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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Effect of low-dose aspirin administration on long-term survival of cirrhotic patients after splenectomy: A retrospective single-center study
Zhao-Qing Du, Jun-Zhou Zhao, Jian Dong, Jian-Bin Bi, Yi-Fan Ren, Jia Zhang, Bilawal Khalid, Zheng Wu, Yi Lv, Xu-Feng Zhang, Rong-Qian Wu
Zhao-Qing Du, Jun-Zhou Zhao, Jian Dong, Jian-Bin Bi, Yi-Fan Ren, Jia Zhang, Bilawal Khalid, Yi Lv, Xu-Feng Zhang, Rong-Qian Wu, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Zhao-Qing Du, Jun-Zhou Zhao, Jian Dong, Jian-Bin Bi, Yi-Fan Ren, Jia Zhang, Bilawal Khalid, Zheng Wu, Yi Lv, Xu-Feng Zhang, Rong-Qian Wu, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: All authors contributed to the study; Du ZQ wrote the manuscript, and collected and analysed the data; Zhao JZ collected and analysed the data, and contributed to the follow-up results; Bi JB, Ren YF, and Zhang J collected the data and performed the analysis; Bilawal K contributed to the data; Wu Z and Lv Y provided the resources and supervision; Zhang XF and Wu RQ contributed to writing the manuscript, and drafting the conception and design. All authors read and approved the final manuscript.
Supported by the Ministry of Education Innovation Team Development Program of China, No. IRT16R57.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (Permit number: XJTU1AF2015LSL-057).
Informed consent statement: Written informed consent from the patients was waived due to the retrospective nature of this study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rong-Qian Wu, MD, PhD, Professor, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, 76 West Yanta Road, P.O. Box 124, Xi’an 710061, Shaanxi Province, China. rwu001@mail.xjtu.edu.cn
Telephone: +86-29-85323204 Fax: +86-29-85252580
Received: April 3, 2019
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
The motivation of this research was to investigate the effect of low-dose aspirin therapy on HCC development and long-term overall survival in patients who underwent splenectomy for cirrhosis-related portal vein hypertension and hypersplenism.
Research objectives
The main objectives of this study was to investigate the effect of postoperative long-term low-dose aspirin on the development of HCC and long-term survival of cirrhotic patients after splenectomy.
Research methods
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.
Research results
Forty-one (15.53%) patients developed HCC and 37 (14.02%) died due to end-stage liver diseases or other serious complications in this study. Postoperative long-term low-dose aspirin therapy reduced the incidence of HCC from 19.02% to 3.40% after splenectomy. Univariate and multivariate analyses showed that not undertaking postoperative long-term low-dose aspirin therapy 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. Univariate and multivariate analyses showed that the only factor that was independently associated with improved overall survival was postoperative long-term low-dose aspirin therapy.
Research conclusions
Post-splenectomy long-term administration of low-dose aspirin reduces the incidence of HCC and improves the long-term overall survival in patients with viral hepatitis-related cirrhosis.
Research perspectives
Long-term low-dose aspirin therapy should be recommended to cirrhotic patients with hypersplenism after splenectomy. Further prospective and multi-center studies should be performed to verify our conclusions.
