A low dosage of aspirin possibly reduces the risk of liver cancer (hepatocellular carcinoma or HCC) in hepatitis patients without raising the risk of gastrointestinal bleeding. Results from a Swedish study were recently published by the New England Journal of Medicine.
Using nationwide Swedish registries, 50,275 adult patients were selected who received a diagnosis of chronic hepatitis B or hepatitis C between 2005 and 2016, and who did not have a history of aspirin use. Of this group, 14,205 patients started taking low-dose aspirin. The research team constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional-hazards regression modeling, the risk of hepatocellular carcinoma and liver-related mortality were estimated, accounting for competing events.
With a median of 7.9 years of follow-up, HCC was diagnosed in 4% of aspirin users and 8.3% of non-users of aspirin (difference, −4.3 percentage points; 95% CI, −5.0 to −3.6; adjusted hazard ratio, 0.69; 95% CI, 0.62 to 0.76). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted hazard ratios were 0.90 (95% CI, 0.76 to 1.06) for 1 to less than 3 years of use, 0.66 (95% CI, 0.56 to 0.78) for 3 to less than 5 years of use, and 0.57 (95% CI, 0.42 to 0.70) for 5 or more years of use.
Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among non-users (difference, −6.9 percentage points [95% CI, −8.1 to −5.7]; adjusted hazard ratio, 0.73 [95% CI, 0.67 to 0.81]). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively; difference, 0.9 percentage points; 95% CI, −0.6 to 2.4).
Use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin. The risk of gastrointestinal bleeding did not rise significantly.
Top
