PMID- 34049373
OWN - NLM
STAT- MEDLINE
DCOM- 20220711
LR  - 20230802
IS  - 1539-2031 (Electronic)
IS  - 0192-0790 (Print)
IS  - 0192-0790 (Linking)
VI  - 56
IP  - 7
DP  - 2022 Aug 1
TI  - Antiplatelet Medications Are Associated With Bleeding and Decompensation Events 
      Among Patients With Cirrhosis.
PG  - 627-634
LID - 10.1097/MCG.0000000000001558 [doi]
AB  - BACKGROUND: In an aging population with cardiovascular comorbidities, 
      anticoagulant (AC), antiplatelet (AP), and nonsteroidal anti-inflammatory drug 
      (NSAID) use are increasing. It remains unclear whether these agents pose 
      increased bleeding risk in cirrhosis. This study aimed to assess the association 
      between these medications and bleeding and portal hypertension complications in 
      cirrhosis. METHODS: The IMS PharMetrics database was used to identify privately 
      insured adults diagnosed with cirrhosis from 2007 to 2015, stratified as 
      compensated or decompensated based on the presence of portal hypertensive 
      complications 1 year before cirrhosis diagnosis. Bleeding or decompensation 
      outcomes were assessed 6 to 18 months after cirrhosis diagnosis using a landmark 
      analysis design. Multivariable Cox proportional hazards regression modeling 
      assessed associations between AC, AP, and NSAID drug exposures and outcomes 
      adjusting for covariates. RESULTS: A total of 18,070 cirrhosis patients were 
      analyzed; 57% male; 74% ages 50 to 64 years; 34% with a prior decompensation. 
      Overall, 377 (2%) had claims for ACs; 385 (2%) APs; and 1231 (7%) NSAIDs. APs 
      were associated with increased bleeding [adjusted hazard ratio (aHR)=1.31; 95% 
      confidence interval (CI): 1.00, 1.72] and decompensation events (aHR=1.44; 95% 
      CI: 1.06, 1.95) in a 9-month landmark analysis. NSAIDs were significantly 
      associated with bleeding events (aHR=1.29; 95% CI: 1.06, 1.57) on 3-month 
      landmark analysis. No statistically significant associations were seen between 
      ACs and bleeding or decompensation outcomes in adjusted analyses. CONCLUSIONS: AP 
      use was associated with increased bleeding and decompensation events among 
      privately insured patients with cirrhosis. NSAID use was associated with 
      significant early bleeding, but not decompensations. Lastly ACs were not 
      associated with bleeding or decompensation outcomes.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Lieber, Sarah R
AU  - Lieber SR
AD  - Department of Medicine, Division of Digestive and Liver Diseases, University of 
      Texas Southwestern (UTSW), Dallas, TX.
FAU - Jiang, Yue
AU  - Jiang Y
AD  - Department of Statistical Science, Duke University, Durham.
FAU - Moon, Andrew
AU  - Moon A
AD  - Department of Medicine, Division of Gastroenterology and Hepatology, University 
      of North Carolina (UNC) Health Care, Chapel Hill, NC.
FAU - Barritt, Alfred S
AU  - Barritt AS
AD  - Department of Medicine, Division of Gastroenterology and Hepatology, University 
      of North Carolina (UNC) Health Care, Chapel Hill, NC.
LA  - eng
GR  - T32 DK007634/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20210528
PL  - United States
TA  - J Clin Gastroenterol
JT  - Journal of clinical gastroenterology
JID - 7910017
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-Inflammatory Agents, Non-Steroidal/adverse effects
MH  - Anticoagulants/adverse effects
MH  - Female
MH  - Hemorrhage
MH  - Humans
MH  - *Hypertension, Portal/complications
MH  - *Liver Cirrhosis/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/adverse effects
PMC - PMC8627524
MID - NIHMS1692893
COIS- Disclosures: The authors have no conflicts of interest to disclose.
EDAT- 2021/05/29 06:00
MHDA- 2022/07/12 06:00
PMCR- 2023/08/01
CRDT- 2021/05/28 20:33
PHST- 2021/05/29 06:00 [pubmed]
PHST- 2022/07/12 06:00 [medline]
PHST- 2021/05/28 20:33 [entrez]
PHST- 2023/08/01 00:00 [pmc-release]
AID - 00004836-202208000-00012 [pii]
AID - 10.1097/MCG.0000000000001558 [doi]
PST - ppublish
SO  - J Clin Gastroenterol. 2022 Aug 1;56(7):627-634. doi: 
      10.1097/MCG.0000000000001558. Epub 2021 May 28.