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Low dose aspirin and clinical outcomes in patients with SARS-CoV-2 pneumonia: a propensity score-matched cohort analysis from the National SIMI‑COVID‑19 Registry

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Abstract

Background

SARS- CoV-2 virus has had dramatic consequences worldwide being able to cause acute respiratory distress syndrome (ARDS), massive thrombosis and pulmonary embolism and, finally, patients’ death. In COVID-19 infection, platelets have a procoagulant phenotype that can cause thrombosis in the pulmonary and systemic vascular network. Aspirin is a well-known anti-platelet drug widely used for the prevention of cardiovascular events and systematic reviews suggest a possible benefit of low-dose aspirin (LDA) use in the prevention and treatment of ARDS in patients with COVID-19 infection. However, several studies are available in the literature which do not support any benefits and no association with the patients’ outcome. Therefore, currently available data are inconclusive.

Materials and patients

Data from the nationwide cohort multicenter study of the Italian Society of Internal Medicine (SIMI) were analyzed. We conducted a propensity score-matched cohort analysis to investigate the impact of chronic assumption of LDA on mortality of adult COVID-19 patients admitted in Internal Medicine Units (IMU). Data from 3044 COVID-19 patients who referred to 41 Italian hospitals between February 3rd to May 8th 2020 were analyzed. A propensity score-matched analysis was conducted using the following variables: age, sex, hypertension, hyperlipidemia diabetes, atrial fibrillation, cerebrovascular disease, COPD, CKD and stratified upon LDA usage, excluding anticoagulant treatment. After matching, 380 patients were included in the final analysis (190 in LDA group and 190 in no-LDA group).

Results

66.2% were male, median age was 77 [70–83]. 34.8% of the population died during the hospitalization. Cardiovascular diseases were not significantly different between the groups. After comparison of LDA and no-LDA subgroups, we didn’t record a significant difference in mortality rate (35.7% vs 33.7%) duration of hospital stay and ICU admission. In a logistic regression model, age (OR 1.05; 95% CI 1.01–1.09), FiO2 (OR 1.024; 95% CI 1.03–1.04) and days between symptoms onset and hospitalization (OR 0.93; 95% CI 0.87–0.99) were the only variables independently associated with death.

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Acknowledgements

Collaborators and co-authors of the GIS Group (Giovani Internisti SIMI, Società Italiana di Medicina Interna) are as follows: Giuseppe Armentaro (Catanzaro), Maria Immacolata Arnone (Napoli), Milena Barone (Catanzaro), Leonardo Bencivenga (Napoli), Lorenzo Bertolino (Napoli), Sara Bianco (Novara), Nicolò Binello (Roma), Simona Brancati (Empoli, FI), Elena Buzzetti (Modena), William Capeci (Ancona), Sebastiano Cicco (Bari), William Cordeddu (Cagliari), Rosa Curcio (Perugia), Marco D’Abbondanza (Terni), Salvatore D’Agnano (Torino), Damiano D’Ardes (Chieti), Martina De Feo (L’Aquila), Salvatore Di Marca (Catania), Emilia Donnarumma (Firenze), Marco Fei (Cagliari), Emanuele Filippini (Ancona), Carmine Gabriele Gambino (Padova), Rosa Lombardi (Milano), Alberto Maria Marra (Napoli), Massimo Mattioli (Ancona), Giuseppe Miceli (Palermo), Silvia Noviello (Bari), Gaia Olivieri (Trieste), Donatella Padula (Milano), Roberta Parente (Salerno), Chiara Pes (Sassari), Salvatore Piano (Padova), Francesca Serena Pignataro (Roma), Sonia Poma (Palermo), Enrica Porceddu (Roma), Marco Ricchio (Catanzaro), Giulio Francesco Romiti (Roma), Anna Sabena (Pavia), Marco Salice (Bologna), Andrea Salzano (Napoli), Moris Sangineto (Foggia), Ambra Savona (Parma), Caterina Savrié (Ferrara), Mario Stabile (Genova), Thomas Teatini (Milano), Elisabetta Tombolini (Milano), Matteo Traversa (Torino), Elia Vettore (Padova), Alessandro Vignali (Parma), Luca Vilardi (Sassari).

Author information

Authors and Affiliations

  1. Section General Medicine C and Liver Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy

    A. Dalbeni & A. Giontella

  2. Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari Medical School, 70124, Bari, Italy

    N. Susca

  3. Internal Medicine and Stroke Care Ward. Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche N.2, Palermo, Italy

    M. Daidone

  4. Department of Medicine and Aging Sciences, Clinica Medica” Institute, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy

    I. Rossi

  5. Internal Medicine Unit, Pugliese-Ciaccio, Hospital, 88100, Catanzaro, Italy

    A. Cimellaro

  6. Internal Medicine Unit, Policlinico Casilino, Rome, Italy

    G. Talerico

  7. Liver Unit, Centro Universitario per la Ricerca e la Cura delle Epatopatie (C.U.R.E.), Università di Foggia, 71100, Foggia, Italy

    R. Villani

  8. Internal Medicine Unit, Department of Surgical and Medical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy

    A. Pietrangelo

  9. Department of Clinical and Molecular Medicine, University of Rome-Sapienza, 00189, Rome, Italy

    G. Sesti

  10. Department of Emergency Medicine, Internal and Sub-Intensive Medicine, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60166, Ancona, Italy

    V. Zaccone

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  1. A. Dalbeni
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Consortia

Giovani Internisti SIMI (GIS)

  • Giuseppe Armentaro
  • , Maria Immacolata Arnone
  • , Milena Barone
  • , Leonardo Bencivenga
  • , Lorenzo Bertolino
  • , Sara Bianco
  • , Nicolò Binello
  • , Simona Brancati
  • , Elena Buzzetti
  • , William Capeci
  • , Sebastiano Cicco
  • , William Cordeddu
  • , Rosa Curcio
  • , Marco D’Abbondanza
  • , Salvatore D’Agnano
  • , Damiano D’Ardes
  • , Martina De Feo
  • , Salvatore Di Marca
  • , Emilia Donnarumma
  • , Marco Fei
  • , Emanuele Filippini
  • , Carmine Gabriele Gambino
  • , Rosa Lombardi
  • , Alberto Maria Marra
  • , Massimo Mattioli
  • , Giuseppe Miceli
  • , Silvia Noviello
  • , Gaia Olivieri
  • , Donatella Padula
  • , Roberta Parente
  • , Chiara Pes
  • , Salvatore Piano
  • , Francesca Serena Pignataro
  • , Sonia Poma
  • , Enrica Porceddu
  • , Marco Ricchio
  • , Giulio Francesco Romiti
  • , Anna Sabena
  • , Marco Salice
  • , Andrea Salzano
  • , Moris Sangineto
  • , Ambra Savona
  • , Caterina Savrié
  • , Mario Stabile
  • , Thomas Teatini
  • , Elisabetta Tombolini
  • , Matteo Traversa
  • , Elia Vettore
  • , Alessandro Vignali
  •  & Luca Vilardi

Corresponding author

Correspondence to V. Zaccone.

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The members of the Giovani Internisti SIMI (GIS) are mentioned in the Acknowledgements section.

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Dalbeni, A., Susca, N., Daidone, M. et al. Low dose aspirin and clinical outcomes in patients with SARS-CoV-2 pneumonia: a propensity score-matched cohort analysis from the National SIMI‑COVID‑19 Registry. Intern Emerg Med 18, 2311–2319 (2023). https://doi.org/10.1007/s11739-023-03432-3

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