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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Alamdari -28% 1.28 [0.67-2.43] death 9/53 54/406 Improvement, RR [CI] Treatment Control Meizlish (PSM) 48% 0.52 [0.34-0.81] death 319 (n) 319 (n) Liu (PSM) 75% 0.25 [0.07-0.87] death 2/28 11/204 Mura 15% 0.85 [0.69-1.01] death 527 (n) 527 (n) Chow 47% 0.53 [0.31-0.90] death 26/98 73/314 Sahai (PSM) 13% 0.87 [0.56-1.34] death 33/248 38/248 Horby (RCT) 4% 0.96 [0.89-1.04] death 1,222/7,351 1,299/7,541 Abdelwahab -8% 1.08 [0.15-3.82] ventilation 11/31 6/36 Al Harthi (PSM) 27% 0.73 [0.56-0.97] death 98/176 107/173 Kim (PSM) 34% 0.66 [0.36-1.23] death 14/124 23/135 Zhao 43% 0.57 [0.41-0.78] death 121/473 140/473 RECOVERY (RCT) 4% 0.96 [0.89-1.04] death 7,351 (n) 7,541 (n) Tau​2 = 0.03; I​2 = 77.1% Late treatment 23% 0.77 [0.67-0.89] 1,536/16,779 1,751/17,917 23% improvement Huh 71% 0.29 [0.14-0.58] cases population-based cohort Improvement, RR [CI] Treatment Control Wang 58% 0.42 [0.01-1.98] death 1/9 13/49 Yuan 4% 0.96 [0.47-1.72] death 11/52 29/131 Osborne (PSM) 59% 0.41 [0.35-0.48] death 272/6,300 661/6,300 Merzon 28% 0.72 [0.53-0.99] cases 73/1,621 589/8,856 Mulhem -14% 1.14 [0.93-1.40] death 300/1,354 216/1,865 Chow (PSM) 19% 0.81 [0.76-0.87] death 1,280/6,781 2,271/10,566 Kim (PSM) -700% 8.00 [1.07-59.6] death 6/15 1/20 Basheer -13% 1.13 [1.05-1.21] death 45/140 29/250 Sisinni -7% 1.07 [0.89-1.29] death 93/253 251/731 Pérez-Segura -49% 1.49 [1.20-1.80] death 66/155 183/608 Tau​2 = 0.16; I​2 = 94.1% Prophylaxis 15% 0.85 [0.64-1.12] 2,147/16,680 4,243/29,376 15% improvement All studies 20% 0.80 [0.70-0.92] 3,683/33,459 5,994/47,293 20% improvement 23 aspirin COVID-19 studies Dec 3, 2021 Tau​2 = 0.07; I​2 = 90.3%; Z = 3.11 Effect extraction pre-specified Favors aspirin Favors control
Database of all aspirin COVID-19 studies. Submit updates/corrections.
Restrict:    All    Late    Prophylaxis
Nov 18
Late RECOVERY Collaborative Group, The Lancet, doi:10.1016/S0140-6736(21)01825-0 (Peer Reviewed)
death, ↓4.0%, p=0.35
Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
Details   RCT 14,892 late stage patients, 7,351 treated with aspirin, showing slightly improved discharge and hospitalization time, and no significant difference for mortality. Results are limited due to low dose (150mg daily), late treatment (9 d..
Oct 14
Late Santoro et al., European Heart Journal, doi:10.1093/eurheartj/ehab724.3002 (Peer Reviewed)
death, ↓71.0%, p<0.0001
Antiplatelet therapy and outcome in patients with COVID-19. Results from a multi-center international prospective registry (HOPE-COVID19)
Details   Retrospective database analysis of 7,824 patients in the HOPE-COVID19 registry, 730 receiving antiplatelet therapy including aspirin, showing lower mortality with treatment. Authors do not provide results restricted to aspirin.
Oct 4
PrEPPEP Pérez-Segura et al., Medicina Clínica, doi:10.1016/j.medcle.2021.02.010 (Peer Reviewed)
death, ↑49.1%, p=0.0001
Prognostic factors at admission on patients with cancer and COVID-19: Analysis of HOPE registry data
Details   Retrospective 770 COVID-19 patients with cancer, showing increased mortality with aspirin use in unadjusted results.
Oct 4
PrEPPEP Sisinni et al., International Journal of Cardiology, doi:10.1016/j.ijcard.2021.09.058 (Peer Reviewed)
death, ↑7.1%, p=0.65
Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study
Details   Retrospective 984 COVID-19 patients, 253 taking aspirin prior to admission, showing lower risk of respiratory support upgrade with treatment.
Oct 2
PrEPPEP Basheer et al., Metabolites, doi:10.3390/metabo11100679 (Peer Reviewed)
death, ↑13.0%, p=0.0003
Clinical Predictors of Mortality and Critical Illness in Patients with COVID-19 Pneumonia
Details   Retrospective 390 hospitalized patients in Israel, showing higher risk of mortality with prior aspirin use. Details of the analysis are not provided.
Oct 1
Late Zhao et al., Anesthesiology, doi:10.1097/ALN.0000000000003999 (Peer Reviewed)
death, ↓43.0%, p=0.0006
Treatments Associated with Lower Mortality among Critically Ill COVID-19 Patients: A Retrospective Cohort Study
Details   Retrospective 2,070 hospitalized patients in the USA, showing lower mortality with aspirin treatment.
Sep 4
PrEPPEP Kim et al., Medicina, doi:10.3390/medicina57090931 (Peer Reviewed)
death, ↑700.0%, p=0.03
Aspirin Is Related to Worse Clinical Outcomes of COVID-19
Details   Retrospective database analysis of 22,660 patients tested for COVID-19 in South Korea. There was no significant difference in cases according to aspirin use. Aspirin use before COVID-19 was related to an increased death rate and aspirin u..
Sep 3
Late Al Harthi et al., Research Square, doi:10.21203/ (Preprint)
death, ↓27.0%, p=0.03
Evaluation of low-dose aspirin use among COVID-19 critically ill patients: A Multicenter Propensity Score Matched Study
Details   Retrospective 1,033 critical condition patients, showing lower in-hospital mortality with aspirin in PSM analysis. Patients receiving aspirin also had a higher risk of significant bleeding, although not reaching statistical significance. ..
Aug 29
PrEPPEP Chow et al., Journal of Thrombosis and Haemostasis, doi:10.1111/jth.15517 (Peer Reviewed)
death, ↓19.0%, p<0.005
Association of Pre-Hospital Antiplatelet Therapy with Survival in Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis
Details   PSM retrospective 6,781 hospitalized patients ≥50 years old in the USA who were on pre-hospital antiplatelet therapy (84% aspirin), and 10,566 matched controls, showing lower mortality with treatment.
Jul 30
Late Abdelwahab et al., Clinical Drug Investigation, doi:10.1007/s40261-021-01061-2 (Peer Reviewed)
ventilation, ↑7.8%, p=0.93
Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study
Details   Retrospective 225 hospitalized patients in Egypt, showing significantly lower thromboembolic events with aspirin treatment, but no significant difference in the need for mechanical ventilation.
Jun 8
Late Horby et al., medRxiv, doi:10.1101/2021.06.08.21258132 (Preprint)
death, ↓4.0%, p=0.35
Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
Details   RCT 14,892 very late stage (9 days from symptom onset) hospitalized patients, not showing a significant difference in mortality with treatment. A statistically significant increased chance of hospital discharge was found for treatment <= ..
May 19
Late Sahai et al., Vascular Medicine, doi:10.1177/1358863X211012754 (Peer Reviewed)
death, ↓13.2%, p=0.53
Effect of aspirin on short-term outcomes in hospitalized patients with COVID-19
Details   PSM retrospective 1,994 PCR+ patients in the USA, not showing a significant difference in mortality with aspirin treatment.
Apr 7
PrEPPEP Mulhem et al., BMJ Open, doi:10.1136/bmjopen-2020-042042 (Peer Reviewed)
death, ↑13.9%, p=0.21
3219 hospitalised patients with COVID-19 in Southeast Michigan: a retrospective case cohort study
Details   Retrospective database analysis of 3,219 hospitalized patients in the USA. Very different results in the time period analysis (Table S2), and results significantly different to other studies for the same medications (e.g., heparin OR 3.06..
Apr 1
Late Chow et al., Anesthesia & Analgesia, doi:10.1213/ANE.0000000000005292 (Peer Reviewed)
death, ↓47.0%, p=0.02
Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019
Details   Retrospective 412 hospitalized patients, 98 treated with aspirin, showing lower mortality, ventilation, and ICU admission with treatment.
Mar 31
Late Mura et al., Signal Transduction and Targeted Therapy, doi:10.1038/s41392-021-00689-y (preprint 3/31/2021) (Peer Reviewed)
death, ↓15.4%, p=0.08
Real-world evidence for improved outcomes with histamine antagonists and aspirin in 22,560 COVID-19 patients
Details   PSM retrospective TriNetX database analysis of 1,379 severe COVID-19 patients requiring respiratory support, showing lower mortality with aspirin (not reaching statistical significance) and famotidine, and improved results from the combin..
Feb 23
PrEPPEP Merzon et al., The FEBS Journal, doi:10.1111/febs.15784 (Peer Reviewed)
cases, ↓27.6%, p=0.04
The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection
Details   Retrospective 10,477 patients in Israel, showing lower risk of COVID-19 cases with existing aspiring use.
Feb 12
Late Liu et al., Medicine, doi:10.1097/MD.0000000000024544 (Peer Reviewed)
death, ↓75.0%, p=0.03
Effect of low-dose aspirin on mortality and viral duration of the hospitalized adults with COVID-19
Details   Retrospective PSM analysis of 232 hospitalized patients, 28 treated with aspirin, showing lower mortality with treatment. There was no significant difference in viral clearance.
Feb 11
PrEPPEP Osborne et al., PloS ONE, doi:10.1371/journal.pone.0246825 (Peer Reviewed)
death, ↓59.4%, p<0.0001
Association of mortality and aspirin prescription for COVID-19 patients at the Veterans Health Administration
Details   Retrospective PSM analysis of pre-existing aspirin use in the USA, showing lower mortality with treatment.
Jan 21
Late Meizlish et al., American Journal of Hematology, doi:10.1002/ajh.26102 (Peer Reviewed)
death, ↓47.8%, p=0.004
Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: A propensity score-matched analysis
Details   Retrospective 638 matched hospitalized patients in the USA, 319 treated with aspirin, showing lower mortality with treatment.
Dec 18
PrEPPEP Yuan et al., Journal of Cellular and Molecular Medicine, doi:10.1111/jcmm.16198 (Peer Reviewed)
death, ↓4.4%, p=0.89
Mortality and pre-hospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease
Details   Retrospective 183 hospitalized patients in China, 52 taking low-dose aspirin prior to hospitalization, showing no significant difference with treatment.
Sep 9
Late Alamdari et al., Tohoku J. Exp. Med., 2020, 252, 73-84, doi:10.1620/tjem.252.73 (Peer Reviewed)
death, ↑27.7%, p=0.52
Mortality Risk Factors among Hospitalized COVID-19 Patients in a Major Referral Center in Iran
Details   Retrospective 459 patients in Iran, 53 treated with aspirin, showing no significant difference with treatment.
Jul 14
PrEPPEP Wang et al., Journal of Hematology & Oncology, doi:10.1186/s13045-020-00934-x (Peer Reviewed)
death, ↓57.7%, p=0.43
A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward
Details   Retrospective 58 multiple myeloma COVID-19 patients in the USA, showing no significant difference with aspirin treatment.
May 18
PrEPPEP Huh et al., medRxiv, doi:10.1101/2020.05.04.20089904 (Preprint)
cases, ↓71.0%, p=0.001
Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea
Details   Retrospective database analysis of 65,149 in South Korea, showing significantly lower cases with existing aspirin treatment. The journal version of this paper does not present the aspirin results (only combined results for NSAIDs).
Please send us corrections, updates, or comments. Vaccines and treatments are both extremely valuable and complementary. All practical, effective, and safe means should be used. Elimination of COVID-19 is a race against viral evolution. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. Denying the efficacy of any method increases the risk of COVID-19 becoming endemic; and increases mortality, morbidity, and collateral damage. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. Treatment protocols for physicians are available from the FLCCC.
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