Is Aspirin the New Horse Dewormer?

Aspirin is one of those drugs that has been around forever. It is commonly used as a pain reliever, anti-inflammatory, and as a blood thinner. Surprisingly it may also have benefit in treating COVID.

A paper in Anesthesia and Analgesia published last spring titled, “Aspirin use is associated with decreased mechanical ventilation, intensive care unit admission, and in-hospital mortality in hospitalized patients with coronavirus disease 2019.”

This was a retrospective, observational study of adult patients admitted to multiple hospitals in the U.S. between March and July 2020, in the early days of COVID. The primary outcome addressed by the researchers from George Washington University was the need for mechanical ventilation, which then, and still now, carries an extremely high chance of never leaving the ICU alive.

This was not a gold standard randomized prospective clinical trial. That would not be feasible in this situation since study patients were already hospitalized and critically ill. Remember in the early days, one needed to be extremely ill before even being admitted to the hospital rather than being sent home until sick enough to return and go straight to the ICU.

But the results were impressive. As reported last week by the Jerusalem Post,

The team investigated more than 400 COVID patients from hospitals across the United States who take aspirin unrelated to their COVID disease, and found that the treatment reduced the risk of several parameters by almost half: reaching mechanical ventilation by 44%, ICU admissions by 43%, and overall in-hospital mortality by 47%.


Why would aspirin be helpful for COVID, a respiratory disease? What if COVID is more than simply a lung disease or pneumonia? COVID is actually thought to be a microvascular disease causing blood clots, as described in the medical journal Circulation,

Although most patients with coronavirus disease 2019 (COVID-19) present with a mild upper respiratory tract infection and then recover, some infected patients develop pneumonia, acute respiratory distress syndrome, multi-organ failure, and death. Clues to the pathogenesis of severe COVID-19 may lie in the systemic inflammation and thrombosis observed in infected patients. We propose that severe COVID-19 is a microvascular disease in which coronavirus infection activates endothelial cells, triggering exocytosis, a rapid vascular response that drives microvascular inflammation and thrombosis.

Note the thrombosis aspect, blood clots forming in the lungs and elsewhere in the body. Aspirin, as a blood thinner, reduces the risk of blood clots, explaining its potential benefit for COVID.

For the same reason, the American Heart Association recommends,

If you have had a heart attack or stroke, your doctor may want you to take a daily low dose of aspirin to help prevent another. Aspirin is part of a well-established treatment plan for patients with a history of heart attack or stroke.

Add the appropriate caveat, which I would echo, “You should not take daily low-dose aspirin on your own without talking to your doctor. The risks and benefits vary for each person.”

How did aspirin get its start? Over 3,500 years ago, willow bark, known as “nature’s aspirin,” was used as a painkiller and anti-pyretic by ancient Egyptians and Greeks, and in a chemical synthesis by a Bayer chemist in 1897.

Aside from pain relief, it was found to have anti-platelet and anti-cancer effects. It’s also on the World Health Organization’s list of essential medicines, along with another familiar drug, ivermectin. The Harvard-based physicians’ health study in the 1980s found that low dose aspirin reduced the risk of heart attack by 44 percent.

A recently published Israeli study found, “Aspirin use is associated with better outcomes among COVID-19 positive patients.” This included lower likelihood of infection, disease duration, and hospital survival. In other words, aspirin works as both a preventative and as a...



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