A nationwide Swedish cohort study suggests that in patients with chronic viral hepatitis, low-dose (75 mg or 160 mg) aspirin use was associated with a duration-dependent significantly lower risk of incident hepatocellular carcinoma and liver-related death than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding. The study included 50,275 patients with chronic hepatitis B or hepatitis C from 2005 through 2015 and who did not have a history of aspirin use. During a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users and 8.3% among nonusers of aspirin (adjusted hazard ratio [HR], 0.69). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted HRs were 0.90 for 1 to < 3 years of use, 0.66 for 3 to < 5 years of use, and 0.57 for 5 or more years of use. Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (adjusted HR, 0.73). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively). The findings are consistent with previous preclinical and clinical observational studies, and support the need to test the benefits of aspirin for primary prevention of hepatocellular carcinoma. Source: https://www.nejm.org/
