Deans' stroke musings: Early aspirin use associated with lower odds of in-hospital mortality and pulmonary embolism in patients hospitalised with moderate COVID-19: Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 28, 2022

Early aspirin use associated with lower odds of in-hospital mortality and pulmonary embolism in patients hospitalised with moderate COVID-19: Study

As long as the hospital knows I'm already taking a daily 325 and keeps that up, I'm good.

Early aspirin use associated with lower odds of in-hospital mortality and pulmonary embolism in patients hospitalised with moderate COVID-19: Study

Early aspirin use was associated with lower odds of 28-day in-hospital mortality and pulmonary embolism incidence among patients hospitalised with moderate coronavirus disease 2019 (COVID-19), according to a study published in JAMA Network Open.

Additionally, the study found that important subgroups that may benefit from aspirin included patients older than 60 years and those with comorbidities.

“Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalised patients with COVID-19, but aspirin’s efficacy in patients with moderate COVID-19 is not well studied,” wrote Jonathan H Chow, MD, George Washington University School of Medicine and Health Sciences, Washington, DC, and colleagues.

To provide insight, researchers conducted an observational cohort study of 112,269 hospitalised patients with moderate COVID-19, enrolled from January 1, 2020 through September 10, 2021, at 64 health systems in the US participating in the National Institute of Health’s National COVID Cohort Collaborative. The COVID-19 severity level was based on the World Health Organization Clinical Progression Scale, with moderate disease being defined as infection requiring hospitalisation.

A total of 15,272 patients (13.6%; median age, 69 years) received aspirin on the first day of admission, while 96,997 (86.4%; median age, 61 years) patients did not receive aspirin. Median aspirin dose was 81 mg, and median treatment duration was 5 days (interquartile range [IQR], 2-10).

The primary outcome was 28-day in-hospital mortality, while secondary outcomes included in-hospital acute pulmonary embolism and acute deep vein thrombosis. Early aspirin use was defined as the administration of aspirin as part of routine care within the first day of hospitalisation.

After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in patients who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% confidence interval [CI], 0.79-0.92; P < 0.001). The relative mortality reduction of 13.6% and the absolute mortality reduction of 1.6%, noted the authors, suggested that 63 patients would need to be treated with early aspirin to prevent 1 in-hospital death.

Meanwhile, the rate of pulmonary embolism (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = 0.004), but not deep vein thrombosis (1.0% vs 1.0%; OR, 1.00; 95% CI, 0.78-1.28; P = 0.98), was also significantly lower in patients who received aspirin.

Further, subgroup analysis showed that patients who appeared to benefit the most included patients older than 60 years (61-80 years: OR, 0.79; 95% CI, 0.72-0.87; P < 0.001; >80 years: OR, 0.79; 95% CI, 0.69-0.91; P < 0.001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P < 0.001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = 0.003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P < 0.001; >3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P < 0.001).

On the other hand, patients receiving early aspirin between ages 18 and 40 years (OR, 1.45 ; 95% CI, 0.63-3.37; P = 0.38) and those aged between 41 and 60 years (OR, 0.88; 95% CI, 0.71-1.09; P = 0.24) did not have lower odds of mortality compared to those who did not receive aspirin. Similarly, in patients without comorbidities, there was no association between early aspirin administration and mortality (OR, 0.99; 95% CI, 0.80-1.23; P = 0.96).

Meanwhile, there were no significant differences between patients receiving early aspirin and those who did not in the rate of gastrointestinal hemorrhage (0.8% vs 0.7%; OR, 1.04; 95% CI, 0.82-1.33; P = 0.72), cerebral hemorrhage (0.6% vs 0.4%; OR, 1.32; 95% CI, 0.92-1.88; P = 0.13), or blood transfusion (2.7% vs 2.3%; OR, 1.14; 95% CI, 0.99-1.32; P = 0.06). Additionally, the composite of hemorrhagic complications did not occur more often in those receiving aspirin in comparison with those who did not receive aspirin (3.7% vs 3.2%; OR, 1.13; 95% CI, 1.00-1.28; P = 0.054).

“This study suggests that early aspirin use may be associated with lower odds of in-hospital mortality among hospitalised patients with moderate COVID-19,” the authors wrote, noting that the findings “are consistent with several prior observational studies of hospitalised patients.”

Nonetheless, the authors cautioned that “although the composite of hemorrhagic complications was not significantly higher in the early aspirin group, aspirin’s risks must be carefully weighed before treatment,” adding that “a randomised controlled trial in a diverse patient population with high-risk conditions is needed to confirm [these] findings because [this] study cannot definitively establish causality.”