 |
1000/874 |
NR |
NR |
NR |
283/238 |
7 |
RECOVERY Collaborative Group 2022
|
UK, Indonesia, Nepal |
Randomized controlled trial |
7351/7541 |
9201/5691 |
1222/1299 |
338/399 |
117/75 |
NR |
NR |
8 |
Chow 2022
|
USA |
Cohort |
15,272/96,997 |
56,216/56,053 |
1410/11,577 |
NR |
504/3193 |
NR |
NR |
8 |
Kevorkian 2021
|
France |
Cohort |
28/40 |
53/NR |
0/2 |
NR |
NR |
NR |
NR |
7 |
Chow 2021b
|
USA |
Retrospective |
5690/10,566 |
NR/NR |
1052/2271 |
NR |
NR |
2122/3403 |
NR |
7 |
Gogtay 2022
|
USA, India |
Retrospective |
38/87 |
68/57 |
45647 |
45,323 |
NR |
45433 |
9/38 |
8 |
Harthi 2022
|
Saudi Arabia |
Retrospective |
176/176 |
238/114 |
98/107 |
45,585 |
45,601 |
23/25 |
NR |
8 |
Aghajani 2021
|
Iran |
Retrospective |
336/655 |
544/447 |
109/147 |
NR |
NR |
54/90 |
NR |
6 |
Alamdari 2020
|
Iran |
Retrospective |
53/406 |
320/139 |
9/54 |
NR |
NR |
NR |
NR |
7 |
Liu 2021
|
China |
Retrospective |
28/204 |
117/NR |
45371 |
NR |
NR |
NR |
NR |
9 |
Lodigiani 2020
|
Italy |
Retrospective |
45465 |
45613 |
45327 |
NR |
NR |
NR |
NR |
7 |
Merzon 2021
|
Israel |
Retrospective |
21/91 |
62/NR |
45297 |
NR |
NR |
NR |
NR |
7 |
Osborne 2021
|
USA |
Retrospective |
13,166/41,530 |
48,763/NR |
445/2042 |
NR |
NR |
NR |
NR |
8 |
Sahai 2020
|
USA |
Retrospective |
248/248 |
NR/NR |
33/38 |
45,569 |
NR |
NR |
NR |
8 |
Sisinni 2021
|
Italy |
Retrospective |
253/731 |
678/306 |
131/387 |
NR |
NR |
NR |
NR |
7 |
Son 2021
|
Korea |
Retrospective |
3825/7650 |
4215/7260 |
128/11 |
NR |
NR |
NR |
175/9 |
8 |
Sullerot 2022
|
France, Switzerland |
Retrospective |
301/746 |
510/537 |
104/229 |
NR |
NR |
NR |
22/26 |
8 |
Viecca 2020
|
Italy |
Retrospective |
45417 |
45506 |
45294 |
NR |
NR |
NR |
NR |
6 |
Yuan 2021
|
China |
Retrospective |
52/131 |
99/84 |
45625 |
NR |
NR |
NR |
NR |
8 |
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值得注意的是,因为Harthi 2022
采用逐一剔除法分别对5个结局指标进行敏感性分析,结果未发生方向性改变,提示研究结果较为稳定。
此外,我们的研究发现阿司匹林在降低血栓事件的发生率方面依然没有保护作用,这可能是因为抗血小板治疗在低分子肝素抗血栓治疗和减少血栓炎症刺激的皮质类固醇治疗的高比例基础上,没有临床显著的额外好处。另外,导致血栓形成和肺泡损伤的其他非血小板途径可能是临床结果更重要的决定因素。此外,在服用阿司匹林时,出血风险是一个潜在的不良事件。而我们的研究发现阿司匹林的使用与大出血事件的发生无关,这可能是由于高凝在COVID-19患者中比较常见,而血小板减少在COVID-19患者中不常见,所以出血的风险似乎很低。然而,阿司匹林可能在一定程度上增加出血风险(特别是消化道出血),应该进行更大规模的研究,以更好地评估使用阿司匹林治疗的COVID-19患者的出血风险
我们的优势在于样本量大,研究包含了回顾性研究、前瞻性研究以及随机对照试验,并且评估了出血风险。本研究的局限性是我们没有收集其他伴随药物的数据,如他汀类,因为大多数服用阿司匹林的患者通常服用上述药物,这是由于心血管疾病的指导药物治疗,这可能会混淆结果。因此,需要进一步的数据来得出阿司匹林对COVID-19患者临床结局影响的有效结论。
所有作者均无利益冲突。
*通讯作者。