Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Aspirin vs Standard care/Placebo

This comparison will not be updated. Last search date 28 Feb, 2022.

On March 17, 2022 study Ghati, 2021 was excluded from the analysis since the paper is not anymore accessible on SSRN nor on published elsewhere. We have contacted authors for further details.

Outpatients

Forest plots
(last update: 2022-04-29)

Hospitalized patients

Forest plots
(last update: 2022-03-17)

Summary of findings
(last update: 2022-06-01)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Aspirin
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.02 (1.00 - 1.04)	15 more per 1000 (from 0 fewer to 29 more)		High certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Not serious
1 trials Horby P, 2021 14892 participants		Aspirin 750 per 1,000 (736 - 765)	Standard care/Placebo 736 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	Outcome not yet measured or reported
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.97 (0.90 - 1.04)	5 fewer per 1000 (from 17 fewer to 7 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Horby P, 2021 81052 participants		Aspirin 167 per 1,000 (155 - 179)	Standard care/Placebo 172 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	Outcome not yet measured or reported
Serious adverse events	Outcome not yet measured or reported

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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click here for Outpatients
click here for Hospitalized patients

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=371

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NCT04498273 ACTIV-4B Connors JM, JAMA, 2021 Full text Commentary	Public/non profit	Aspirin Apixaban prophylactic-dose Apixaban therapeutic-dose	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated in 52 centers in USA	N=657	Some concerns Details	Full description
NCT04381936; ISRCTN50189673 RECOVERY-ASA Horby P, Lancet, 2021 Full text Full text Commentary Commentary	Mixed	Aspirin	Standard care	RCT	Patients with suspected and confirmed COVID-19 (mild-critical) admitted to 167 hospitals in the UK, 2 hospitals in Indonesia and 2 hospitals in Nepal	N=14892	Some concerns Details	Full description

Trial

Funding

Comparisons

Design

Participants

Sample size

Overall risk
of bias
Highest assessment

Full description

Treatment 1

Treatment 2

NCT04498273
ACTIV-4B
Connors JM, JAMA, 2021
Full text
Commentary

Public/non profit

Aspirin

Apixaban prophylactic-dose

Apixaban therapeutic-dose

Placebo

RCT

Outpatients with confirmed COVID-19 (mild) treated in 52 centers in USA

N=657

Some concerns
Details

Full description

NCT04381936; ISRCTN50189673
RECOVERY-ASA
Horby P, Lancet, 2021
Full text
Full text
Commentary
Commentary

Mixed

Aspirin

Standard care

RCT

Patients with suspected and confirmed COVID-19 (mild-critical) admitted to 167 hospitals in the UK, 2 hospitals in Indonesia and 2 hospitals in Nepal

N=14892

Some concerns
Details

Full description