Aspirin Use and Risk of HCC and Gastrointestinal Bleeding in Patients With HBV-Related Cirrhosis: A Landmark Analysis

Abstract

Background and Aims The use of aspirin in hepatocellular carcinoma (HCC) prevention and the risk of gastrointestinal (GI) bleeding is still uncertain in patients with hepatitis B virus (HBV)-related cirrhosis. We investigated the association between aspirin use and the risks of HCC and GI bleeding in patients with HBV-related cirrhosis.Methods We conducted a 3-year landmark analysis using nationwide cohort data from the National Health Insurance Service of South Korea. Patients diagnosed with compensated HBV-related cirrhosis in 2005-2017 were included. Patients who were prescribed aspirin for at least 90 days consecutively during the 3-year exposure period were classified as the aspirin-treated group. The risks of HCC and GI bleeding were estimated in a cohort matched by propensity scores.Results During a median of 7.6 years of follow-up, the 10-year cumulative incidence of HCC was 41.8% among aspirin users (n = 608) and 46.5% among nonusers (n = 2432) (p = 0.033). The aspirin-treated group showed a significantly lower risk of HCC than the untreated group (adjusted hazard ratio [aHR] = 0.84, 95% confidence interval [CI] = 0.73-0.96; p = 0.013). The 10-year cumulative incidence of GI bleeding was 29.5% among aspirin users and 24.0% among nonusers (p = 0.016). The aspirin-treated group showed a significantly higher risk of GI bleeding than the untreated group (aHR = 1.20, 95% CI = 1.02-1.42; p = 0.029).Conclusions In patients with HBV-related cirrhosis, the aspirin-treated group showed a significantly lower risk of HCC than the untreated group, whereas the risk of GI bleeding was significantly higher in the aspirin-treated group.