Antiplatelet drugs up bleeding, decompensation events in cirrhosis patients

Use of antiplatelet (AP) medication appears to increase bleeding and decompensation events among privately insured patients with cirrhosis, a study has found. Use of nonsteroidal anti-inflammatory drug (NSAID) is also associated with significant early bleeding, but not decompensations. Anticoagulants (AC), on the other hand, are not associated with bleeding or decompensation outcomes.

The authors used the IMS PharMetrics database to identify privately insured adults diagnosed with cirrhosis from 2007 to 2015 and stratify them as compensated or decompensated based on the presence of portal hypertensive complications 1 year prior to cirrhosis diagnosis.

A landmark analysis design was utilized to assess bleeding or decompensation outcomes 6‒18 months after cirrhosis diagnosis. The authors then used multivariable Cox proportional hazards regression modeling to examine the relations between AC, AP, and NSAID drug exposures and outcomes, with adjustments for covariates.

Of the 18,070 cirrhosis patients (57 percent male, 74 percent aged 50‒64 years) analysed, 34 percent had a prior decompensation. Overall, claims were 377 (2 percent) for ACs, 385 (2 percent) for APs, and 1,231 (7 percent) for NSAIDs.

A 9-month landmark analysis revealed that AP use correlated with increased bleeding (adjusted hazard ratio [aHR], 1.31, 95 percent confidence interval [CI], 1.00‒1.72) and decompensation events (aHR, 1.44, 95 percent CI, 1.06‒1.95).

NSAIDs were also significantly associated with bleeding events (aHR, 1.29, 95 percent CI, 1.06‒1.57) on a 3-month landmark analysis. In contrast, AC use showed no statistically significant association with either bleeding or decompensation outcomes in adjusted analyses.