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COVID-19 Management

RECOVERY RCT Results: Does Aspirin Reduce COVID-19 Mortality?

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BACKGROUND AND PURPOSE:

  • The RECOVERY Collaborative Group (The Lancet, 2021) evaluated the efficacy and safety of aspirin in patients admitted to hospital with COVID-19

METHODS:

  • Randomized, controlled, open-label, platform trial
    • UK (117 hospitals) | Indonesia (2 hospitals) | Nepal (2 hospitals)
  • Participants
    • Patients hospitalized with COVID-19
  • Interventions
    • Usual care
    • Usual care plus 150 mg aspirin once daily until discharge
  • Study design
    • All analyses were by intention to treat
    • Trial steering committee determined that study would end when enough patients enrolled to provide ≥90% power at a two-sided significance level of 1% to detect a clinically relevant proportional reduction in 28 day mortality of 12.5% between the two groups
    • Subgroup analysis: Age | Sex | Ethnicity | Amount of respiratory support | Days since symptom onset | Use of corticosteroids
  • Primary outcome
    • 28-day mortality
  • Secondary outcome
    • Composite: Progression to invasive mechanical ventilation or death within 28 days
    • Among patients not receiving invasive mechanical ventilation at randomization

RESULTS:

  • Aspirin group: 7351 patients | Usual care group: 7541 patients
  • There was no difference in 28-day mortality between the groups
    • Aspirin group: 17%
    • Usual care group: 17%
    • Rate ratio (RR) 0.96 (95% CI, 0.89 to 1.04); P=0.35
    • Results consistent in all prespecified patient subgroups
  • Patients is aspirin group had slightly shorter duration of hospitalization
    • Aspirin: median (IQR) 8 (5 to >28) days
    • Usual care: 9 (5 to >28) days
  • A higher proportion of aspirin patients were discharged from the hospital alive within 28 days
    • Aspirin: 75%
    • Usual care: 74%
    • Rate ratio 1.06 (95% CI, 1.02 to 1.10); P=0.0062
  • There was not difference for secondary composite outcome (invasive mechanical ventilation or death)
    • Aspirin: 21%
    • Usual care: 22%
    • Risk ratio 0.96 (95% CI, 0.90 to 1.03); P=0.23
  • Aspirin use was associated with
    • A reduction in thrombotic events
      • Aspirin: 4.6%
      • Usual care: 5.3%
      • Absolute reduction 0.6%
    • An increase in major bleeding events
      • Aspirin: 1.6%
      • Usual care: 1.0%
      • Absolute increase 0.6%

CONCLUSION:

  • Aspirin did not reduce 28-day mortality among patients hospitalized for COVID-19
  • There was a small increase in the rate of discharge at 28 days but also an increase in bleeding events
  • The authors state

In summary, the results of this large, randomised trial do not support the addition of aspirin to standard thromboprophylaxis or therapeutic anticoagulation in patients hospitalised with COVID-19 

Learn More – Primary Sources:

Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

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Related ObG Topics:

RECOVERY Trial: Does Tocilizumab Reduce Mortality in Hospitalized COVID-19 Patients?
RCT Results: Does Apixaban or Aspirin Improve Cardiopulmonary Outcomes in Symptomatic COVID-19 Outpatients?
Is Blood Viscosity Greater in Patients with Severe COVID-19?

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