阿司匹林对COVID-19临床结局的影响：Meta分析
Effects of Aspirin on Clinical Outcomes of COVID-19: A Meta-Analysis
摘要: 目的：系统评价阿司匹林对COVID-19患者临床结局的影响。方法：计算机检索PubMed数据库，搜集阿司匹林对COVID-19患者临床结局影响的研究，检索时限为2019年12月1日至2022年10月31日，文献筛选、资料提取、纳入研究的偏倚风险评价均由2位研究员独立完成，之后采用RevMan 5.4软件进行Meta分析。结果：共纳入20个研究，包括221,263例患者。Meta分析的结果显示，阿司匹林组与对照组在COVID-19患者死亡率[OR = 1.09，95% CI为(0.93, 1.29)，P = 0. 28]、进展到ICU [OR = 1.86，95% CI为(0.53, 6.60)，P = 0. 33]和使用机械通气[OR = 0.94，95% CI为(0.68, 1.31)，P = 0.73]、发生血栓事件[OR = 1.34，95% CI为(0.77, 2.32)，P = 0. 30]、大出血事件[OR = 1.25，95% CI为(0.85, 1.83)，P = 0.26]之间比较差异无统计学意义。结论：阿司匹林在降低COVID-19患者死亡率、血栓及大出血事件、进展到ICU及使用机械通气没有保护作用。由于受到纳入研究质量和数量的限制，尚需开展更多高质量研究对上述结论予以验证。
Abstract: 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.
文章引用：李田田, 王蒙蒙. 阿司匹林对COVID-19临床结局的影响：Meta分析[J]. 临床医学进展, 2024, 14(7): 901-911. https://doi.org/10.12677/acm.2024.1472094

参考文献

[1] Chow, J.H., Khanna, A.K., Kethireddy, S., Yamane, D., Levine, A., Jackson, A.M., et al. (2020) Aspirin Use Is Associated with Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients with Coronavirus Disease 2019. Anesthesia & Analgesia, 132, 930-941. [Google Scholar] [CrossRef] [PubMed]
[2] Formiga, F., Rubio-Rivas, M., Mora-Luján, J.M., et al. (2022) Does Admission Acetylsalicylic Acid Uptake in Hospitalized COVID-19 Patients Have a Protective Role? Data from the Spanish SEMI-COVID-19 Registry. Internal and Emergency Medicine, 17, 761-775.
[3] RECOVERY Collaborative Group (2021) Tocilizumab in Patients Admitted to Hospital with COVID-19 (RECOVERY): A Randomised, Controlled, Open-Label, Platform Trial. The Lancet, 397, 1637-1645.
[4] Chow, J.H., Rahnavard, A., Gomberg-Maitland, M., et al. (2022) Association of Early Aspirin Use with In-Hospital Mortality in Patients with Moderate COVID-19. JAMA Network Open, 5, e223890.
[5] Kevorkian, J., Lopes, A., Sène, D., Riveline, J., Vandiedonck, C., Féron, F., et al. (2021) Oral Corticoid, Aspirin, Anticoagulant, Colchicine, and Furosemide to Improve the Outcome of Hospitalized COVID-19 Patients—The COCAA-COLA Cohort Study. Journal of Infection, 82, 276-316. [Google Scholar] [CrossRef] [PubMed]
[6] Chow, J.H., Yin, Y., Yamane, D.P., Davison, D., Keneally, R.J., Hawkins, K., et al. (2021) Association of Prehospital Antiplatelet Therapy with Survival in Patients Hospitalized with COVID‐19: A Propensity Score‐matched Analysis. Journal of Thrombosis and Haemostasis, 19, 2814-2824. [Google Scholar] [CrossRef] [PubMed]
[7] Gogtay, M., Singh, Y., Bullappa, A. and Scott, J. (2022) Retrospective Analysis of Aspirin’s Role in the Severity of COVID-19 Pneumonia. World Journal of Critical Care Medicine, 11, 92-101. [Google Scholar] [CrossRef] [PubMed]
[8] Al Harthi, A.F., Aljuhani, O., Korayem, G.B., Altebainawi, A.F., Alenezi, R.S., Al Harbi, S., et al. (2022) Evaluation of Low-Dose Aspirin Use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study. Journal of Intensive Care Medicine, 37, 1238-1249. [Google Scholar] [CrossRef] [PubMed]
[9] Haji Aghajani, M., Moradi, O., Amini, H., Azhdari Tehrani, H., Pourheidar, E., Rabiei, M.M., et al. (2021) Decreased In‐Hospital Mortality Associated with Aspirin Administration in Hospitalized Patients Due to Severe Covid‐19. Journal of Medical Virology, 93, 5390-5395. [Google Scholar] [CrossRef] [PubMed]
[10] Alamdari, N.M., Afaghi, S., Rahimi, F.S., Tarki, F.E., Tavana, S., Zali, A., et al. (2020) Mortality Risk Factors among Hospitalized COVID-19 Patients in a Major Referral Center in Iran. The Tohoku Journal of Experimental Medicine, 252, 73-84. [Google Scholar] [CrossRef] [PubMed]
[11] Liu, Q., Huang, N., Li, A., Zhou, Y., Liang, L., Song, X., et al. (2021) Effect of Low-Dose Aspirin on Mortality and Viral Duration of the Hospitalized Adults with Covid-19. Medicine, 100, e24544. [Google Scholar] [CrossRef] [PubMed]
[12] Lodigiani, C., Iapichino, G., Carenzo, L., Cecconi, M., Ferrazzi, P., Sebastian, T., et al. (2020) Venous and Arterial Thromboembolic Complications in COVID-19 Patients Admitted to an Academic Hospital in Milan, Italy. Thrombosis Research, 191, 9-14. [Google Scholar] [CrossRef] [PubMed]
[13] Merzon, E., Green, I., Vinker, S., Golan‐Cohen, A., Gorohovski, A., Avramovich, E., et al. (2021) The Use of Aspirin for Primary Prevention of Cardiovascular Disease Is Associated with a Lower Likelihood of COVID‐19 Infection. The FEBS Journal, 288, 5179-5189. [Google Scholar] [CrossRef] [PubMed]
[14] Osborne, T.F., Veigulis, Z.P., Arreola, D.M., Mahajan, S.M., Röösli, E. and Curtin, C.M. (2021) Association of Mortality and Aspirin Prescription for COVID-19 Patients at the Veterans Health Administration. PLOS ONE, 16, e0246825. [Google Scholar] [CrossRef] [PubMed]
[15] Sahai, A., Bhandari, R., Koupenova, M., et al. (2020) SARS-CoV-2 Receptors Are Expressed on Human Platelets and the Effect of Aspirin on Clinical Outcomes in COVID-19 Patients.
[16] Sisinni, A., Rossi, L., Battista, A., Poletti, E., Battista, F., Battista, R.A., et al. (2021) Pre-Admission Acetylsalicylic Acid Therapy and Impact on In-Hospital Outcome in COVID-19 Patients: The ASA-CARE Study. International Journal of Cardiology, 344, 240-245. [Google Scholar] [CrossRef] [PubMed]
[17] Son, M., Noh, M., Lee, J.H., Seo, J., Park, H. and Yang, S. (2021) Effect of Aspirin on Coronavirus Disease 2019: A Nationwide Case-Control Study in South Korea. Medicine, 100, e26670. [Google Scholar] [CrossRef] [PubMed]
[18] Sullerot, C., Bouiller, K., Laborde, C., Gilis, M., Fèvre, A., Hacquin, A., et al. (2022) Premorbid Aspirin Use Is Not Associated with Lower Mortality in Older Inpatients with SARS-CoV-2 Pneumonia. GeroScience, 44, 573-583. [Google Scholar] [CrossRef] [PubMed]
[19] Viecca, M., Radovanovic, D., Forleo, G.B. and Santus, P. (2020) Enhanced Platelet Inhibition Treatment Improves Hypoxemia in Patients with Severe Covid-19 and Hypercoagulability. A Case Control, Proof of Concept Study. Pharmacological Research, 158, Article ID: 104950. [Google Scholar] [CrossRef] [PubMed]
[20] Yuan, S., Chen, P., Li, H., Chen, C., Wang, F. and Wang, D.W. (2020) Mortality and Pre‐Hospitalization Use of Low‐Dose Aspirin in COVID‐19 Patients with Coronary Artery Disease. Journal of Cellular and Molecular Medicine, 25, 1263-1273. [Google Scholar] [CrossRef] [PubMed]
[21] Srivastava, R. and Kumar, A. (2021) Use of Aspirin in Reduction of Mortality of COVID‐19 Patients: A Meta‐Analysis. International Journal of Clinical Practice, 75, e14515. [Google Scholar] [CrossRef] [PubMed]
[22] Brambilla, M., Canzano, P., Becchetti, A., Tremoli, E. and Camera, M. (2021) Alterations in Platelets during SARS-CoV-2 Infection. Platelets, 33, 192-199. [Google Scholar] [CrossRef] [PubMed]
[23] Sayed Ahmed, H.A., Merrell, E., Ismail, M., Joudeh, A.I., Riley, J.B., Shawkat, A., et al. (2021) Rationales and Uncertainties for Aspirin Use in COVID-19: A Narrative Review. Family Medicine and Community Health, 9, e000741. [Google Scholar] [CrossRef] [PubMed]
[24] Manarini, S., Dell’Elba, G., Martelli, N., Napoleone, E., Santo, A.D., Savi, P., et al. (2005) Clopidogrel Inhibits Platelet-Leukocyte Adhesion and Plateletdependent Leukocyte Activation. Thrombosis and Haemostasis, 94, 568-577. [Google Scholar] [CrossRef] 
[25] Hussain, M., Javeed, A., Ashraf, M., Zhao, Y., Mukhtar, M.M. and Rehman, M.U. (2012) Aspirin and Immune System. International Immunopharmacology, 12, 10-20. [Google Scholar] [CrossRef] [PubMed]
[26] Morris, T., Stables, M., Hobbs, A., de Souza, P., Colville-Nash, P., Warner, T., et al. (2009) Effects of Low-Dose Aspirin on Acute Inflammatory Responses in Humans. The Journal of Immunology, 183, 2089-2096. [Google Scholar] [CrossRef] [PubMed]
[27] Manne, B.K., Denorme, F., Middleton, E.A., Portier, I., Rowley, J.W., Stubben, C., et al. (2020) Platelet Gene Expression and Function in Patients with Covid-19. Blood, 136, 1317-1329. [Google Scholar] [CrossRef] [PubMed]
[28] Gurbel, P.A., Bliden, K.P. and Schrör, K. (2020) Can an Old Ally Defeat a New Enemy? Circulation, 142, 315-317. [Google Scholar] [CrossRef] [PubMed]
[29] Bianconi, V., Violi, F., Fallarino, F., Pignatelli, P., Sahebkar, A. and Pirro, M. (2020) Is Acetylsalicylic Acid a Safe and Potentially Useful Choice for Adult Patients with COVID-19? Drugs, 80, 1383-1396. [Google Scholar] [CrossRef] [PubMed]
[30] Paranjpe, I., Fuster, V., Lala, A., Russak, A.J., Glicksberg, B.S., Levin, M.A., et al. (2020) Association of Treatment Dose Anticoagulation with In-Hospital Survival among Hospitalized Patients with Covid-19. Journal of the American College of Cardiology, 76, 122-124. [Google Scholar] [CrossRef] [PubMed]
[31] Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., et al. (2020) Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID-19 in Wuhan, China: A Retrospective Cohort Study. The Lancet, 395, 1054-1062. [Google Scholar] [CrossRef] [PubMed]
[32] Barnes, G.D., Burnett, A., Allen, A., Ansell, J., Blumenstein, M., Clark, N.P., et al. (2022) Thromboembolic Prevention and Anticoagulant Therapy during the COVID-19 Pandemic: Updated Clinical Guidance from the Anticoagulation Forum. Journal of Thrombosis and Thrombolysis, 54, 197-210. [Google Scholar] [CrossRef] [PubMed]

为你推荐