Does Antiplatelet Therapy Cut Liver Cancer Risk in Patients with Hep B?

SAN FRANCISCO, CA—Aspirin and clopidogrel therapy are associated with reduced risk of hepatocellular carcinoma (HCC) among patients with chronic hepatitis B infection, according to a study reported at the The Liver Meeting® 2015.

“Antiplatelet therapy was associated with a significantly lower incidence of hepatocellular carcinoma than [seen] in those not treated with antiplatelet therapy,” reported Minjong Lee, MD, of the Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, in Seoul, Korea, and colleagues. “Antiplatelet therapy might have significant effects on HCC prevention according to the severity of hepatic fibrosis.”

In mouse models, platelets promote the accumulation of virus-specific CD8 T cells in the liver, damaging liver tissue. “A recent study showed that the long-term use of the antiplatelet drugs in a mouse model of chronic hepatitis B can prevent hepatocarcinogenesis,” Dr. Lee said.

In order to determine the incidence of hepatocellular carcinoma in patients who were treated with anti-platelet drugs with incidence in those who were not, the researchers conducted a retrospective analysis “of data from 3,479 consecutive patients with chronic hepatitis B who had HBV DNA completely suppressed with antiviral treatment,” Dr. Lee explained. Group 1 was composed of 2,566 patients who had not been treated with anti-platelet drugs and Group 2 was composed of 592 patients treated with aspirin and/or clopidogrel.

According to multivariable analyses, Group 2 patients showed a significantly lower risk of HCC than that in Group 1 (HR 0.18; P<0.001), and all kinds of antiplatelets (aspirin monotherapy [HR 0.15, 95% CI: 0.06, 0.31; P<0.001]; clopidogrel monotherapy [HR 0.18, 95% CI: 0.04, 0.53, P=0.001], and aspirin/clopidogrel dual therapy [HR 0.23, 95% CI: 0.08, 0.51; P=0.009]) reduced the risk of HCC compared to Group 1.

In regards to bleeding events, patients in the aspirin group had a non-significant increased risk than the non-aspirin group (HR 1.49; P=0.163). Patients who took dual therapy with aspirin/clopidogrel (HR 2.46; P=0.041) had an increased risk compared to patients who took no antiplatelets (HR 4.69; P<0.001).

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