ASPIRIN ROB HOLLAND TRIAL

Prespecified subsidiary clinical outcomes were use of non-invasive respiratory support, time to successful cessation of invasive mechanical ventilation (defined as cessation of invasive mechanical ventilation within, and survival to, 28 days), use of renal dialysis or haemofiltration, cause-specific mortality, major bleeding events (defined as intracranial bleeding or bleeding requiring transfusion, endoscopy, surgery, or vasoactive drugs), thrombotic events (defined as acute pulmonary embolism, deep-vein thrombosis, ischaemic stroke, myocardial infarction, or systemic arterial embolism) and major cardiac arrhythmias. Secondary outcomes were time to discharge from hospital, and, among patients not on invasive mechanical ventilation at randomisation, progression to invasive mechanical ventilation (including extracorporeal membrane oxygenation) or death. The primary outcome was all-cause mortality. Outcomes were assessed 28 days after randomisation, with further analyses specified at 6 months. The WHO ICTRP database listed seven ongoing randomised trials of aspirin, two in outpatients and five in inpatients. We identified no published randomised controlled trials assessing aspirin as a treatment for patients with COVID-19 in any clinical scenario. For medRxiv and bioRxiv, we used the search term “aspirin”. For MEDLINE and Embase, we used the search terms “Coronavirus infections/”, “SARS-CoV-2.mp.”, “Coronavirus/” or “CORONAVIRUS.mp”, “COVID.mp.”, “COVID-19.mp.”, “2019-nCoV.mp.”, “COVID19.mp”, “SARSCoV2.mp”, or “SARS-Cov2.mp” and “aspirin.mp”, “aspirin/”, or “acetylsalicylic acid/”, filtered by randomised controlled trials according to validated filters. We searched MEDLINE, Embase, bioRxiv, medRxiv, and the WHO International Clinical Trials Registry Platform (ICTRP), from Sept 1, 2019, up to Feb 25, 2021, for completed published randomised clinical trials establishing the effect of aspirin in patients with COVID-19. Anti-thrombotic therapies such as aspirin might be useful to prevent vascular events and improve outcomes. Patients with COVID-19 are at risk of thromboembolic complications. Aspirin use was associated with a reduction in thrombotic events (4♶% vs 5♳% absolute reduction 0♶%, SE 0♴%) and an increase in major bleeding events (1♶% vs 1♰% absolute increase 0♶%, SE 0♲%). Among patients not on invasive mechanical ventilation at baseline, there was no significant difference in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (21% vs 22% risk ratio 0♹6, 95% CI 0♹0–1♰3 p=0♲3). Patients allocated to aspirin had a slightly shorter duration of hospitalisation (median 8 days, IQR 5 to >28, vs 9 days, IQR 5 to >28) and a higher proportion were discharged from hospital alive within 28 days (75% vs 74% rate ratio 1♰6, 95% CI 1♰2–1♱0 p=0♰062). Consistent results were seen in all prespecified subgroups of patients. Overall, 1222 (17%) of 7351 patients allocated to aspirin and 1299 (17%) of 7541 patients allocated to usual care died within 28 days (rate ratio 0♹6, 95% CI 0♸9–1♰4 p=0♳5). 7351 patients were randomly allocated (1:1) to receive aspirin and 7541 patients to receive usual care alone.

ASPIRIN ROB HOLLAND TRIAL

The Lancet Regional Health – Western Pacificīetween Nov 1, 2020, and March 21, 2021, 14 892 (66%) of 22 560 patients enrolled into the RECOVERY trial were eligible to be randomly allocated to aspirin.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.

Aspirin rob holland