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.

中文翻译：

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抗血小板药物与肝硬化患者的出血和失代偿事件相关

背景： 

在患有心血管合并症的老龄化人群中，抗凝剂（AC）、抗血小板剂（AP）和非甾体抗炎药（NSAID）的使用正在增加。目前尚不清楚这些药物是否会增加肝硬化的出血风险。本研究旨在评估这些药物与肝硬化出血和门脉高压并发症之间的关联。

方法： 

IMS PharMetrics 数据库用于识别 2007 年至 2015 年诊断为肝硬化的私人参保成年人，根据肝硬化诊断前 1 年是否存在门脉高压并发症，将其分层为代偿或失代偿。使用标志性分析设计在肝硬化诊断后 6 至 18 个月评估出血或失代偿结果。多变量 Cox 比例风险回归模型评估了 AC、AP 和 NSAID 药物暴露与调整协变量的结果之间的关联。

结果： 

总共分析了18,070 名肝硬化患者；57% 男性；74% 年龄在 50 岁至 64 岁之间；34% 之前有过失代偿。总体而言，377 人 (2%) 提出了空调索赔；385 (2%) 受影响人；和 1231 种 (7%) 非甾体抗炎药。AP 与出血增加相关[调整后的风险比 (aHR)=1.31；9 个月里程碑分析中的 95% 置信区间 (CI)：1.00，1.72] 和失代偿事件（aHR=1.44；95% CI：1.06，1.95）。根据 3 个月里程碑分析，NSAID 与出血事件显着相关（aHR=1.29；95% CI：1.06，1.57）。在调整分析中，未发现 AC 与出血或失代偿结果之间存在统计学上的显着关联。

结论： 

AP的使用与私人保险肝硬化患者出血和失代偿事件的增加有关。非甾体抗炎药的使用与明显的早期出血有关，但与失代偿无关。最后，AC 与出血或失代偿结果无关。