Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 7:13:957-970.
doi: 10.2147/JEP.S330776. eCollection 2021.

Aspirin as an Adjunctive Pharmacologic Therapy Option for COVID-19: Anti-Inflammatory, Antithrombotic, and Antiviral Effects All in One Agent

Udaya S Tantry  1 , Karsten Schror  2 , Eliano Pio Navarese  3 , Young-Hoon Jeong  4 , Jacek Kubica  3 , Kevin P Bliden  1 , Paul A Gurbel  1
Affiliations

Aspirin as an Adjunctive Pharmacologic Therapy Option for COVID-19: Anti-Inflammatory, Antithrombotic, and Antiviral Effects All in One Agent

Udaya S Tantry et al. J Exp Pharmacol. .

Abstract

Introduction: Pharmacologic therapy options for COVID-19 should include antiviral, anti-inflammatory, and anticoagulant agents. With the limited effectiveness, currently available virus-directed therapies may have a substantial impact on global health due to continued reports of mutant variants affecting repeated waves of COVID-19 around the world.

Methods: We searched articles pertaining to aspirin, COVID-19, acute lung injury and pharmacology in PubMed and provide a comprehensive appraisal of potential use of aspirin in the management of patients with COVID-19. The scope of this article is to provide an overview of the rationale and currently available clinical evidence that supports aspirin as an effective therapeutic option in COVID-19.

Results: Experimental and clinical evidence are available for the potential use of aspirin in patients with COVID-19.

Discussion: Aspirin targets the intracellular signaling pathway that is essential for viral replication, and resultant inflammatory responses, hypercoagulability, and platelet activation. With these multiple benefits, aspirin can be a credible adjunctive therapeutic option for the treatment of COVID-19. In addition, inhaled formulation with its rapid effects may enhance direct delivery to the lung, which is the key organ damaged in COVID-19 during the critical initial course of the disease, whereas the 150-325 mg/day can be used for long-term treatment to prevent thrombotic event occurrences. Being economical and widely available, aspirin can be exploited globally, particularly in underserved communities and remote areas of the world to combat the ongoing COVID-19 pandemic.

Keywords: COVID-19; acetyl salicylic acid; acute respiratory syndrome; inflammation; lungs; platelets.

PubMed Disclaimer

Conflict of interest statement

Dr Tantry received Honoraria from UpToDate and AggreGuide. Dr Gurbel has received consulting fees and/or honoraria from Bayer, Otitopic, Janssen, UpToDate, US WorldMeds, Hikari Dx, and Medicure; institutional research grants from the National Institutes of Health, Haemonetics, Bayer, Medicure, Instrumentation Laboratories, US WorldMeds, Amgen, Idorsia, Otitopic, and Janssen. Dr Schror has received personal fees from Bayer, during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
SARS-CoV-2 infection and replication inside the host cell. Initially, SARS-CoV-2 enters the host cell through binding to the ACE2 receptor and the function of TEMRSS2. The virus undergoes replication using host machinery (“hostile takeover”) and the mature virus is released (exocytosis) from the host cell. Inside the endosome, the viral RNA binds to the TLR and activates IRF7 that translocate into the nucleus to induce the expression of Type I interferon. SARS-CoV-2 binding to TLR also activates IKKβ and leads to NF-kB-mediated expression of cytokines, chemokines and adhesion molecules.
Figure 2
Figure 2
Host cell response to SARS-CoV-2 infection and role of aspirin in SARS-CoV-2 infection. SARS-CoV-2 induced cytokine storm, endothelial dysfunction, NETosis and hypercoagulability result in microthrombosis/thromboembolism in lungs as well as heart and kidney leading to multiorgan dysfunction, ARDS and ultimately death in a substantial percentage of patients. Aspirin/SA/LSAG can attenuate the viral replication and inhibit NF-κB activation and subsequent expression of cytokines and chemokines. In addition, ASA exhibits anti-inflammatory and antiplatelet effects, and attenuates NETosis, endothelial dysfunction and hypercoagulability.
See this image and copyright information in PMC

References

    1. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950–2973. doi:10.1016/j.jacc.2020.04.031 - DOI - PMC - PubMed
    1. Cuker A, Tseng EK, Nieuwlaat R, et al. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv. 2021;5:872–888. doi:10.1182/bloodadvances.2020003763 - DOI - PMC - PubMed
    1. Bianconi V, Violi F, Fallarino F, Pignatelli P, Sahebkar A, Pirro M. Is acetylsalicylic acid a safe and potentially useful choice for adult patients with COVID-19? Drugs. 2020;80:1383–1396. doi:10.1007/s40265-020-01365-1 - DOI - PMC - PubMed
    1. Grabowski F, Preibisch G, Giziński S, et al. SARS-CoV-2 variant of concern 202012/01 has about twofold replicative advantage and acquires concerning mutations. Viruses. 2021;1(13):392. doi:10.3390/v13030392 - DOI - PMC - PubMed
    1. Harrison AG, Lin T, Wang P. Mechanisms of SARS-CoV-2 transmission and pathogenesis. Trends Immunol. 2020;41:1100–1115. doi:10.1016/j.it.2020.10.004 - DOI - PMC - PubMed

LinkOut - more resources