J. Pharm. Pharmacogn. Res., vol. 14, no. 5, Article ID 2652, Sep-Oct 2026.
DOI: https://doi.org/10.56499/jppres_14.5.2652
Review
Aspirin use and clinical outcomes in coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis
[Uso de aspirina y desenlaces clínicos en la enfermedad por coronavirus de 2019 (COVID-19): revisión sistemática y metanálisis]
Krittin Bunditanukul1, Yotsaya Kunlamas1, Trai Tharnpanich1, Sirichai Chusiri1, Jiraphan Ritsamdang1, Chaisiri Wanlapakorn2, Bunchai Chongmelaxme3,4,5*
1Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Phyathai Road, Pathumwan, Bangkok, 10330, Thailand.
2Division of Cardiovascular Disease, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
3Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
4The Federation of Asian Pharmaceutical Associations (FAPA), College of Pharmacy, Bangkok, Thailand.
5Revolution Health Research Consulting (RHRC) Group, Bangkok, Thailand.
*E-mail: bunchai.c@chula.ac.th
Abstract
Context: Aspirin has been proposed as an adjunctive therapy for COVID-19. However, its clinical benefit remains uncertain.
Aims: This systematic review and meta-analysis was conducted to evaluate whether aspirin use was associated with short-term all-cause mortality in adults with confirmed COVID-19.
Methods: The review was registered in PROSPERO (CRD42022361632). PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and Scopus were searched from inception to September 2024. Randomized controlled trials and non-randomized studies comparing aspirin plus standard care with standard care alone were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects models were used to estimate pooled risk ratios or mean differences with 95% confidence intervals.
Results: Thirty-three studies were included. Thirty-one studies contributed to quantitative syntheses, and the primary mortality analysis was based on five randomized controlled trials. Aspirin use was not associated with reduced short-term all-cause mortality compared with control treatment (RR 0.95; 95% CI, 0.89-1.02). Aspirin use was associated with a significantly increased risk of major bleeding compared with control (RR 1.38, 95% CI 1.10–1.73; p = 0.01). Evidence certainty was limited by risk of bias, heterogeneity in outcome definitions, and imprecision for some outcomes.
Conclusions: The available evidence does not support the routine use of aspirin for reducing short-term mortality. Furthermore, aspirin use may be associated with an increased risk of bleeding.
Keywords: aspirin; COVID-19; mortality; platelet aggregation inhibitors; SARS-CoV-2; treatment outcome.
Resumen
Contexto: Se ha propuesto la aspirina como tratamiento coadyuvante para la COVID-19. Sin embargo, su beneficio clínico sigue siendo incierto.
Objetivos: Esta revisión sistemática y metaanálisis se realizó para evaluar si el uso de aspirina se asociaba con la mortalidad por cualquier causa a corto plazo en adultos con COVID-19 confirmada.
Métodos: La revisión fue registrada en PROSPERO (CRD42022361632). Se realizaron búsquedas en PubMed, Embase, la Biblioteca Cochrane, ClinicalTrials.gov y Scopus desde el inicio de cada base de datos hasta septiembre de 2024. Se incluyeron ensayos controlados aleatorizados y estudios no aleatorizados que compararon la aspirina más la atención estándar con la atención estándar sola. El riesgo de sesgo se evaluó mediante RoB 2 y ROBINS-I. Se utilizaron modelos de efectos aleatorios para estimar los riesgos relativos agrupados o las diferencias de medias, con intervalos de confianza del 95%.
Resultados: Se incluyeron treinta y tres estudios. Treinta y un estudios contribuyeron a las síntesis cuantitativas y el análisis principal de mortalidad se basó en cinco ensayos controlados aleatorizados. El uso de aspirina no se asoció con una reducción de la mortalidad por cualquier causa a corto plazo en comparación con el tratamiento de control (RR 0.95; IC del 95%: 0.89–1.02). El uso de aspirina se asoció con un aumento significativo del riesgo de hemorragia mayor en comparación con el grupo de control (RR 1.38; IC del 95%: 1.10–1.73; p = 0.01). La certeza de la evidencia estuvo limitada por el riesgo de sesgo, la heterogeneidad en las definiciones de los desenlaces y la imprecisión de algunos desenlaces.
Conclusiones: La evidencia disponible no respalda el uso rutinario de aspirina para reducir la mortalidad a corto plazo. Además, la aspirina puede asociarse con un mayor riesgo de hemorragia.
Palabras Clave: aspirina; COVID-19; inhibidores de la agregación plaquetaria; mortalidad; resultado del tratamiento; SARS-CoV-2.
https://jppres.com/jppres/pdf/vol14/jppres_14.5.2652.pdf
Citation Format: Bunditanukul K, Kunlamas Y, Tharnpanich T, Chusiri S, Ritsamdang J, Wanlapakorn C, Chongmelaxme B (2026) Aspirin use and clinical outcomes in coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis. J Pharm Pharmacogn Res 14(5): 2652. https://doi.org/10.56499/jppres_14.5.2652
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