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

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.