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dc.contributor.authorChow, Jonathan H
dc.contributor.authorRahnavard, Ali
dc.contributor.authorGomberg-Maitland, Mardi
dc.contributor.authorChatterjee, Ranojoy
dc.contributor.authorPatodi, Pranay
dc.contributor.authorYamane, David P
dc.contributor.authorLevine, Andrea R
dc.contributor.authorDavison, Danielle
dc.contributor.authorHawkins, Katrina
dc.contributor.authorJackson, Amanda M
dc.contributor.authorQuintana, Megan T
dc.contributor.authorLankford, Allison S
dc.contributor.authorKeneally, Ryan J
dc.contributor.authorAl-Mashat, Mustafa
dc.contributor.authorFisher, Daniel
dc.contributor.authorWilliams, Jeffrey
dc.contributor.authorBerger, Jeffrey S
dc.contributor.authorMazzeffi, Michael A
dc.contributor.authorCrandall, Keith A
dc.date.accessioned2022-03-28T13:26:47Z
dc.date.available2022-03-28T13:26:47Z
dc.date.issued2022-03-01
dc.identifier.urihttp://hdl.handle.net/10713/18383
dc.description.abstractImportance: Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin's efficacy in patients with moderate COVID-19 is not well studied. Objective: To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19. Design, setting, and participants: Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health's National COVID Cohort Collaborative (N3C). Exposure: Aspirin use within the first day of hospitalization. Main outcome and measures: The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups. Results: Among the 2 446 650 COVID-19-positive patients who were screened, 189 287 were hospitalized and 112 269 met study inclusion. For the full cohort, Median age was 63 years (IQR, 47-74 years); 16.1% of patients were African American, 3.8% were Asian, 52.7% were White, 5.0% were of other races and ethnicities, 22.4% were of unknown race and ethnicity. In-hospital mortality occurred in 10.9% of patients. After inverse probability treatment weighting, 28-day in-hospital mortality was significantly lower in those who received aspirin (10.2% vs 11.8%; odds ratio [OR], 0.85; 95% CI, 0.79-0.92; P < .001). The rate of pulmonary embolism, but not deep vein thrombosis, was also significantly lower in patients who received aspirin (1.0% vs 1.4%; OR, 0.71; 95% CI, 0.56-0.90; P = .004). Patients who received early aspirin did not have higher rates of gastrointestinal hemorrhage (0.8% aspirin vs 0.7% no aspirin; OR, 1.04; 95% CI, 0.82-1.33; P = .72), cerebral hemorrhage (0.6% aspirin vs 0.4% no aspirin; OR, 1.32; 95% CI, 0.92-1.88; P = .13), or blood transfusion (2.7% aspirin vs 2.3% no aspirin; OR, 1.14; 95% CI, 0.99-1.32; P = .06). The composite of hemorrhagic complications did not occur more often in those receiving aspirin (3.7% aspirin vs 3.2% no aspirin; OR, 1.13; 95% CI, 1.00-1.28; P = .054). Subgroups 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 < .001; >80 years: OR, 0.79; 95% CI, 0.69-0.91; P < .001) and patients with comorbidities (1 comorbidity: 6.4% vs 9.2%; OR, 0.68; 95% CI, 0.55-0.83; P < .001; 2 comorbidities: 10.5% vs 12.8%; OR, 0.80; 95% CI, 0.69-0.93; P = .003; 3 comorbidities: 13.8% vs 17.0%, OR, 0.78; 95% CI, 0.68-0.89; P < .001; >3 comorbidities: 17.0% vs 21.6%; OR, 0.74; 95% CI, 0.66-0.84; P < .001). Conclusions and relevance: In this cohort study of US adults hospitalized with moderate COVID-19, early aspirin use was associated with lower odds of 28-day in-hospital mortality. A randomized clinical trial that includes diverse patients with moderate COVID-19 is warranted to adequately evaluate aspirin's efficacy in patients with high-risk conditions.en_US
dc.description.urihttps://doi.org/10.1001/jamanetworkopen.2022.3890en_US
dc.language.isoenen_US
dc.publisherAmerican Medical Associationen_US
dc.relation.ispartofJAMA Network Openen_US
dc.titleAssociation of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19.en_US
dc.typeArticleen_US
dc.identifier.doi10.1001/jamanetworkopen.2022.3890
dc.identifier.pmid35323950
dc.source.journaltitleJAMA network open
dc.source.volume5
dc.source.issue3
dc.source.beginpagee223890
dc.source.endpage
dc.source.countryUnited States


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