Hepatology. 2017 Jun 15. doi: 10.1002/hep.29318. [Epub ahead of print]
Antiplatelet therapy and the risk of hepatocellular carcinoma in chronic hepatitis B patients on antiviral treatment.Lee M1,2, Chung GE3, Lee JH1, Oh S4, Nam JY1, Chang Y1, Cho H1, Ahn H1, Cho YY1, Yoo JJ1, Cho Y1, Lee DH1, Cho EJ1, Yu SJ1, Lee DH5, Lee JM5, Kim YJ1, Yoon JH1. Author information 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.2Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.3Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul, Korea.4Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.5Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
AbstractAntiplatelet therapy has shown protective effects against hepatocellular carcinoma (HCC) in preclinical studies. However, it is unclear whether antiplatelet therapy lowers the risk of HCC in patients with chronic hepatitis B (CHB). A retrospective analysis was conducted of data from 1,674 CHB patients, enrolled between January 2002 and May 2015, whose serum hepatitis B virus (HBV) DNA levels were suppressed by antivirals to <2,000 IU/mL. The primary and secondary outcomes were development of HCC and bleeding events, respectively. Risk was compared between patients with antiplatelet treatment (aspirin, clopidogrel, or both; antiplatelet group) and patients who were not treated (non-antiplatelet group) using a time-varying Cox proportional hazards model for total population and propensity score-matching analysis. The antiplatelet group included 558 patients and the non-antiplatelet group had 1,116 patients. During the study period, 63 patients (3.8%) developed HCC. In time-varying Cox proportional analyses, the antiplatelet group showed a significantly lower risk of HCC (hazard ratio [HR]: 0.44; 95% confidence interval [CI]: 0.23-0.85, P=0.01), regardless of antiplatelet agent. In propensity score-matched pairs, antiplatelet therapy significantly reduced the risk of HCC (HR: 0.34, 95% CI: 0.15-0.77, P=0.01). However, the overall risk of bleeding was higher in the antiplatelet group (HR: 3.28, 95% CI: 1.98-5.42, P<0.001), particularly for clopidogrel with or without aspirin. Treatment with aspirin alone was not associated with a higher bleeding risk (HR: 1.11, 95% CI: 0.48-2.54, P=0.81).
CONCLUSIONS: Antiplatelet therapy reduces the risk of HCC in CHB patients whose HBV is effectively suppressed. However, antiplatelet therapy containing clopidogrel may increase the risk of bleeding. This article is protected by copyright. All rights reserved.