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Daily Antiplatelets Other Than Aspirin Reduce Liver Cancer Risk but Increase Intracranial Hemorrhage Risk in Cirrhotic Patients.

Authors :
Lee CH
Lin CL
Yen TH
Hsieh SY
Source :
International journal of general medicine [Int J Gen Med] 2024 Oct 17; Vol. 17, pp. 4755-4767. Date of Electronic Publication: 2024 Oct 17 (Print Publication: 2024).
Publication Year :
2024

Abstract

Purpose: Aspirin, known to reduce the risk of liver cancer, has been proposed as a preventive measure for patients with chronic hepatitis and cirrhosis. However, concerns regarding aspirin's potential to cause gastrointestinal (GI) mucosal injury and bleeding have emerged. Several antiplatelets other than aspirin (APOA) that pose a smaller risk of GI bleeding than aspirin have been proposed as potential aspirin substitutes. This study investigated whether APOAs were effective at reducing the risk of hepatocellular carcinoma (HCC). Additionally, we evaluated the safety of APOAs, specifically regarding their potential to increase the risk of GI bleeding, in a nationwide cirrhosis cohort.<br />Patients and Methods: For the period January 1, 2000, to December 31, 2017, we identified 686 993 patients with cirrhosis from a national database. A control group was established using 1:2 propensity score matching on the basis of sex, age, comorbidities, and medication use.<br />Results: Daily use of APOAs was significantly associated with lower incidences of HCC (aHR 0.67; 95% CI, 0.60-0.73; P < 0.001) and showed no significant increase in GI bleeding risk (aHR 1.04; 95% CI, 0.93-1.15; P = 0.533) compared to nonuse of APOAs. However, the risks of intracranial hemorrhage (aHR, 1.41; 95% CI, 1.18 to 1.69; P < 0.001) and overall mortality (aHR, 2.03; 95% CI, 1.95 to 2.10; P < 0.001) were higher in the APOA user group.<br />Conclusion: Our results suggest that although daily use of APOAs other than aspirin may decrease the HCC risk of patients with cirrhosis, it may also increase their risks of intracranial hemorrhage and overall mortality. Therefore, the use of APOAs as an alternative to aspirin for HCC prevention in patients with cirrhosis requires careful consideration.<br />Competing Interests: The authors declare no conflicts of interest in this work.<br /> (© 2024 Lee et al.)

Details

Language :
English
ISSN :
1178-7074
Volume :
17
Database :
MEDLINE
Journal :
International journal of general medicine
Publication Type :
Academic Journal
Accession number :
39435412
Full Text :
https://doi.org/10.2147/IJGM.S472260