Aspirin after hospitalisation with Pneumonia to prevent cardiovascular Events randomised Controlled Trial (ASPECT)

Inclusion Criteria:

• Participants (aged ≥ 50 years)
• Admitted to hospital with pneumonia or decision to admit
• Symptoms and signs of acute lower respiratory tract infection
• Radiographic changes in keeping with infection on chest radiograph, CT scan or lung ultrasound scan

Exclusion Criteria:

• Already taking regular prescribed anti-platelet* medication, including aspirin, clopidogrel, cangrelor, selexipag, cilostazol, dipyridamole, prasugrel, ticagrelor, abciximab, eptifibatide, tirofiban, epoprostenol, iloprost;
• A known allergy, previous important adverse reaction, or contraindication to aspirin.
• At high risk of excessive bleeding (e.g. large trauma or haemorrhage or urgent need for major surgery or uncorrectable coagulopathy) in the opinion of the treating physician.
• Hospital acquired pneumonia, defined as related to an inpatient hospital stay within the last 10 days or acquired at least 48 hours after current admission.
• Discharged without a ‘Decision to Admit’ to hospital by urgent care/emergency department
• Unlikely to tolerate/adhere to medication regimen.
• Prisoners.
• Known to be pregnant.
• Life expectancy less than 3 months due to pre-existing condition (e.g. terminal malignancy).
• Presentation more likely due to acute COVID-19 pneumonitis in the opinion of the treating physician. i.e. newly positive Polymerase Chain Reaction (PCR) or similar antigen test for COVID-19;
• Enrolment onto another study where the burden on the participant will be too high if they are enrolled onto both. Or, if the enrolment onto both would compromise one or both of the study’s objectives.

*Anti-coagulation medication is not an exclusion, however the increased bleeding risk should be considered by the clinician. For more details see section 5.6.8

If the patient is eligible:

Step by Step Guide to Recruitment:

In standard working hours; 9-5

• Please contact the ED Research Team when eligible patients arrive in ED:
  Send the ED Research Team a message via Epic chat "ED research Team" or phone 217907
• The ED Research team will see the patient to arrange consent and randomisation.

Out of hours and weekends:

• Please send the ED Research team an EPIC message with the patient's details, as they have 7 days from admission to approach the patient to discuss the trial.