Covid 19 - Role of aspirin as a treatment or prophylaxis ?  Whether to use low dose aspirin (75-100mg) for post covid prophylaxis in mild self limiting covid disease is still a dilemma for many physicians. The majority of coronavirus disease 2019 (COVID-19) cases are mild, but critical illness has been reported in 6%–19% of patients. Along with pneumonia and acute respiratory distress syndrome (ARDS), thrombotic complications have been reported in 25%–42% of patients and are associated with increased mortality. SARS-CoV-2 infects endothelial cells in multiple organs, causing endothelialitis, impaired microcirculation, and apoptosis, all of which leads to inflammation and microthrombosis. Patients frequently have elevated D-dimer and fibrinogen concentration & microthrombi have been observed in the heart, lung, and kidneys of COVID-19 patients.  The prothrombotic and hypercoagulable state that is induced by COVID-19 is well described, & prior many studies had shown that systemic anticoagulation can reduce mortality in mechanically ventilated COVID-19 patients. Aspirin’s potential benefits in lung injury are thought to be related to reduced platelet-neutrophil aggregates in the lungs, reduced inflammation, and increased lipoxin formation, which restores pulmonary endothelial cell function. Aspirin also shown to decrease the production of interleukin-6 (IL-6), C-reactive protein (CRP), and macrophage colony-stimulating factor which in turn will reduces the incidence of cytokine storm. Aspirin use is associated with reduced mechanical ventilation, ICU admission, and in-hospital mortality in moderate to severe covid -19 cases. Considering the cardiovascular safety profile of this drug, aspirin can sometime lead to bleeding complications in vulnerable patients and thus its use in routine prophylaxis during treatment of mild self limiting covid 19 disease should be avoided, but to prevent complications arising from frequent hypercoagulable states in moderate to severe covid disease low dose  aspirin (75-100mg) along with systemic anticoagulation may show promising results.  Dr Ajitkumar Jadhav MD Med DNB Card Consultant & Interventional Cardiologist