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

Chern-Horng Lee,1 Cheng-Li Lin,2 Tzung-Hai Yen,3 Sen-Yung Hsieh4,5 1Department of Geriatric Medicine and General Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; 2Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 3Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; 4Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; 5College of Medicine, Chang Gung University, Taoyuan, TaiwanCorrespondence: Sen-Yung Hsieh, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan, Tel +886-975368031, Fax +886-33272324, Email [email protected]; [email protected]: 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.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.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.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.Keywords: cirrhosis, antiplatelet agents, hepatocellular carcinoma, intracranial hemorrhage, mortality