Long term low- dose aspirin use in patients with chronic viral hepatitis reduces the risk of HCC and liver related mortality.

Hepatocellular cancer (HCC) remains an issue worldwide and strategies to reduce its incidence are important. This Swedish study examines the role of low-dose aspirin (75mg or 160mg) in people with chronic viral hepatitis in reducing the risk of HCC and liver-related mortality without a significantly higher risk of gastrointestinal bleeding.

The results showed that over a median of 7.9 years of follow up the cumulative incidence of HCC was 4.0% in low-dose aspirin users versus 8.3% in non-aspirin users. Ten- year liver-related mortality was 11.0% in aspirin users and 17.9% in non-aspirin users. The risk of gastrointestinal bleeding over 10 years did not significantly differ between those using and not using aspirin (7.8% versus 6.9% respectively). The benefit of aspirin use was duration dependent with a significantly lower risk of HCC after 3-5 years of use.

The authors conclude:

“ in a nationwide population of persons with chronic viral hepatitis, low-dose 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.”

And call for further research in this area:

“Our findings support the need for randomized clinical trials designed to test the benefits of aspirin for primary prevention of hepatocellular carcinoma.”

For more information please see:

Simon TG, Duberg AS, Aleman S, Chung RT, Chan AT and Ludvigsson JF. Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality. N Engl J Med 2020; 382:1018-28. DOI: 10.1056/NEJMoa1912035