Randomized Evaluation of COVID-19 Therapy - RECOVERY (Aspirin)

Contribution To Literature:

The RECOVERY trial showed that aspirin therapy does not improve survival among patients hospitalized with COVID-19 infection.

Description:

The goal of the trial was to evaluate aspirin therapy compared with control among patients hospitalized with COVID-19 infection.

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients hospitalized with COVID-19 infection were randomized to standard of care plus aspirin 150 mg daily (n = 7,351) versus standard of care alone (n = 7,541).

  • Total number of enrollees: 14,892
  • Duration of follow-up: 28 days
  • Mean patient age: 59 years
  • Percentage female: 38%
  • Percentage with diabetes: 22%

Inclusion criteria:

  • Patients hospitalized with COVID-19
  • ≥18 years of age

Exclusion criteria:

  • Hypersensitivity to aspirin
  • Recent history of major bleeding
  • Currently receiving aspirin or another antiplatelet therapy

Principal Findings:

The primary outcome, mortality at 28 days, occurred in 17% of the aspirin group versus 17% of the control group (p = 0.35).

Secondary outcomes:

  • Mechanical ventilation or death: 21% in the aspirin group vs. 22% in the control group
  • Thrombotic events: 4.6% in the aspirin group vs. 5.3% in the control group
  • Major bleeding events: 1.6% in the aspirin group vs. 1.0% in the control group
  • Duration of hospitalization: median 8 days in the aspirin group vs. 9 days in the control group

Interpretation:

Among patients hospitalized with COVID-19 infection, standard of care plus aspirin was not superior compared to standard of care alone. Aspirin was not associated with reduction in the composite outcome of mechanical ventilation or death compared to standard of care alone. Aspirin was associated with a modest reduction in thrombotic events and a modest increase in major bleeding events compared to standard of care alone.

References:

RECOVERY Collaborative Group. Aspirin in patients admitted to the hospital with COVID-19 (RECOVERY): a randomized, controlled, open-label, platform trial. Lancet 2022;399:143-51.

Keywords: Anticoagulants, Aspirin, COVID-19, Hemorrhage, Platelet Aggregation Inhibitors, Primary Prevention, Respiration, Artificial, Standard of Care, Thrombosis, Ventilation, Vascular Diseases


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