#student_ieu Treatment of Covid-19 patients with non-steroidal anti-inflammatory drugs (NSAIDs)
Early this year, the French Health Ministry advised health professionals against the use of NSAIDs on people with suspected covid-19 symptoms. This advice stemmed from an incident where four young covid-19 patients with no prior health problems developed worsening covid-19 symptoms following the use of Ibuprofen, an NSAID (Day, 2020). On the other hand, a case report by Oxley et al. (2020) analysed five cases of severe acute covid-19 patients below the age of 50 years old at a New York City hospital, who were found to have stroke of the large blood vessel. Although these patients exhibited covid-19 symptoms such as persistent fever, headache and cough; one of the cases developed dysarthria with numbness of the limbs in less than 28 hours which was investigated and confirmed with a computed tomography (CT) scan. Because covid-19 is linked to increased risk of thromboembolism and hypercoagulability in severely ill patients, a cohort study of 412 hospitalised covid-19 patients by Chow et al. (2020) suggested that the use of Aspirin may be linked with enhanced patient outcomes. However, it is important to note that the sample used in this study is small which could limit its’ accuracy. To establish any presence of causal link between aspirin and covid-19 treatment outcomes, a randomized controlled trial should be carried out. Despite the identified weakness of Chow et al.’s (2020) study, Zhou et al. (2020) in their retrospective cohort study emphasise that vascular endothelial dysfunction and coagulopathy are known covid-19 complications. Because evidence indicate that Aspirin acts as an antithrombotic against acetylate cyclooxygenase-1 (COX-1), reducing platelet aggregation; it could be used to lower the risks associated with coagulation in covid-19 patients.
Chow, J. H., Khanna, A. K., Kethireddy, S., Yamane, D., Levine, A., Jackson, A. M., … & Benjenk, I. (2020). Aspirin Use is Associated with Decreased Mechanical Ventilation, ICU Admission, and In-Hospital Mortality in Hospitalized Patients with COVID-19. Anesthesia & Analgesia.
Day, M. (2020). Covid-19: Ibuprofen should not be used for managing symptoms, say doctors and scientists. British Medical Journal, 368 doi: https://doi.org/10.1136/bmj.m1086
Oxley, T. J., Mocco, J., Majidi, S., Kellner, C. P., Shoirah, H., Singh, I. P., … & Skliut, M. (2020). Large-vessel stroke as a presenting feature of Covid-19 in the young. New England Journal of Medicine, 382(20), e60.
Umapathi, T., Kor, A. C., Venketasubramanian, N., Lim, C. T., Pang, B. C., Yeo, T. T., … & Tan, P. H. (2004). Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). Journal of neurology, 251(10), 1227-1231.
Undas, A., Brummel-Ziedins, K. E., & Mann, K. G. (2007). Antithrombotic properties of aspirin and resistance to aspirin: beyond strictly antiplatelet actions. Blood, 109(6), 2285-2292.
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., … & Guan, L. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395 (10229), pp. 1054-1062