After some time of a current of a pandemic it is already known that the majority of cases of infection with a koronavirusny infection (COVID-19) of a malosimptomna, however a part of the diseased has heavy symptoms and the disease gets a life-threatening current. Distinguishing characters of a koronavirusny infection is pneumonia and the acute respiratory distress syndrome (ARDS). Approximately at 25-42% of patients trombotichesky complications which are associated with increase in mortality come to light. Rather often not only the deep vein thrombosis of the lower extremities, but also arterial thrombosis meet. At autopsy of patients with COVID-19 blood clots with the high content of megacaryocytes and thrombocytes in heart, lungs and kidneys were observed. There are specific changes of a gemostaziogramma testifying to hypercoagulation. Also microthrombosis of capillaries of alveoluses which frequency is much higher, than at patients with flu was observed. It is supposed that thrombosis promotes severe damage of lungs and an anoxemia which meet patients COVID-19.
Results of the researches which are available today allow to assume that system antitrombotichesky therapy reduces quantity of lethal outcomes at patients of COVID-19 which are on IVL. Small doses of aspirin are used for prevention of a stroke and a myocardial infarction at patients of risk group for a long time and accept them often adult with the increased risk of cardiovascular complications. But, on the one hand, aspirin reduces the frequency of emergence of cardiovascular complications, and with another as revealed a recent research and meta-analysis, also increases risk of bleeding. In turn, use of aspirin at ORDS also showed contradictory results: the favorable effect in some researches was revealed, and in others — no.
Aspirin pluses: the broad availability, its low price, numerous researches demonstrating its efficiency and safety at patients with cardiovascular diseases. Considering all this, the research in which authors studied data on influence of aspirin on clinical outcomes at the patients hospitalized with COVID-19 was conducted. The main objective of a research was in defining whether intake of aspirin will affect IVL frequency. Besides, authors investigated communication of intake of aspirin with reduction of risk of the transfer to ORIT and hospital lethality.
For carrying out the discussed research of data on patients from COVID-19 hospitalized during the period from March to July, 2020 were extracted from the database of the multicenter CRUSH COVID project. Four hospitals participated in a research: Medical center of the Maryland university, Baptist medical center of the Ueyk university Forrest, Hospital of Health service of northeast Georgia and Hospital of the George Washington University. Data entry was made for all patients through the system of research electronic data collection REDCap4. Was considered that purpose of aspirin within 24 hours on hospitalization or in 7 days prior to receipt in clinic is its reception. Why such definition was chosen for a basis? It is all about long effect of aspirin as irreversible inhibitor of thrombocytes and in speed of the beginning of its action. If aspirin was appointed after the beginning of IVL, then the patient was carried to "neaspirinovy" group. Thus, 412 patients entered a research.
Need of invasive IVL, including ventilation by means of an endotracheal or tracheostomy tube was the key parameter of this research. Noninvasive ventilation was excluded. Transfer to intensive care unit and hospital lethality became secondary parameters.
Following the results of the discussed research, use of aspirin showed independent communication with reduction of risk of IVL, transfer to ORIT and hospital lethality. Results are clinically significant if to speak about an opportunity to avoid IVL at patients with COVID-19.
Speaking about mechanisms of effect of aspirin, it is possible to assume that as COVID-19 is connected with hypercoagulation and pulmonary microthrombosis, aspirin can weaken these effects. This drug is cheap, available and has well described risk profile. The specified qualities of aspirin in combination with experimental data confirm its role as potential supportive therapeutic application at a new koronavirusny infection. Nevertheless, you should not forget that the research has preliminary character and its authors consider that before performing randomized clinical trials on the matter, it is strongly recommended to weigh after careful consideration risks of intake of aspirin and its potential advantage for patients with COVID-19.