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Aspirin Use and Risk of HCC and Gastrointestinal Bleeding in Patients With HBV-Related Cirrhosis: A Landmark Analysis

Mi Na Kim1,2,3, Geun U Park4, Seng Chan You5

  • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Journal of Gastroenterology and Hepatology
|October 1, 2025
PubMed

Insights

Aspirin use in patients with hepatitis B virus (HBV)-related cirrhosis was associated with a reduced risk of hepatocellular carcinoma (HCC). However, aspirin use also significantly increased the risk of gastrointestinal (GI) bleeding in this patient group.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Oncology

Background:

  • Hepatitis B virus (HBV)-related cirrhosis poses a significant risk for hepatocellular carcinoma (HCC).
  • The role of aspirin in HCC prevention and its associated risks, particularly gastrointestinal (GI) bleeding, remains unclear in HBV-related cirrhosis patients.

Purpose of the Study:

  • To investigate the association between aspirin use and the risks of HCC and GI bleeding.
  • To evaluate the safety and efficacy of aspirin for HCC prevention in patients with HBV-related cirrhosis.

Main Methods:

  • A 3-year landmark analysis was conducted using nationwide cohort data from South Korea's National Health Insurance Service.
  • Patients with compensated HBV-related cirrhosis (2005-2017) were included, with aspirin users defined as those prescribed aspirin for ≥90 days.
  • Propensity score matching was used to compare the risks of HCC and GI bleeding between aspirin users and nonusers.

Main Results:

  • Over a median follow-up of 7.6 years, aspirin users showed a significantly lower 10-year cumulative incidence of HCC (41.8% vs. 46.5%, p=0.033).
  • The adjusted hazard ratio (aHR) for HCC was 0.84 (95% CI=0.73-0.96; p=0.013) in the aspirin-treated group.
  • Conversely, the 10-year cumulative incidence of GI bleeding was higher in aspirin users (29.5% vs. 24.0%, p=0.016), with an aHR of 1.20 (95% CI=1.02-1.42; p=0.029).

Conclusions:

  • Aspirin use in patients with HBV-related cirrhosis is associated with a significantly reduced risk of developing HCC.
  • However, aspirin treatment in this population also leads to a significantly increased risk of GI bleeding.
  • These findings highlight a critical trade-off between HCC prevention and bleeding risk when considering aspirin for patients with HBV-related cirrhosis.
Abstract

Keywords:
aspirinchronic hepatitis Bcirrhosisgastrointestinal bleedinghepatocellular carcinoma

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