TY - JOUR T1 - Rationales and uncertainties for aspirin use in COVID-19: a narrative review JF - Family Medicine and Community Health JO - Fam Med Com Health DO - 10.1136/fmch-2020-000741 VL - 9 IS - 2 SP - e000741 AU - Hazem A Sayed Ahmed AU - Eric Merrell AU - Mansoura Ismail AU - Anwar I Joudeh AU - Jeffrey B Riley AU - Ahmed Shawkat AU - Hanan Habeb AU - Edward Darling AU - Reda A Goweda AU - Mohamed H Shehata AU - Hossam Amin AU - Gary F Nieman AU - Hani Aiash Y1 - 2021/04/01 UR - http://fmch.bmj.com/content/9/2/e000741.abstract N2 - Objectives To review the pathophysiology of COVID-19 disease, potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.Design Narrative review.Setting The online databases PubMed, OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021. International guidelines from relevant societies, journals and forums were also assessed for relevance.Participants Not applicable.Results A review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction, coagulopathy and dysregulated inflammation. Aspirin has anti-inflammatory effects, antiplatelet aggregation, anticoagulant properties as well as pleiotropic effects on endothelial function. During the COVID-19 pandemic, low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease, prevention of venous thromboembolism after total hip or knee replacement, prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children. Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19, whereas aspirin association with mortality is still debatable.Conclusion The authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40–70 years who are at high atherosclerotic cardiovascular disease risk, or an intermediate risk with a risk-enhancer and have a low risk of bleeding. Aspirin’s protective roles in COVID-19 associated with acute lung injury, vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions. ER -