Journal of gastroenterology and hepatology · 2026
Association of Aspirin With Improved Clinical Outcomes and Survival in Patients With Compensated Cirrhosis: A Propensity Score-Matched Study of 25 782 Individuals.
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Abbarh Shahem, Sawaf Bisher, Cerqueira Tiago Lemos, Huttner Hagen B, Sedghi Annahita, Diel Norma J, Siepmann Timo
Аннотация
BACKGROUND: Pharmacologic therapies to prevent decompensation in cirrhosis remain limited.
AIM: To evaluate the association between aspirin use and cirrhosis-related outcomes and mortality.
METHODS: This retrospective cohort study utilized deidentified electronic health records from a global federated network (January 2013-July 2025). Adults with cirrhosis without decompensation in the preceding 12 months and without prior HCC were included. Following 1:1 propensity score matching, outcomes were assessed at 12, 24, and 36 months. The primary outcome was a composite of cirrhosis-related decompensation (ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatorenal syndrome, encephalopathy). Secondary outcomes included hepatocellular carcinoma (HCC), mortality, and gastrointestinal bleeding.
RESULTS: Among 458 165 patients, matching yielded 25 782 patients (12 891 per group; mean age 63.3 years). Aspirin was associated with a lower risk of the composite outcome at 12 (HR, 0.75; 95% CI, 0.67-0.83), 24 (HR, 0.76; 95% CI, 0.70-0.84), and 36 months (HR, 0.77; 95% CI, 0.68-0.84), driven by reduced variceal bleeding, spontaneous bacterial peritonitis, and ascites. Absolute risks were 17.8% vs. 22.7% at 12 months, 20.4% vs. 24.7% at 24 months, and 22.0% vs. 25.7% at 36 months. At 12 months, the NNT was 21 for the composite outcome and 20 for mortality. Despite an increased risk of nonvariceal bleeding (NNH 143 at 12 months), serving as a positive control outcome, aspirin demonstrated a net clinical benefit, with more pronounced benefits in high cardiovascular risk patients (pinteraction < 0.05).
CONCLUSIONS: Aspirin use is associated with reduced cirrhosis complications, HCC, and mortality, suggesting a potential role in the management of compensated cirrhosis.
AIM: To evaluate the association between aspirin use and cirrhosis-related outcomes and mortality.
METHODS: This retrospective cohort study utilized deidentified electronic health records from a global federated network (January 2013-July 2025). Adults with cirrhosis without decompensation in the preceding 12 months and without prior HCC were included. Following 1:1 propensity score matching, outcomes were assessed at 12, 24, and 36 months. The primary outcome was a composite of cirrhosis-related decompensation (ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatorenal syndrome, encephalopathy). Secondary outcomes included hepatocellular carcinoma (HCC), mortality, and gastrointestinal bleeding.
RESULTS: Among 458 165 patients, matching yielded 25 782 patients (12 891 per group; mean age 63.3 years). Aspirin was associated with a lower risk of the composite outcome at 12 (HR, 0.75; 95% CI, 0.67-0.83), 24 (HR, 0.76; 95% CI, 0.70-0.84), and 36 months (HR, 0.77; 95% CI, 0.68-0.84), driven by reduced variceal bleeding, spontaneous bacterial peritonitis, and ascites. Absolute risks were 17.8% vs. 22.7% at 12 months, 20.4% vs. 24.7% at 24 months, and 22.0% vs. 25.7% at 36 months. At 12 months, the NNT was 21 for the composite outcome and 20 for mortality. Despite an increased risk of nonvariceal bleeding (NNH 143 at 12 months), serving as a positive control outcome, aspirin demonstrated a net clinical benefit, with more pronounced benefits in high cardiovascular risk patients (pinteraction < 0.05).
CONCLUSIONS: Aspirin use is associated with reduced cirrhosis complications, HCC, and mortality, suggesting a potential role in the management of compensated cirrhosis.