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Original Article
Available online 22 September 2022
Pre-hospital Aspirin Use and Patient Outcomes in COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)
Amos Lala,
Corresponding author
, Juan Pablo Domecq Garcesb,q, Vikas Bansala, Aysun Tekina, Simon Zeca, Ashish K. Khannac,d, Matthew A. Warnere, Amy B. Christief, Rodrigo Cartin-Cebag, Valerie M. Banner-Goodspeedh, Donna Lee Armaignaci, Sreekanth R. Cherukuj, Umamaheswara Rajuk, Yasir Tarabichil, Joshua L. Densonm, Vishakha Kumarn, Allan Walkeyo, Karen Bomann, Neha Deoa, Rahul Kashyapp, Ognjen Gajica, from the Society of Critical Care Medicine Discovery Viral Infection, Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group 1
a Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
b Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
c Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
d Outcomes Research Consortium, Cleveland, OH, USA
e Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
f Atrium Health Navicent, Macon, GA, USA
g Department of Critical Care Medicine, Mayo Clinic, AZ, USA
h Beth Israel Deaconess Medical Center, Boston, MA, USA
i Center for Advanced Analytics, Baptist Health South Florida, USA
j Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, USA
k Gandhi Medical College and Hospital, Hyderabad, India
l MetroHealth Medical Center, USA
m Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, USA
n Society of Critical Care Medicine, Mount Prospect, IL, USA
o Pulmonary Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Evans Center of Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
p Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
q Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USA
Received 22 June 2022. Accepted 26 July 2022
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The goal of this investigation is to assess the association between prehospital use of aspirin (ASA) and patient-centered outcomes in a large global cohort of hospitalized COVID-19 patients.


This study utilizes data from the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry. Adult patients hospitalized from February 15th, 2020, to September 30th, 2021, were included. Multivariable regression analyses were utilized to assess the association between pre-hospital use of ASA and the primary outcome of overall hospital mortality.


21,579 patients were included from 185 hospitals (predominantly US-based, 71.3%), with 4691 (21.7%) receiving pre-hospital ASA. Patients receiving ASA, compared to those without pre-admission ASA use, were generally older (median 70 vs. 59 years), more likely to be male (58.7 vs. 56.0%), caucasian (57.4 vs. 51.6%), and more commonly had higher rates of medical comorbidities. In multivariable analyses, patients receiving pre-hospital ASA had lower mortality (HR: 0.89, 95% CI 0.82–0.97, p=0.01) and reduced hazard for progression to severe disease or death (HR: 0.91, 95% CI 0.84–0.99, p=0.02) and more hospital free days (1.00 days, 95% CI 0.66–1.35, p=0.01) compared to those without pre-hospital ASA use. The overall direction and significance of the results remained the same in sensitivity analysis, after adjusting the multivariable model for time since pandemic.


In this large international cohort, pre-hospital use of ASA was associated with a lower hazard for death in hospitalized patients with COVID-19. Randomized controlled trials may be warranted to assess the utility of pre-hospital use of ASA.

Mechanical ventilation
Length of stay


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