Effect of Aspirin on the prevention of pro-thrombotic states in hospitalized COVID-19 patients: Systematic review.

INTRODUCTION Thromboembolic events are one of the important complications in COVID-19 patients, especially in severe cases. Aspirin affects platelet function through irreversibly inhibiting the activity of cyclooxygenase, and it reduces the risk of thrombosis. The current systematic review was aimed to evaluate the effectiveness of aspirin in preventing prothrombotic states in COVID-19 hospitalized patients. METHODS The systematic search was done in PubMed/Medline, EMBASE, and Medrxiv up to September 27, 2021. The following keywords were used: "COVID-19", "SARS-CoV-2", "2019 Novel Coronavirus", "Aspirin", and "Acetylsalicylic Acid". RESULTS Twelve studies were included. In COVID-19 patients, aspirin can reduce CRP, IL-6 levels, and platelet aggregation by inhibiting thromboxane A2. It can also improve antiviral immunity by hindering the biosynthesis of prostaglandins and lipoxin. Eight out of twelve articles indicated that aspirin provided a beneficial effect in COVID-19. Most studies consider lowered mechanical ventilation needs, ICU admission, illness severity, overt thrombosis, and clinical outcomes in COVID-19 patients receiving aspirin. CONCLUSIONS Aspirin as an antiplatelet and anti-inflammatory agent may reduce the mortality rates in hospitalized patients with severe COVID-19. Further observational studies are necessary to determine the effect of aspirin on the prevention of prothrombotic states in hospitalized COVID-19 patients. The study was registered in the Systematic Review Registration: PROSPERO (pending registration ID: 300515).