Antiplatelets pose risks of bleeding, decompensation in cirrhosis patients

In patients with cirrhosis, use of antiplatelets appears to contribute to increased risk of bleeding and decompensation events, according to a study. Meanwhile, nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with significant early bleeding only, whereas anticoagulants have a null effect on both outcomes.

The study used data from the IMS PharMetrics database and included 18,070 privately insured adults diagnosed with cirrhosis, stratified as compensated or decompensated based on the presence of portal hypertensive complications 1 year before cirrhosis diagnosis. Landmark analysis design facilitated analysis of bleeding or decompensation outcomes 6 to 18 months after cirrhosis diagnosis.

About three-fourths of the population (74 percent) were aged 50–64 years, 57 percent were men, and 34 percent had a prior decompensation. Overall, 377 patients (2 percent) had claims for anticoagulants, 385 (2 percent) for antiplatelets, and 1,231 (7 percent) for NSAIDs.

Multivariable Cox proportional hazards regression modeling showed that antiplatelets conferred a risk increase in 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) in a 9-month landmark analysis.

NSAIDs, on the other hand, contributed to an increased risk of bleeding events only (aHR, 1.29, 95 percent CI, 1.06–1.57) in a 3-month landmark analysis.

Anticoagulants showed no statistically significant associations with either bleeding or decompensation events.