ASPIRIN

What is aspirin?

Aspirin is an antiplatelet agent that is commonly used for the prevention of blood clots and secondary prevention of cardiovascular disease after patients have a stroke or heart attack. It is often taken indefinitely in these cases at a low dose of 81 mg, also known as baby aspirin. Aspirin has many strengths, and its drug properties vary depending on the dosage. At higher doses greater than 325 mg every 4-6 hours, it serves as a non-steroidal anti-inflammatory drug (NSAID) that can be used to relieve pain and reduce fever.

How can aspirin help alleviate certain long COVID symptoms?

An acute COVID infection can lead to hyperactivated platelets and damaged red blood cells, making it more likely for the body to form a clot. Patients from South Africa with long COVID have been found to have amyloid deposits in their blood samples called microclots.¹ It is believed that these microclots can prevent oxygen from adequately reaching all of our tissues, which may cause long COVID symptoms. Aspirin works by irreversibly inhibiting enzymes called COX-1 and COX-2 that are needed for platelets (cells in our blood that form clots) to aggregate and activate. Thus, agents that prevent clots may play a role in helping people experiencing long COVID symptoms such as fatigue, brain fog, loss of concentration, shortness of breath, and joint and muscle pains.

What evidence supports aspirin’s use for long COVID?

The use of aspirin within the first day of hospitalization for moderate COVID was associated with lower odds of in-hospital mortality within 28 days. However, the absolute difference in mortality rates for the treatment vs placebo group was slight.²

A study done in South Africa treated 24 patients with a combination of clopidogrel 75 mg (an antiplatelet agent), aspirin 75 mg daily, and a direct oral anticoagulant apixaban (Eliquis) 5 mg twice a day. A proton pump inhibitor, pantoprazole, was also added to prevent gastrointestinal ulcers or bleeding. All patients reported that their main fatigue symptoms were resolved, as well as their other long-term COVID symptoms.³ It is important to note, however, that this study was not placebo-controlled and has not yet been peer-reviewed for publication. This treatment combination also puts patients at high risk of bleeding and is not recommended for certain patients and demographics.

While aspirin does have beneficial effects in preventing blood clots, aspirin alone may not be sufficient for the breakdown of microclots. Increased risks of bleeding with aspirin should also be taken into consideration when asking your doctor about treatments for long COVID.

What should you be aware of when taking aspirin?

Aspirin is associated with a 2- to 4-fold increase in upper gastrointestinal (GI) events ranging from indigestion to GI ulcers or bleeding. The use of enteric-coated aspirin does not necessarily decrease this risk. Some people can have immediate or delayed allergic reactions to aspirin, leading to anaphylaxis, which can be serious in some rare cases. Because of its antiplatelet effects, it can cause you to bleed more easily, especially if you are taking other blood thinners or medications/supplements that can increase your risk of bleeding.

Large doses of aspirin (greater than 325 mg daily) should be avoided for long-term use, especially in people with chronic kidney disease, heart failure, cirrhosis, older adults, or those taking diuretics (also known as water pills). Even if you are taking baby aspirin, it is important to let your doctor know you are on this medication.

References:

1)      Pretorius E, Vlok M, Venter C, Bezuidenhout JA, Laubscher GJ, Steenkamp J, Kell DB. Persistent clotting protein pathology in Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin. Cardiovasc Diabetol. 2021 Aug 23;20(1):172. doi: 10.1186/s12933-021-01359-7

2)      Chow JH, Rahnavard A, Gomberg-Maitland M, Chatterjee R, Patodi P, Yamane DP, Levine AR, Davison D, Hawkins K, Jackson AM, Quintana MT, Lankford AS, Keneally RJ, Al-Mashat M, Fisher D, Williams J, Berger JS, Mazzeffi MA, Crandall KA; N3C Consortium and ANCHOR Investigators. Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19. JAMA Netw Open. 2022 Mar 1;5(3):e223890. doi: 10.1001/jamanetworkopen.2022.3890

3)      Pretorius E, Venter C, Laubscher GJ, et al. Combined triple treatment of fibrin amyloid microclots and platelet pathology in individuals with long COVID/post-acute sequelae of COVID-19 (PASC) can resolve their persistent symptoms. Preprint. 2021 Dec 28. doi: 10.21203/rs.3.rs-1205453/v1.