Objectives To review the pathophysiology of COVID-19 disease,potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.Design Narrative review.Setting The online databa...Objectives To review the pathophysiology of COVID-19 disease,potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.Design Narrative review.Setting The online databases PubMed,OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021.International guidelines from relevant societies,journals and forums were also assessed for relevance.Participants Not applicable.Results A review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction,coagulopathy and dysregulated inflammation.Aspirin has anti-inflammatory effects,antiplatelet aggregation,anticoagulant properties as well as pleiotropic effects on endothelial function.During the COVID-19 pandemic,low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease,prevention of venous thromboembolism after total hip or knee replacement,prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children.Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19,whereas aspirin association with mortality is still debatable.Conclusion The authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40-70 years who are at high atherosclerotic cardiovascular disease risk,or an intermediate risk with a risk-enhancer and have a low risk of bleeding.Aspirin’s protective roles in COVID-19 associated with acute lung injury,vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.展开更多
文摘Objectives To review the pathophysiology of COVID-19 disease,potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.Design Narrative review.Setting The online databases PubMed,OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021.International guidelines from relevant societies,journals and forums were also assessed for relevance.Participants Not applicable.Results A review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction,coagulopathy and dysregulated inflammation.Aspirin has anti-inflammatory effects,antiplatelet aggregation,anticoagulant properties as well as pleiotropic effects on endothelial function.During the COVID-19 pandemic,low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease,prevention of venous thromboembolism after total hip or knee replacement,prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children.Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19,whereas aspirin association with mortality is still debatable.Conclusion The authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40-70 years who are at high atherosclerotic cardiovascular disease risk,or an intermediate risk with a risk-enhancer and have a low risk of bleeding.Aspirin’s protective roles in COVID-19 associated with acute lung injury,vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.
