• integrativedrmom

Aspirin and COVID19

COVID19 is a virus that causes viral endothelitits in the capillary vessels. Virchow's triad is something I learned about in medical school- it is the triangle that makes up the perfect storm to create a DVT (deep vein thrombosis). The triad is changes in the endothelium (or injury), blood stasis (abnormal flow, like staying in bed or sitting in a car driving across country) and a hypercoagulability state (genetic factors, trauma, illness, ect.). When infected with COVID-19 this could be an issue.

Papers have showed small case studies and hypothesis about aspirin alone or aspirin with statins to help with this problem. However, there is a need for more clinical trials. Another thing that has lacked in COVID19 research, studies on cheap, available medications.

One thing I see that is lacking is how to treat this virus at home. How to prevent complications, how to keep individuals out of the hospitals.

One of my favorite protocols from Dr. Paul Marik recommends

"ASA 81 -325 mg/day (unless contraindicated). ASA has anti-inflammatory, anti-thrombotic, and antiviral effects. Platelet activation may play a major role in propagating the prothrombotic state associated with COVID-19."

This recommendation is to start it during the viral stage, before the inflammation stage (or cytokine storm). The inflammation stage is where the respiratory and other complications seem to occur. Once in the hospital, patients are usually given an anticoagulant such as heparin or Lovenox.

So how long do you continue aspirin for? Well, some people take a baby aspirin (81 mg) daily anyways. The best answer, it depends and you need to work with your doctor.

Aspirin was actually first made from willow bark. Aspirin is not to be given to children and can increase the risk of bleeding (including GI bleeding). Another concern about aspirin is the kind you are taking. (Some of it has red dye in it, fillers, talc, gluten, ect.) I did find a cleaner kind here.

I hope this helps and doesn't confuse the topic more! Another pointer would be to find out about your family's history if you can- any history of coagulation issues, DVTs, or PEs (blood clots). Things like MTHFR and Factor V are important to know. Information is power and I will keep you updated as I find out more information.

My favorite resource right now is here.


Warmly,

Dr. Jen



ref:

Ghati N, Roy A, Bhatnagar S, Bhati S, Bhushan S, Mahendran M, Thakur A, Tiwari P, Dwivedi T, Mani K, Gupta R, Mohan A, Garg R, Saxena A, Guleria R, Deepti S. Atorvastatin and Aspirin as Adjuvant Therapy in Patients with SARS-CoV-2 Infection: A structured summary of a study protocol for a randomised controlled trial. Trials. 2020 Oct 30;21(1):902. doi: 10.1186/s13063-020-04840-y. PMID: 33126910; PMCID: PMC7598224.


Chow JH, Khanna AK, Kethireddy S, Yamane D, Levine A, Jackson AM, McCurdy MT, Tabatabai A, Kumar G, Park P, Benjenk I, Menaker J, Ahmed N, Glidewell E, Presutto E, Cain S, Haridasa N, Field W, Fowler JG, Trinh D, Johnson KN, Kaur A, Lee A, Sebastian K, Ulrich A, Peña S, Carpenter R, Sudhakar S, Uppal P, Fedeles BT, Sachs A, Dahbour L, Teeter W, Tanaka K, Galvagno SM, Herr DL, Scalea TM, Mazzeffi MA. Aspirin Use is Associated with Decreased Mechanical Ventilation, ICU Admission, and In-Hospital Mortality in Hospitalized Patients with COVID-19. Anesth Analg. 2020 Oct 21. doi: 10.1213/ANE.0000000000005292. Epub ahead of print. PMID: 33093359.


Haque S, Jawed A, Akhter N, Dar SA, Khan F, Mandal RK, Areeshi MY, Lohani M, Wahid M. Acetylsalicylic acid (Aspirin): a potent medicine for preventing COVID-19 deaths caused by thrombosis and pulmonary embolism. Eur Rev Med Pharmacol Sci. 2020 Sep;24(18):9244-9245. doi: 10.26355/eurrev_202009_23005. PMID: 33015764.


Chow, Jonathan H. MD; Khanna, Ashish K. MD2,3; Kethireddy, Shravan MD4; Yamane, David MD5; Levine, Andrea MD6; Jackson, Amanda M. MD, MAJ, MC, USA7; McCurdy, Michael T. MD7; Tabatabai, Ali MD6,8; Kumar, Gagan MD4; Park, Paul MD9; Benjenk, Ivy RN, MPH.10; Menaker, Jay MD8,11; Ahmed, Nayab MD12; Glidewell, Evan MD13; Presutto, Elizabeth MD9; Cain, Shannon M.D.14; Haridasa, Naeha B.S10; Field, Wesley MD12; Fowler, Jacob G. B.S.13; Trinh, Duy MD9; Johnson, Kathleen N. B.S.13; Kaur, Aman DO12; Lee, Amanda B.S.9; Sebastian, Kyle MD13; Ulrich, Allison MD9; Peña, Salvador MD, PhD13; Carpenter, Ross MD9; Sudhakar, Shruti MD9; Uppal, Pushpinder MD9; Fedeles, Benjamin T. MD, Capt., USAF, MC9; Sachs, Aaron MD9; Dahbour, Layth MD9; Teeter, William MD8,15; Tanaka, Kenichi MD16; Galvagno, Samuel M. DO, PhD1,8; Herr, Daniel L. MD7; Scalea, Thomas M. MD8,11; Mazzeffi, Michael A. MD, MPH1,16 Aspirin Use is Associated with Decreased Mechanical Ventilation, ICU Admission, and In-Hospital Mortality in Hospitalized Patients with COVID-19, Anesthesia & Analgesia: October 21, 2020 - Volume Publish Ahead of Print - Issue -

doi: 10.1213/ANE.0000000000005292


Florêncio FKZ, Tenório MO, Macedo Júnior ARA, Lima SG. Aspirin with or without statin in the treatment of endotheliitis, thrombosis, and ischemia in coronavirus disease. Rev Soc Bras Med Trop. 2020 Sep 21;53:e20200472. doi: 10.1590/0037-8682-0472-2020. PMID: 32965455; PMCID: PMC7508194.


https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf?fbclid=IwAR0HNYKFx8g-sfYgUI8bRXeW50F0RqwhKNxFM5n77vO6KwDDLCEDR5-Ds5I

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