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 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.
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.
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.
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.
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.
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.