Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3798
Peer-review started: April 3, 2019
First decision: May 30, 2019
Revised: June 4, 2019
Accepted: June 22, 2019
Article in press: June 23, 2019
Published online: July 28, 2019
Cirrhosis is a major risk factor for the development of hepatocellular carcinoma (HCC). Portal vein thrombosis is not uncommon after splenectomy in cirrhotic patients, and many such patients take oral anticoagulants including aspirin. However, the long-term impact of postoperative aspirin on cirrhotic patients after splenectomy remains unknown.
The main purpose of this study was to investigate the effect of postoperative long-term low-dose aspirin administration on the development of HCC and long-term survival of cirrhotic patients after splenectomy.
The clinical data of 264 adult patients with viral hepatitis-related cirrhosis who underwent splenectomy at the First Affiliated Hospital of Xi’an Jiaotong University from January 2000 to December 2014 were analyzed retrospectively. Among these patients, 59 who started taking 100 mg/d aspirin within seven days were enrolled in the aspirin group. The incidence of HCC and overall survival were analyzed.
During follow-up, 41 (15.53%) patients developed HCC and 37 (14.02%) died due to end-stage liver diseases or other serious complications. Postoperative long-term low-dose aspirin therapy reduced the incidence of HCC from 19.02% to 3.40% after splenectomy (log-rank test, P = 0.028). Univariate and multivariate analyses showed that not undertaking postoperative long-term low-dose aspirin therapy [odds ratio (OR) = 6.211, 95% confidence interval (CI): 1.142-27.324, P = 0.016] was the only independent risk factor for the development of HCC. Similarly, patients in the aspirin group survived longer than those in the control group (log-rank test, P = 0.041). Univariate and multivariate analyses showed that the only factor that independently associated with improved overall survival was postoperative long-term low-dose aspirin therapy [OR = 0.218, 95%CI: 0.049-0.960, P = 0.044].
In patients with viral hepatitis-related cirrhosis, long-term post-splenectomy administration of low-dose aspirin reduces the incidence of HCC and improves the long-term overall survival.
Core tip: Anticoagulant therapy reduces the incidence of post-splenectomy portal thrombosis and improves prognosis by inhibiting thrombus formation. This study was to investigate the effect of postoperative long-term low-dose aspirin therapy on the development of hepatocellular carcinoma and long-term survival of cirrhotic patients after splenectomy. Post-splenectomy long-term administration of low-dose aspirin reduced the incidence of hepatocellular carcinoma and improved the long-term overall survival in patients with viral hepatitis-related cirrhosis. Thus, long-term low-dose aspirin therapy should be recommended to cirrhotic patients with hypersplenism after splenectomy.