COVID-19: Aspirin Reduced Mortality, ICU Admissions, and Need for Mechanical Ventilation

…in hospitalized patients. The usual aspirin dose was 81 mg/day. Here’s the abstract from April 2021 in Anesthesia & Analgesia.


Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality.


A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions.

anesthesiologist medical doctor working with anesthesia patent
Intubation in preparation for mechanical ventilation


Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users.


Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.

At the start of the pandemic, many physicians were avoiding use of nonsteroidal anti-inflammatory drugs like aspirin. I don’t remember why.

This was a small study, so results are not as reliable as a 2000-patient experiment. But low-dose ASA is well-tolerated and cheap.

Steve Parker, M.D.

4 responses to “COVID-19: Aspirin Reduced Mortality, ICU Admissions, and Need for Mechanical Ventilation

  1. After having COVID last year, I was over most of worst of it, but had a low fever that lingered. Aspirin fixed that. It’s easy to forget how powerful a drug aspirin really is.

    • Thx for the tip. A short course of aspirin at typical doses is usually safe unless someone has low platelets, a bleeding propensity, stomach or duodenal ulcers, is on a blood thinner, or has chronic kidney disease not treated with dialysis

  2. Hope you are doing ok post-shot #2.

    • Thx. I went to CVS for it and their supply was exhausted. Re-scheduled in near future. In a recent video, Dr Peter McCullough said that 80% of the severe adverse effects occur during the first week post-vax. Since many of the acute deaths and severe adverse effects seem to be related to thrombosis, I’m taking aspirin 324 mg/day. I can’t support the aspirin choice with a scientific reference and have never seen anybody else do it. 81 mg may be just as good.